New Jersey MGMA State Chapter Legislative Update
Prepared By: Nick DeRose, New Jersey MGMA State Chapter Legislative Liaison
Date: February 14, 2025
1. 2024 Legislative Updates
• New Legislation:
• Senate Bill No. 912: Requires prenatal care providers to assist patients in
creating individualized postpartum care plans, including follow-ups and
mental health guidance.
• Assembly Bill No. 2804: Improves efficiency in reviewing NJ FamilyCare
provider applications by mandating timely notifications between licensing
boards and the Department of Human Services.
• Regulatory Changes:
• The Ensuring Transparency in Prior Authorization Act (ETPAA) was signed into
law, modernizing prior authorization processes and emphasizing
transparency for healthcare providers and insurers.
2. Legislation Effective January 1, 2025
• Description:
• Health Insurance Prior Authorization Law: Requires insurers to decide on
urgent medical requests within 24 hours and non-urgent cases within 72
hours. Long-term care authorizations remain valid for 180 days, and denials
must involve a physician from the same specialty as the requesting doctor.
• Impact:
• Reduces delays in patient care and improves access to necessary
treatments. Practices must ensure compliance with stricter timelines for
prior authorization submissions.
3. What to Watch for in 2025
• New or Pending Legislation:
• Graduate Physician Licensing Act (A5273): Proposes allowing graduate
physicians to provide primary care services in underserved areas under
supervision, with reimbursement parity for mid-level providers.
• Key Dates:
• Open Enrollment for health coverage ends January 31, 2025, under the New
Jersey Health Insurance Market Preservation Act.
• Industry Trends:
• Continued focus on streamlining administrative processes like prior
authorizations and addressing workforce shortages through innovative
licensing models.
4. Resources and Next Steps
• State Resources: Visit the New Jersey Department of Banking & Insurance website
for updates on ETPAA compliance requirements.
• Legislative Tracking: Use NCSL’s public health database to monitor upcoming bills.
• National Conference of State Legislatures (NCSL)
Database: https://www.ncsl.org/research/health/health-innovations-
database.aspx
• New Jersey Legislature: https://www.njleg.state.nj.us/
• Healthcare Compliance Pros: https://www.healthcarecompliancepros.com/
This is a summary of a recent settlement with Blue Cross Blue Shield. There are some timelines involved.
A recent settlement involving Blue Cross Blue Shield is set to benefit healthcare providers by over $17.3 billion in the next decade. This includes a direct payment of $2.8 billion and improvements to processing claims, making it easier and faster for providers to get paid. Key features of the settlement include commitments to better communication about claims, interest payments on delayed claims, and opportunities for improved care. Providers opting out of this settlement will miss out on these valuable benefits, which could also impact the patients they serve.
Providers must decide by March 4, 2025, whether to participate in the settlement. If they don't opt out, they'll automatically be included.
Providers must submit a claim on the settlement platform by July 29, 2025
The settlement agreement includes information about which types of providers are included and excluded. Providers can find more information about the settlement on the court-authorized settlement website. They can also contact the Claims Administrator at info@BCBSsettlement.com or toll-free at (888) 681-1142
This bill takes effect in Jan 2025. It was passed this year. It is cutting edge because New Jersey has severely limited the time Payers are allowed to "drag their feet" on prior auth. The law currently allows 15 days on PA requests. Under the new law, urgent medication requests must be decided in 24 hours and non-urgent ones within 72 hours, with the treating physician determining urgency. For diagnostics and procedures 72 hours at most if urgent and nine days if non-urgent. Only New Jersey and Washington have passed laws like this.
This law also takes effect this year. Payers must offer more than one reimbursement for services. They typically are now reimbursing with a virtual credit card that comes with a 4 or 5% fee. In 2025 they will need to offer other types of reimbursement so groups can avoid a 4 or 5% charge.
The following are in the pipeline:
- The State Senate Budget and Appropriations Committee will hear
- S2988 which extends telemedicine and telehealth pay parity for an additional year.
- S1192 limits prior authorization and step therapy for mental health treatment
Stay tuned for more updates.
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From measuring quality to completing prior authorization requirements, medical practices face mounting regulatory hurdles that interfere with clinical goals and improving patient outcomes. To help MGMA better educate Congress and the Administration about obstacles to delivering high-quality patient care, we are asking members to please take one minute to rank key regulatory issues from 1 to 10. You can access the poll here: https://www.surveymonkey.com/r/8CVH3J8.
Your feedback is greatly appreciated and will help guide MGMA's advocacy efforts in Washington, D.C., as we work to improve the regulatory landscape in which group practices operate.