§ 17B:30-55.15 — Failure by payer to comply with deadline, health care services subject to review, automatic authorization.

New Jersey § 17B:30-55.15

• Jurisdiction: New Jersey
• Title 17B: INSURANCE

Text

16. a. In addition to the protections afforded to a health care provider or patient by the requirements of P.L.2023, c.296 (C.17B:30-55.1 et al.), any failure by a payer to comply with a deadline shall result in any health care services subject to review being automatically deemed authorized. b. Notwithstanding any health care services being automatically deemed authorized pursuant to the terms of P.L.2023, c.296 (C.17B:30-55.1 et al.), the Commissioner of Banking and Insurance shall enforce the provisions of sections 3 through 15 of P.L.2023, c.296 (C.17B:30-55.2 through 17B:30-55.14) and sections 2, 3, 4, 5, 6, 7 and 10 of P.L.1999, c.154 (C.17:48-8.4, 17:48A-7.12, 17:48E-10.1, 17B:26-9.1, 17B:27-44.2, 26:2J-8.1 and 17:48F-13.1) as amended by P.L.2023, c.296 (C.17B:30-55.1 et al.). A payer found in violation of those sections shall be liable for a civil penalty of not more than $10,000 for each day that the payer is in violation if reasonable notice in writing is given of the intent to levy the penalty and, at the discretion of the commissioner, the payer has 30 days, or such additional time as the commissioner shall determine to be reasonable, to remedy the condition which gave rise to the violation and fails to do so within the time allowed. The penalty shall be collected by the commissioner in the name of the State in a summary proceeding in accordance with the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.). The commissioner's determination shall be a final agency decision subject to review by the Appellate Division of the Superior Court. c. If the Commissioner of Banking and Insurance has reason to believe that a person is engaging in a practice or activity, for the purpose of avoiding or circumventing the legislative intent of sections 4 through 17 of P.L.2023, c.296 (C.17B:30-55.3 through 17B:30-55.16) and sections 2, 3, 4, 5, 6, 7 and 10 of P.L.1999, c.154 (C.17:48-8.4, 17:48A-7.12, 17:48E-10.1, 17B:26-9.1, 17B:27-44.2, 26:2J-8.1 and 17:48F-13.1) as amended by P.L.2023, c.296 (C.17B:30-55.1 et al.), the Commissioner of Banking and Insurance is authorized to promulgate rules or regulations necessary to prohibit that practice or activity and levy a civil penalty of not more than $10,000 for each day that person is in violation of that rule or regulation. d. For the purpose of administering the provisions of sections 3 through 15 of P.L.2023, c.296 (C.17B:30-55.2 through 17B:30-55.14) and sections 2, 3, 4, 5, 6, 7 and 10 of P.L.1999, c.154 (C.17:48-8.4, 17:48A-7.12, 17:48E-10.1, 17B:26-9.1, 17B:27-44.2, 26:2J-8.1 and 17:48F-13.1) as amended by P.L.2023, c.296 (C.17B:30-55.1 et al.), 50 percent of the penalty monies collected pursuant to subsections b. and c. of this section shall be deposited into the General Fund. For the purpose of providing payments to hospitals in accordance with the formula used for the distribution of charity care subsidies that are provided pursuant to P.L.1992, c.160 (C.26:2H-18.51 et seq.), 50 percent of the penalty monies collected pursuant to subsections b. and c. of this section shall be deposited into the Health Care Subsidy Fund established pursuant to section 8 of P.L.1992, c.160 (C.26:2H-18.58). e. A penalty levied pursuant to this section against a payer that does not reserve the right to change the premium shall be credited towards a penalty levied against the payer by the Department of Human Services for the same violation. L.2023, c.296, s.16.