Since it first learned in late April of a surprise announcement by Horizon Blue Cross Blue Shield to implement a new policy to impose Medical Necessity Determinations (MND) on various ultrasound services, the New Jersey Patient Care and Access Coalition has been working virtually non-stop to reverse this illadvised decision.
NJPCAC President and Chairman Dr. Bob Gialanella, Vice Chairman Dr. Alan Krieger, Counsel Howard Rubin and lobbyist Don Sico met with Dr. Herb Conaway, Chairman of the Assembly Health and Senior Services Committee on April 29th in New Brunswick. The group discussed two key issues with the Chairman: Maintenance of Certification and a new ultrasound […]
New Jersey became the first state in the nation to formally oppose the draft recommendation made by the U.S. Preventive Services Task Force (USPSTF) that healthy men should no longer receive prostate-specific antigen (PSA) blood tests as part of routine cancer screening. The joint resolution requesting the U.S. Congress to seek the withdrawal of the USPSTF’s […]
Two of NJPCAC’s priority issues are heating up in Trenton as Legislators tackle an aggressive pre-holiday agenda. The Out of Network issue and the NJPCAC-led initiative to reform New Jersey’s “Codey Act” to allow for value-based/alternative payment model health care are expected to see action.
UPDATE: On Monday, December 5th, the sponsor of the bill, Senator Joe Vitale, Chair of the Senate Health Committee, delayed action on the legislation to give stakeholders more time to reach a compromise. Brand new coalitions have been created in recent weeks to both support and oppose out of network reform. Horizon Blue Cross Blue […]
UPDATE: An identical bill (A4334) introduced in the Assembly by Dr. Herb Conaway, Chairman of the Assembly Health and Senior Services Committee, was unanimously and favorably reported from that committee on December 5th. The vote was 13-0 with no abstentions and no absent members. Legislation advanced by the New Jersey Patient Care and Access Coalition […]
Efforts to reform New Jersey’s network adequacy and plan disclosure laws that were introduced in the Legislature late last year in response to the roll out of Horizon’s new OMNIA tiered network product have stalled and have little hope of enactment. Court cases – one of which NJPCAC participated amicus – have also hit a […]