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MSNJ Leads Rule-making that Directly Impacts Physicians

Two state regulatory proposals will have a direct impact on virtually every member of MSNJ and physicians practicing in New Jersey. DOBI’s re-proposed regulation on managed care contracts is the culmination of seven years of MSNJ work, beginning with the passage of the managed care reform law in 2006 and the settlement of national class-action lawsuits with the major healthcare insurers over the past decade. One element of managed care reform is regulations that will legally bind healthcare insurers to fair contract principles with participating physicians. MSNJ has tirelessly spearheaded this initiative, meeting with representatives at the highest level of both DOBI and the Governor’s Office. This has caused the re-proposal to be released for comments.

Similarly, DOBI re-proposed regulations governing the personal injury protection (PIP) program in New Jersey when MSNJ expressed concerns over the comprehensive rule proposal. This has already resulted in the removal of the proposed workers compensation managed care organization (WCMCO) network. DOBI also removed 117 of the CPT codes of concern for spinal surgeons and neurosurgeons, permitting these codes to be paid at usual, customary and reasonable (UCR) rates until further study can be concluded.

MSNJ will file comments on the “fair contract” rule proposal and PIP rule proposal by the due date of April 21, 2012. Any member with questions or suggestions for comments should contact Melinda Martinson, MSNJ Assistant General Counsel, at (609) 896-1766, ext. 258.

A pending federal rule proposal will impact physicians nation-wide: CMS has proposed changes to the Medicare program’s overpayment recovery program which would permit the federal government to “look back” for a period of ten years on alleged overpayments. MSNJ has a long history of objecting to unreasonable overpayment recovery requests which includes meeting with representatives at the highest level of Aetna in Hartford, Connecticut, and urging both the AMA and the Physician Advocacy Institute (PAI) to make overpayment recovery issues a national priority. MSNJ is considered a national leader on this issue. Read PAI’s whitepaper.

We will work with the AMA on this issue and will file comments in opposition to the proposed expansion of the Medicare overpayment recovery program. Comments on the Medicare proposal are due on April 16.

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.