NJ LEG approved Bill A1255 and substituted Bill S1794 which updates NJ INS 17B:30-48 with regards to authorization and prior authorization of health care services.
Health Care Service Authorization
Bill will be known as Ensuring Transparency in Prior Authorization Act, and excluded State Health Benefits Program and School Employees’ Health Benefits Program.
Allows payer to include prescription drug formularies in processing payment of claims.
Must respond to emergency prior authorization within 24 hours, 72 hours for non emergency requests, after obtaining necessary information to make a determination.
Starting from Jan. 1, 2027, a carrier shall only accept and respond to requests for prior authorization for medication through the NCPDP SCRIPT Standard (NCPDP).
Prior authorizations to remain for 180 days except where shorter time frames needed to monitor patient safety or treatment effectiveness, with notice to treating provider.
Any denial or approval of prior authorizations should not be compensated or have preferential treatment by payer if physician is also a network provider for the payer.
Denial of prior authorization requests for outpatient facilities but be done in 12 days.
Prior authorization timeframes extended for long term care or for chronic conditions.
Legislative History
On Jan. 11, 2022, bill introduced in Assembly; on Dec. 21, 2023, bill passed Assembly.
On Dec. 28, 2023, bill returned to Senate; on Jan. 8, 2024, bill was passed in Senate.
On Jan. 16, 2024, bill was approved by governor and became P.L.2023, c.296.
Effectiveness
Act will take effect on Jan. 1, 2025.
Regulators
NJ LEG
Entity Types
CNSM; Ins
Reference
Act, P.L.2023, c.296, Bill AB 1255, SB 1794, 1/16/2024; Citation: NJ INS 17B:30-48;
