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 has completed the carrier's appeals process and applies within 60 days of the final decision.

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 an appeal and provide updates as the appeal progresses. Notably, a specific section (c) has been deleted from the current law, although the content of that section is not specified in the summary. 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