BME, BON and DOBI Propose Amendments to Regulations and a New DOBI RuleSeptember 18, 2017

Two New Jersey professional licensing boards, the State Board of Medical Examiners (BME) and the State Board of Nursing (BON), published proposed amendments to regulations in the September 5, 2017 New Jersey Register. In addition, the New Jersey Department of Banking and Insurance (DOBI) proposed amendments to certain regulations and a new regulation.

The BME published a proposed amendment to N.J.A.C. 13:35-7.5, Requirements for the Dispensing of Drugs and Special Limitations Applicable to the Dispensing of Drugs for a Fee. Under New Jersey law, N.J.S.A. 45:9-22, physicians are prohibited from dispensing more than a seven-day supply of drugs or medications. The law provides exemptions to this prohibition, including a statutory amendment adding a new exemption for dispensing a food concentrate, food extract, vitamin, mineral, herb, enzyme, amino acid, tissue or cell salt, glandular extract, neutraceutical, botanical, homeopathic remedy, or other nutritional supplement. The BME proposes to amend its regulations to recognize the new exemption to the seven-day dispensing limitation.

The BON proposes to readopt nursing rules at N.J.A.C. 13:37, with amendment. The proposal includes an amendment to continuing education requirements. In particular, the rule adds an additional manner in which a registered professional nurse or licensed practical nurse may obtain continuing educational hours, as follows: successful completion of continuing education courses or programs related to nursing approved by, or offered by entities accredited by, the American Nurse Credentialing Center. Credits will be awarded one hour for each 60 minutes of attendance. The BON also proposes to delete certain outdated/expired requirements regarding continuing education for organ and tissue donation and certain proofs for certification training.

The DOBI, Office of Life and Health, has proposed amendments to N.J.A.C. 11:24-1.2 and 11:24A-1.2 and 2.3, to reinforce the existing rights of a covered person (a person who receives benefits or health care services under a health benefits plan) to request to receive services from an out-of-network provider, but pay only network-level cost sharing when the network associated with the covered person’s plan does not contain a qualified, accessible, and available provider to perform the needed service.

The DOBI also proposes to amend regulations governing prompt payment of health benefit claims, at N.J.A.C. 1:22-1.2, 1.6, 1.9 and 1.10, and proposes a new rule at 11:22-1.5. DOBI proposes to amend the rules governing the prompt payment of claims to increase transparency and accountability related to health benefit plans. The new rule at N.J.A.C. 11:22-1.5 would set forth the minimum requirements for an Explanation of Benefits (EOB), including that every carrier will be required to provide an EOB, electronically or in writing, to a covered person in response to the filing of a claim by a provider or a person covered under a health benefits plan. A carrier or its agent must provide an EOB within 30 days if the claim is filed electronically or 40 days if the claim is submitted in writing. The EOB will be required to include at least: (1) name of the covered person; (2) name of the provider; (3) date of service; (4) clear description of the service; (5) billed charge; (6) allowed charge; (7) non-covered amount; (8) a specific explanation of why a charge is not covered by the health benefits plan, with specific requirements for how denial reasons must be stated; (9) the amount that is the covered person’s responsibility due to deductible, coinsurance, and copayment; (10) the accumulation toward the covered person’s deductible or family deductible, if applicable; (11) amount paid by plan, with any paid interest shown separately; (12) an explanation of the process to appeal the determination on the claim; and (13) a telephone number for additional information on the processing of the claim, or (14) if review of the claim is still pending upon issuance of the EOB, the EOB shall so state and items (6) through (10) can be omitted.

Related Practice: Health Law

Attorneys: John Fanburg, Joseph Gorrell and Keith Roberts

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