NJ S952

Two or more independent physicians practicing in a carrier's service area may jointly negotiate with health insurance carriers on non-fee-related contract terms affecting patient care, including medical necessity definitions, utilization management criteria, drug formularies, quality assurance programs, and credentialing standards.

Fee-related negotiations (payment amounts, reimbursement methodology, discounts, bonuses) require prior Attorney General approval based on findings that the carrier has substantial market power and contract terms threaten patient care quality or availability.

Joint negotiation representatives must submit petitions to the Attorney General for approval before negotiating, and any resulting contracts must also receive Attorney General approval within 30 days of submission.

The bill does not apply to Medicaid or NJ FamilyCare plans, and explicitly prohibits physicians from jointly engaging in coordinated work stoppages or limiting health care services.

The Attorney General must report to the Governor and Legislature within four years on the law's implementation, including its effects on competitive balance, patient care access, and health insurance premiums.