NJ S952

Two or more independent physicians practicing in a carrier's service area may jointly negotiate with health insurance carriers over non-fee-related contract terms affecting patient care, including medical necessity definitions, utilization management criteria, clinical practice guidelines, drug formularies, credentialing standards, and dispute resolution mechanisms.

Joint negotiations over fees and fee-related matters (payment amounts, reimbursement methodology, discounts, bonuses) are permitted only if the Attorney General finds the carrier has substantial market power and contract terms pose an actual or potential threat to patient care quality and availability.

Physicians must work through a joint negotiation representative who must submit a petition to the Attorney General for approval before negotiations can begin, and any resulting contract must also receive Attorney General approval within 30 days.

The bill excludes health benefits plans primarily serving Medicaid or NJ FamilyCare recipients and prohibits physicians from jointly engaging in coordinated cessation or reduction of health care services.

The legislation repeals P.L.2001, c.371 (which authorized similar joint negotiations but expired in 2008), takes effect 90 days after enactment, and requires the Attorney General to report to the Governor and Legislature within four years on implementation and impact on competition and insurance premiums.