Title 17B, Title 17B: INSURANCE

17B:30-55.17 Liberal construction. 27. P.L.2023, c.296 (C.17B:30-55.1 et al.) shall be liberally construed to effectuate the legislative purposes thereof. L.2023, c.296, s.27.

17B:30-55.2 Findings, declarations. 3. The Legislature finds and declares that: a. Prior authorization is a type of utilization management technique used by health plans and carriers to ensure safety and appropriateness of medical and pharmacy services, reduce low-value care, and…

17B:30-55.3 Definitions. 4. As used in sections 4 through 17 of P.L.2023, c.296 (C.17B:30-55.3 through 17B:30-55.16): "Adverse determination" means a decision by a payer that the health care services furnished or proposed to be furnished to a covered person are not medically nece…

17B:30-55.4 Payer, information, utilization management, processing, payment of claims. 5. a. A payer shall provide the following information concerning utilization management and the processing and payment of claims in a clear and conspicuous manner, described in detail but also …

17B:30-55.5 Payer, respond, hospital, health care provider request, prior authorization. 6. A payer shall respond to a hospital or health care provider request for prior authorization of health care services by either approving or denying the request based on the covered person's…

17B:30-55.6 Carrier, respond, prior authorization requests, medication coverage submitted, NCPDP SCRIPT Standard for ePA transactions. 7. a. A carrier shall respond to prior authorization requests for medication coverage submitted using the NCPDP SCRIPT Standard for ePA (electron…

17B:30-55.7 Prior authorization, chronic, long-term care condition, validity, exception, timeline. 8. Except where shorter time frames are necessary to monitor patient safety or treatment effectiveness and with notice to the treating provider, if a payer requires prior authorizat…

17B:30-55.8 Prior authorization, denial, limitation imposed by payer, physician, scope of actions. 9. Any denial of a request for prior authorization or limitation imposed by a payer on a requested service on the basis of utilization management determination shall be made by a ph…

17B:30-55.9 Prior authorization, defined number, discrete services, set time frame, validity, exception. 10. Except where shorter time frames are necessary to monitor patient safety or treatment effectiveness and with notice to the treating provider, prior authorization for a ser…

17B:30-56 Rules, regulations. 20. The Commissioner of Banking and Insurance shall promulgate rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to carry out the purposes of P.L.2023, c.296 (C.17B:30-55.1 et al.). L…

17B:30-57 Liberal construction. 21. This act shall be liberally construed to effectuate the legislative purposes of the act. L.2005,c.352,s.21.

17B:30-58 Definitions relative to reimbursement for certain ambulance services. 1. As used in this act: "Ambulance service" means the provision of emergency health care services, basic life support services, advanced life support services, critical care services, mobile intensive…

17B:30-59 Assignment of benefits to service provider of right to receive reimbursement for ambulance service. 2. a. Notwithstanding any provision of law to the contrary, a covered person may, through an assignment of benefits, assign to a service provider his right to receive rei…

17B:30-6. "Twisting" prohibited No person shall make any misleading representations or incomplete or fraudulent comparison of any insurance policies or annuity contracts or insurers for the purpose of inducing, or tending to induce, any person to lapse, forfeit, surrender, termin…

17B:30-60 Definitions relative to certain dental provider networks. 1. As used in this act: "Contracting entity" means any person or entity that enters into direct contracts with providers for the delivery of dental services in the ordinary course of business, including a third p…

17B:30-61 Third party access. 2. a. A contracting entity shall not grant to a third party access to a provider network contract, or a provider's dental services or contractual discounts, or both, pursuant to a provider network contract, unless the contracting entity meets the req…

17B:30-62 Inapplicability. 3. This act shall not apply to: a. a provider network contract for dental services provided to beneficiaries of the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), the Medicare program established pursuant to the federal So…

17B:30-63 Rules, regulations. 4. The Commissioner of Banking and Insurance shall, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), adopt rules and regulations necessary to effectuate the purpose of this act. The commissioner shall ensure the r…

17B:30-7. Defamation No person shall make, publish, disseminate, or circulate, directly or indirectly, or aid, abet or encourage the making, publishing, disseminating or circulating of any oral or written statement or any pamphlet, circular, article or literature which is false o…

17B:30-8. Boycott, coercion and intimidation No person or persons shall enter into any agreement to commit, or by any concerted action commit, any act of boycott, coercion or intimidation resulting in or tending to result in unreasonable restraint of, or monopoly in, the business…

17B:30-9. Stock operations and advisory board contracts No person shall issue or deliver or permit agents, officers, or employees to issue or deliver, agency company stock or other capital stock, or benefit certificates or shares in any common-law corporation, or securities or an…