MSNJ’s Statement on NJ Medicaid Expansion

Governor Christie’s decision to expand Medicaid is a positive step that will create access to health insurance for many uninsured residents. Importantly, this decision will make additional investment in the program possible. This is also an opportunity to align incentives and create a robust network of physicians and other healthcare providers for the Medicaid program. Expanding an underfunded program will increase access to insurance, but will not deliver adequate access to physician services for our newly insured citizens.

The Medical Society of New Jersey supports reform of the state’s Medicaid Program. Our Medicaid Program is one of the poorest paying healthcare programs in the nation.* Conversely, practice expenses in New Jersey are among the highest in the nation. These unfortunate facts prevent many physicians and other healthcare providers from being financially able to participate in the Medicaid program. We look forward to working with our government and private sector partners to ensure access to quality healthcare for all New Jersey residents.

*Health Affairs August 2012 vol. 31 no. 8 1673-1679

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.