Bill > A5873

Introduced Session

This bill establishes the "Commission on Insurance Reimbursement." The commission is to review and approve or deny applications submitted by health insurance carriers approved to issue health benefits plans in New Jersey and which seek to reduce the payment rate for any Current Procedural Terminology ("CPT") code when the CPT code is appended with one or more modifiers. The application to be submitted is to include, among other items, the amount of the proposed reduction in payment rate and a full and complete justification for the reduction in payment rate. As part of the review process, the commission is to consider if the proposed reduction will interfere with the ability of residents of the State to access necessary medical care; have an adverse effect on the stability of the State's health care system; and adversely affect one or more State-licensed health care providers or one or more State-licensed health care facilities. The commission is to affirmatively solicit and consider information from parties other than the applicant, including, but not limited to, health care providers anticipating an impact by the proposed reduction to the payment rate, as to the anticipated effect of the proposed reduction. A final written determination is to be issued by the commission within 60 days of receipt of an application. Under the bill, the commission may approve in whole, approve in part and deny in part, or deny in whole an application. The applicant is to have the opportunity to be heard before the commission issues its final determination. The commission is to annually submit a report to the Governor and the Legislature regarding this application process. The report is to include a summary of its determinations and its overall findings and activities; and recommendations for proposed changes to the current laws regarding health benefits plans.

Committee Categories

Herbert Conaway (D)*, 

Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 12/11/2023)

Official Document