Proposed Rulemaking—PIP and Managed Care Contracts

This week, the New Jersey Department of Banking & Insurance (DOBI) proposed two significant regulations that are of interest to our membership.

MSNJ and many other physicians, practices, and specialty organizations filed comments on DOBI’s proposed comprehensive personal injury protection (PIP) regulations. DOBI has re-proposed certain key provisions in an effort to respond to the meritorious comments. In particular, MSNJ asked that the fees for spinal surgeons and neurosurgeons be re-examined in light of the shortage of these specialists and the amount of the fees. DOBI has responded by removing from the fee schedule 117 of the CPT codes of concern, permitting these codes to be paid at usual customary and reasonable (UCR) rates until further study can be concluded. MSNJ also asked that the proposed workers compensation managed care organization (WCMCO) network entity be removed from the proposed new regulatory framework. DOBI has responding by removing WCMCOs as network providers.

MSNJ has advocated for rulemaking on managed care contracts for over five years. Our effort has been focused on leveling the playing field and creating a “fair contract” environment between healthcare insurers and physicians. DOBI worked diligently with all affected stake-holders and publication of proposed fair contract regulations was imminent when Governor Christie signed Resolution One, the red-tape reduction initiative, which had the impact of holding regulations. With the cooperation of Governor Christie’s administration and DOBI, those proposed rules on managed care contracts were released this week. The proposed regulations appear to incorporate many of our desired provisions and we will work to ensure that the adopted “fair contract” regulations benefit our members.

Comments on the proposed PIP and managed care contract rules are due on April 21, 2012.