Sponsored by:
Senator ANTHONY R. BUCCO
District 25 (Morris and Somerset)
SYNOPSIS
Requires health insurance carriers to reimburse network providers of diagnostic radiologic services at the same rate.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health insurance reimbursement for certain radiologic services and supplementing P.L.1997, c.192 (C.26:2S-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Notwithstanding the provisions of any law to the contrary, a carrier which offers a managed care plan that provides benefits for diagnostic radiologic services shall offer the same fee schedule, including any additional compensation in addition to the fee schedule, for those diagnostic radiologic services to all participating providers. Each billing code for a diagnostic radiologic service shall be reimbursed at the same rate to all participating providers. A carrier shall not negotiate a fee schedule for diagnostic radiologic services that is specific to a particular health care provider to the detriment of other participating providers providing the same service. Nothing in this section shall be construed to otherwise limit or alter the ability of a carrier to negotiate or revise a fee schedule for services that are not diagnostic radiologic services consistent with existing law.
2. This act shall take effect immediately and shall apply to any contract entered into after the effective date of this act.
STATEMENT
This bill provides that providers of diagnostic radiologic services that participate in a managed care network shall be reimbursed at the same rate for the same service. Currently, carriers are permitted to negotiate a fee schedule that can be specific to a particular provider and, therefore, reimbursement rates can vary based on the size and negotiating ability of a particular provider relative to the carrier.
Specifically, this bill provides that a carrier which offers a managed care plan that provides benefits for diagnostic radiologic services shall offer the same fee schedule, including any additional compensation in addition to the fee schedule for those diagnostic radiologic services to all participating providers. Each billing code for a diagnostic radiologic service shall be reimbursed at the same rate to all participating providers. The bill further stipulates that a carrier shall not negotiate a fee schedule for diagnostic radiologic services that is specific to a particular health care provider to the detriment of other participating providers providing the same service.
It has come to the sponsor's attention that recent revisions to certain fee schedules offered to diagnostic radiology centers have resulted in significant reductions in reimbursement rates to certain, usually smaller, facilities and created wide variation in reimbursement rates between facilities. In order to protect smaller, locally owned, facilities from severe economic consequences of such a change, this bill would require all facilities to be reimbursed at the same rate for the same diagnostic radiologic service.