52:17B-199 Joint negotiations regarding fees, fee related matters.
4. a. Upon a finding by the Attorney General, in consultation with the Commissioners of Banking and Insurance and Health and Senior Services, that the carrier has substantial market power in its service area and that any of the terms or conditions of the contract with the carrier pose an actual or potential threat to the quality and availability of patient care among covered persons, two or more independent physicians or dentists who are practicing in the service area of a carrier may jointly negotiate with the carrier and engage in related joint activity, as provided in this act regarding fees and fee-related matters, including, but not limited to, any of the following:
(1)the amount of payment or the methodology for determining the payment for a health care or dental service, including, but not limited to, cost of living increases;
(2)the conversion factor for a resource-based relative value scale or similar reimbursement methodology for health care or dental services;
(3)the amount of any discount on the price of a health care or dental service;
(4)the procedure code or other description of a health care or dental service covered by a payment and the appropriate grouping of the procedure codes;
(5)the amount of a bonus related to the provision of health care or dental services or a withholding from the payment due for a health care or dental service; and
(6)the amount of any other component of the reimbursement methodology for a health care or dental service.
b.The Department of Banking and Insurance, in consultation with the Department of Health and Senior Services, shall have the authority to collect and investigate such information as it reasonably believes is necessary to determine, on an annual basis:
(1)the average number of covered lives and geographical distribution of covered lives per quarter per county for every carrier in the State; and
(2)the impact of the provisions of this section on average physician or dentist fees in the State.
The Department of Banking and Insurance shall provide this information to the Attorney General on an annual basis.
L.2001,c.371,s.4; per s.15, act expires April 8, 2008.
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Last modified: October 11, 2016