The bill amends Section 11 of P.L.1997, c.192 (C.26:2S-11) to enhance the Independent Health Care Appeals Program in New Jersey. The program is designed to provide an independent review of medical necessity or appropriateness of services when a carrier denies, reduces, or terminates benefits, provided that the covered person or their health care provider contests the decision with the covered person's consent. The bill outlines the application process for appeals, requiring that the covered person or health care provider apply within 60 days of the carrier's final decision and submit specific information, including the carrier's details and a description of the medical condition in question.

Additionally, the bill includes provisions for consent forms that allow health care providers to appeal on behalf of covered persons, ensuring that the consent remains valid throughout all stages of the appeals process. It mandates that health care providers notify covered persons whenever they initiate or continue an appeal regarding a carrier's decision. Notably, a section of the previous law has been deleted, which may have contained specific provisions that are no longer applicable. The act is set to take effect immediately upon approval.

Statutes affected:
Introduced: 26:2S-11
Advance Law: 26:2S-11
Pamphlet Law: 26:2S-11