Senate Commerce Committee Statement to Senate, No. 2031 (State of New Jersey, June 20, 2022)

Summary

This is a Senate Commerce Committee statement to the New Jersey Senate on Senate Bill No. 2031, dated June 20, 2022. The committee reports the bill favorably. The bill establishes a process by which certain health care providers can be barred from collecting reimbursement from the medical expense benefits under the personal injury protection (PIP) coverage of an automobile insurance policy. The Commissioner of Banking and Insurance is to set standards for investigating and temporarily suspending or barring providers, with notice and an opportunity to be heard and at least 90 days' notice before the regulations take effect. The commissioner is to compile a list of barred providers and make it available to the public by website and toll free number.

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     SENATE COMMERCE COMMITTEE

                   STATEMENT TO

                 SENATE, No. 2031

 STATE OF NEW JERSEY
                     DATED: JUNE 20, 2022

   The Senate Commerce Committee reports favorably Senate Bill
No. 2031.
   This bill establishes a process by which certain health care
providers can be barred from collecting reimbursement from the
medical expense benefits under the personal injury protection (PIP)
coverage of an automobile insurance policy.
   Specifically, the bill provides that the Commissioner of Banking
and Insurance (the “commissioner”), in consultation with the
Commissioner of Health and Senior Services and the Director of the
Division of Consumer Affairs in the Department of Law and Public
Safety, shall, by regulation, promulgate standards and procedures
for investigating and, as appropriate, temporarily suspending or
barring a health care provider from demanding, requesting or
receiving reimbursement for services or equipment for which
payment is to be made by an automobile insurer under PIP
coverage. The bill requires the commissioner to ensure adequate
due process protection to health care providers, including notice and
opportunity to be heard, and to provide notice to health care
providers at least 90 days in advance of the effective date of the
regulations implementing the bill.
   The bill establishes a process in which the commissioner, either
by his own initiative or based on the recommendation of the
Commissioner of Health and Senior Services or the Director of the
Division of Consumer Affairs, may conduct an investigation into
any health care provider who the commissioner reasonably believes:
   (1) may be guilty of professional misconduct, incompetence, or
negligence;
   (2) exceeded the limits of his or her professional competence in
rendering medical care or may have knowingly made a false
statement or representation as to a material fact in any medical
report under PIP;
   (3) has solicited, or has employed another to solicit for himself
or herself or for another, professional treatment, examination or
care of an injured person in connection with certain claims;
   (4) has refused to appear before, or to answer upon request of,
the Commissioner of Banking and Insurance, the Commissioner of
Health and Senior Services, the Director of the Division of
Consumer Affairs, or any duly authorized officer of the State, any
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legal question, or to produce any relevant information concerning
his or her conduct in connection with rendering medical services; or
   (5) has engaged in patterns of billing for services which were
never rendered, are of no diagnostic value or are medically
unnecessary.
   The bill then requires the commissioner to notify any health care
provider being investigated and provide the health care provider
with adequate notice and opportunity to be heard. Under the bill,
the commissioner is then required to make a determination, based
on the investigation and the health care provider’s response,
whether to temporarily suspend or bar the health care provider from
demanding, requesting or receiving reimbursement for services or
equipment for which payment is to be made by an automobile
insurer under PIP coverage.
   The bill also requires the commissioner to compile a list of those
health care providers who are barred from collecting reimbursement
under the bill. Health care providers who are barred from collecting
reimbursement under the bill are prohibited from subsequently
treating for remuneration, as a private patient, any person seeking
medical treatment under personal injury protection coverage. An
injured claimant so treated or examined is permitted to raise this as
a defense in any action by that health care provider for payment for
treatment rendered at any time after that health care provider has
been barred from demanding or requesting payment for medical
services pursuant to this section.
   The bill also provides that the commissioner, the Commissioner
of Health and Senior Services and the Director of the Division of
Consumer Affairs shall make the list of health care providers who
are barred from reimbursement under the bill’s provisions available
to the public by means of a website and by a toll free number.
   The bill also permits the commissioner, while conducting an
investigation pursuant to the bill and, after a hearing and upon
written notice to the provider, to temporarily suspend a health care
provider from demanding, requesting or receiving any
reimbursement for services or equipment for medical expense
benefits for which payment is to be made by an automobile insurer
under PIP coverage.
   The bill is not intended to affect or alter the provisions of
P.L.1989, c.19 (C.45:9-22.4 et seq.), which pertain to referrals of
patients by practitioners.


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