NJ S2913

Creates a seven-member Commission on Insurance Reimbursement within the Department of Banking and Insurance to review and approve or deny requests from health insurance carriers seeking to reduce payment rates for medical procedures identified by CPT codes with modifiers

Commission membership includes the Commissioner of Banking and Insurance (or designee), a State Board of Medical Examiners member, and appointees recommended by the Medical Society of New Jersey, NJ Hospital Association, NJ Association of Health Plans, and two public members from patient advocacy organizations

Carriers must submit applications detailing the proposed payment reduction amount, full justification, affected CPT codes, prior year billing frequency, and number of covered persons impacted

Commission must evaluate whether proposed reductions would interfere with patient access to medical care, adversely affect healthcare system stability, or harm licensed healthcare providers and facilities, and must issue a final written determination within 60 days

Commission must submit annual reports to the Governor and Legislature summarizing its determinations, findings, and recommendations for changes to health benefits plan laws