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September 5, 2017 Regulatory Developments

September 14, 2017 | No Comments
Posted by Beth Christian

Here are the most recent health care related regulatory developments as published in the New Jersey Register on September 5, 2017:

  • On September 5, 2017 at 49 N.J.R. 2876, the Department of Banking & Insurance published notice of its proposal of amendments to its rules to clarify impermissible practices relating to health benefits plan claim processing.  The proposed amendments also set forth requirements for the timing of authorization of services and payment of claims after an independent utilization review organization determination adverse to the carrier or health maintenance organization.  The proposed amendments would require payment of the claim no later than 10 business days from receipt of the IURO determination.
  • On September 5, 2017 at 49 N.J.R. 2877, the Department of Banking & Insurance published notice of its proposal of amendments to its rules governing the prompt payment of health benefit claims.  The proposed amendments would set forth minimum requirements for explanation of benefits forms.
  • On September 5, 2017 at 49 N.J.R. 2880, the Department of Banking & Insurance published notice of its proposal of amendments to its rules regarding out of network benefits.  The Department is proposing amendments to its rules to reinforce the existing rights of a covered person to request the opportunity to receive services from an out of network provider, and pay only network level cost sharing, where the network associated with the covered person’s health plan does not have a qualified, accessible and available provider to perform the needed service.
  • On September 5, 2017 at 49 N.J.R. 2895, the State Board of Medical Examiners published notice of its proposal of amendments to its rules governing prescriptions.  Current rules prohibit physicians from dispensing more than a 7 day supply of drugs or medications.  The proposed amendments will implement a statutory change which added an exemption from the 7 day limitation for dispensing a food concentrate, food extract, vitamin, mineral, herb, enzyme, amino acid, tissue or cell solid, glandular extract from a nutraceutical, botanical, homeopathic remedy, or other nutritional supplement.
  • On September 5, 2017 at 49 N.J.R. 2895, the State Board of Nursing published notice of its proposal of amendments to its rules regarding completion of continuing education courses and continuing education requirements for advanced practice nurses.

 

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