REGULATORY ACTIVITY:

• Postednotice of amendment to rule 12:235-1.6 regarding maximum workers' compensation benefits.  The proposed maximum benefit for be in effect for injuries occurring in calendar year 2018.  The proposed maximum benefit will be $903.00 per week.
• Published comments received on proposed rule regarding the conduct of judges.  The state is proposing to repeal N.J.A.C. 12:235-10.1-10.12.  Amend rules N.J.A.C. 12:235-10.13,10.16, and 10.20. It is also proposing a new rule N.J.Z.C. 12:235-10 Appendix.  The Department is proposing repeals, amendments, and a new rule, which would result in the adoption of a new Code of Conduct for Judges of Compensation (Code). The proposed adoption of a new Code is prompted by the Supreme Court of New Jersey (Supreme Court) having recently adopted a revised New Jersey Code of Judicial Conduct, effective September 1, 2016, which applies to judges who serve within the judicial branch of State government, as opposed to those, like Judges of Compensation, who serve within the executive branch of State government. The existing Code of Conduct for Judges of Compensation is reflected within the rules at N.J.A.C. 12:235-10.1 through 10.12 and was modeled on the New Jersey Code of Judicial Conduct. Consequently, it only follows that with the recent revision of the New Jersey Code of Judicial Conduct, the Division of Workers' Compensation would want to update its Code of Conduct for Judges of Compensation so as to ensure that Judges of Compensation are held to the same exacting standards as are their counterparts in the Judiciary.  Thus, the Department is proposing the repeal of N.J.A.C. 12:235-10.1 through 10.12 and its replacement with N.J.A.C. 12:235-10 Appendix, which would contain a Code of Conduct for Judges of Compensation virtually identical to the recently revised New Jersey Code of Judicial Conduct. As to the nature of the revisions to the New Jersey Code of Judicial Conduct recently made by the Supreme Court, which are reflected in the proposed new Code of Conduct for Judges of Compensation, the December 12, 2014 letter from Deborah T. Poritz, Chief Justice (Ret.), Chair of the Ad Hoc Committee on the Code of Judicial Conduct to Chief Justice Stuart Rabner (available online: http://www.judiciary.state.nj.us/reports2016/judicialconduct.pdf) is instructive. In that document, the Committee Chair explained, for example, that in general, the Committee had sought more precisely to describe the conduct prohibited (or permitted) by the Rules, adding that language in the Code had been modified, not necessarily to conform to the language found in the American Bar Association (ABA) Model but, rather, to achieve the goals of clarity and specificity, for example, the phrase "in All Activities" at the end of Canon 2 was deleted as too vague. Also, the Chair explained that consistent with its goal of "certainty," it had unanimously recommended that the word "should" be changed to "shall" in every Canon and Rule where it previously existed, except in Canon 1 as is evident within the revised Code itself. According to the Chair, this recommendation had followed the approach implemented in the revision of the 1990 ABA Model Code and found in the current Model Code. Specifically, regarding format, the Chair stated the following: The Committee members found that the disciplinary process had become more formal and public over the past several years and concluded, in that context, that the format of our Code could be confusing and that it is sometimes difficult to differentiate between general principles, rules (the violation of which can result in discipline), and interpretive comments. The Committee therefore determined that there is a need for greater specificity in respect of those actions requiring discipline but that aspirational goals found in our current Code should be retained. That approach continues to build on both the bedrock principles under which our current system has operated and the over 30 years of New Jersey precedent interpreting the Canons. Thus, as does the ABA Model Code, the Committee's proposal contains Canons that express general principles of conduct followed by rules that prescribe specific standards of conduct. As to the amendments proposed within this rulemaking, most of those are technical in nature, either eliminating cross-references to the sections of N.J.A.C. 12:235-10 that are proposed for repeal and replacing them with references to the Code of Conduct for Judges of Compensation, which would be appended to N.J.A.C. 12:235-10; or changing other cross-references throughout the subchapter to reflect recodifications resulting from the repeal of N.J.A.C. 12:235-10.1 through 10.12. In addition, the Department is proposing new N.J.A.C. 12:235-10.13(a)4 (recodified as N.J.A.C. 12:235-10.1(a)4), which would include, as a cause for discipline or removal, failure to notify the Director when the judge has reason to believe that a medical report, medical bill for services, or medical finding has been altered, falsified, or withheld by a licensed physician, dentist, chiropractor, osteopath, optometrist, physical therapist, medical technician, attorney, or a representative of an insurance carrier or self-insured. This workers' compensation-specific provision appears within the current rules at N.J.A.C. 12:235-10.12; however, there is no corresponding provision within the revised New Jersey Code of Judicial Conduct. Consequently, in order to preserve this important prescription for Judges of Compensation, the Department is proposing that it be added to the list of causes for discipline or removal at recodified N.J.A.C. 12:235-10.1. Finally, due to the proposed repeal of N.J.A.C. 12:235-10.1 through 10.12, the Department is proposing that N.J.A.C. 12:235-10.13 through 10.23 be recodified as N.J.A.C. 12:235-10.1 through 10.11. As the Department has provided a 60-day comment period for this notice of proposal, this notice is excerpted from the rulemaking calendar requirements, pursuant toJ.A.C. 1:30-3.3(a)5.
• Has posted notice for a public hearing regarding the 2018 maximum benefit rates and conduct of judges.
• As per the N.J. Department of Treasury, Division of Purchase and Property, the N.J. Department of Labor and Workforce Development – Division of Workers’ Compensation shall utilize certified court reporter services set forth under the current Statewide Contract (T-2767) for Certified Court Reporters/Certified Real Time Court Reporters. In accordance with that contact and its method of operation, J.H. Buehrer & Associates, Jersey Shore Reporting, L.L.C., and William C. O’Brien & Associates, Inc., shall provide the certified court reporters for all the courts in the N.J. Division of Workers’ Compensation for the period of September 11, 2017 through September 29, 2017.
• As per the N.J. Department of Treasury, Division of Purchase and Property, the N.J. Department of Labor and Workforce Development - Division of Workers' Compensation shall utilize certified court reporter services set forth under the current Statewide Contract (T-2767) for Certified Court Reporters/Certified Real Time Court Reporters. In accordance with that contact and its method of operation, J.H.  Buehrer & Associates, Jersey Shore Reporting, L.L.C., and William C. O’Brien & Associates, Inc., shall provide the certified court reporters for all the courts in the N.J. Division of Workers' Compensation for the period of September 11, 2017 through September 29, 2017.  J.H. Buehrer & Associates shall provide certified court reporters for the Central region of the State.  This consists of the workers’ compensation courts in New Brunswick, Lebanon, Freehold, Trenton and Toms River. Jersey Shore Reporting, L.L.C., shall provide certified court reporters for the workers' compensation courts in portions of the Northern region and all the Southern region as follows:  Paterson, Hackensack, Jersey City, Plainfield, Mt. Holly, Camden, Atlantic City and Bridgeton.  William C. O'Brien & Associates, Inc. shall provide certified court reporters for the courts in the remainder of the Northern region as follows: Mt. Arlington and Newark.  As per the contract, the fees for stenographic services shall be:
  • Dismissal for Lack of Prosecution $30.00
  • Section 20 Dismissals $90.00
  • Order Approving Settlement $90.00
  • Trials on Reports $125.00
  • Total Award w/ Decision of 2nd Injury Fund (SIF) Eligibility $125.00
  • Testimony on litigated Matters (per Yi day) Transcripts $150.00

REGULATORY ACTIVITY:

• In accordance with the Order entered by the Hon. Douglas H. Hurd, P.J.C.V., on August 8, 2017, and as per the N.J. Department of Treasury, Division of Purchase and Property, the N.J. Department of Labor and Workforce Development – Division of Workers’ Compensation shall utilize certified court reporter services set forth under the current Statewide Contract (T-2767) for Certified Court Reporters/Certified Real Time Court Reporters. In accordance with that contact and its method of operation, effective August 9, 2017, J.H. Buehrer & Associates, Jersey Shore Reporting, L.L.C., and William C. O’Brien & Associates, Inc., shall provide the certified court reporters for all the courts in the N.J. Division of Workers’ Compensation for the period of August 9, 2017 through August 18, 2017. J.H. Buehrer & Associates shall provide certified court reporters for the Central region of the State.  This consists of the workers’ compensation courts in New Brunswick, Lebanon, Freehold, Trenton and Toms River. Jersey Shore Reporting, L.L.C., shall provide certified court reporters for the workers’ compensation courts in portions of the Northern region and the entire Southern region as follows:  Paterson, Hackensack, Jersey City, Plainfield, Mt. Holly, Camden, Atlantic City and Bridgeton. William C. O’Brien & Associates, Inc., shall provide certified court reporters for the courts in the remainder of the Northern region as follows: Mt. Arlington and Newark.
• Proposed amendments to rule 49 N.J.R. 2726(a) regarding PBMs. N.J.S.A. 17B:27F-1 et seq., effective April 10, 2016, set forth various requirements for contracts between a pharmacy benefits manager (PBM) and a contracted pharmacy. A PBM acts on behalf of an insurer to reimburse contracted pharmacies for the costs of drugs covered under an insurance or health benefits contract. Given the volatility in the costs for generic drugs, PBMs may be reimbursing pharmacies using out-of-date sources that do not reflect the actual available costs of such drugs at the time reimbursement is made. The statute seeks to address this issue by establishing various requirements for contracts between a PBM and a contracted pharmacy, including: the provision of the sources utilized to determine multiple source generic drug pricing, including, if applicable, the maximum allowable costs or any successive pricing formula utilized by the PBM; the updating of that pricing information every seven days; and establishing a reasonable process by which contracted pharmacies have a method to access relevant maximum allowable cost pricing lists and any successive pricing formulas in a timely manner. The statute also sets forth requirements for placing prescription drugs on multiple source generic lists, and requires that contracts between a PBM and a contracted pharmacy include a process to appeal, investigate, and resolve disputes. The statute also directs the Commissioner of Banking and Insurance (Commissioner) to adopt rules to effectuate the purposes of the statute, including any penalty provisions the Commissioner deems necessary. The Department of Banking and Insurance (Department) is proposing these new rules to implement the statute.

REGULATORY ACTIVITY:

• As per the N.J. Department of Treasury, Division of Purchase and Property, the N.J. Department of Labor and Workforce Development - Division of Workers’ Compensation shall utilize the certified court reporter’s services set forth under the current Statewide Contract (T-2767) for Certified Court Reporters/Certified Real Time Court Reporters. In accordance with that contract and its method of operation, effective July 10, 2017, J.H. Buehrer & Associates, Jersey Shore Reporting, L.L.C., and William C. O’Brien & Associates, Inc., shall provide the certified court reporters for all the courts in the N.J. Division of Workers’ Compensation for the period of July 10, 2017 through July 28, 2017.
• New Jersey has published Benefit rates for 2018.
• Pursuant to the Order to Show Cause with Temporary Restraints, entered by the Honorable Douglas H. Hurd, P.J.C.V., on July 10, 2017, the N.J. Department of Labor and Workforce Development - Division of Workers’ Compensation shall utilize the certified court reporter services as set forth in Director and Chief Judge Russell Wojtenko, Jr., memorandum of November 16, 2016.  Further instruction will be provided upon the expiration of the temporary restraining order.

REGULATORY ACTIVITY:

• Posted a rule regarding hospital operations and reporting.  The proposal amends rules H.J.A.C. 8:31B-3.3 and 4.6 and 8:43G-41 and creates a new rule N.J.A.C. 8:96. New Jersey posted notice of a new rule regarding hospital reporting of financial data. While this rule does not specifically regulate the workers' compensation industry it is of interest. On January 17, 2014, Governor Christie approved P.L. 2013, c. 195, "An Act concerning reporting of certain information by hospitals and supplementing Title 26 of the Revised Statutes" (Act). The Act directs the Commissioner of Health (Commissioner) to "undertake a review of New Jersey's hospital financial reporting requirements [and to] report any findings and recommendations directly to the Governor" by mid-July 2014. The Act specifically directs the Commissioner to "examine the impact of, and make recommendations on, the following areas for all [page=1294] entities receiving Health Care Subsidy Fund payments from the State: Internal Revenue Service filings, Securities and Exchange Commission filings, and audited financial statements."
• The Department of Labor and Workforce Development is adopting a final rule issued by the Federal Occupational Safety and Health Administration (OSHA) about its Hazard Communication Standard (HCS).  Specifically, OSHA explains that it is modifying its HCS to conform to the United Nations' Globally Harmonized System of Classification and Labeling of Chemicals (GHS).  Adoption of the final rule discussed above is necessary in order to comply with J.S.A. 34:6A-30, which requires that the Commissioner of Labor and Workforce Development adopt all OSHA standards by reference upon adoption of those standards by the United States Secretary of Labor.  The statutory requirement ensures that the State's Public Employees Occupational Safety and Health (PEOSH) program is at least as effective as OSHA, thereby making the State program eligible for Federal approval and funding under the 1970 Federal Occupational Safety and Health Act.      N.J.S.A. 34:6A-30 provides that the adoption of Federal standards are not subject to the formal rulemaking requirements of N.J.S.A. 52:14B-4, but shall be duly adopted upon publication in the New Jersey Register.  As a result, the Department has not held a public hearing, nor has it requested formal written comments on its adoption of the amended Federal standards.

REGULATORY ACTIVITY:

• The N.J. Division of Workers’ Compensation has just been informed that Castlepoint National Insurance Company is insolvent and has been placed into liquidation by the Insurance Commissioner of the State of California.  The administration of all claims against this carrier will be handled the office of the New Jersey Property-Liability Insurance Guaranty Association (NJ PLIGA) in accordance with N.J.S.A. 34:15–103 et seq.
• New Jersey has issued an order effective Monday April 17, 2017 regarding the requirement of physicians to use specific forms when filing for an internal appeal form with the state for PIP Pre-Service Appeal Form and PIP Post-Service Appeal Form.

REGULATORY ACTIVITY:

• New Jersey has adopted Medical Protocols for their PIP program.  The effective date is October 17, 2016 and the operative date is April 17, 2017.

LEGISLATIVE ACTIONS:

• Senate Bill 3
  This bill requires health insurance coverage for substance use disorders and regulates opioids and certain other prescription drugs in several ways. The bill requires health insurers, the State Health Benefits Program, and the School Employees’ Health Benefits Program, to adhere to certain coverage requirements for treatment of substance use disorders. The bill also places certain restrictions on the prescription of opioids, and requires certain notifications when prescribing Schedule II controlled dangerous substances used to treat chronic or acute pain. The bill also requires certain health care professionals to receive training on topics related to prescription opioid drugs.  Finally, the bill repeals certain sections of law that are obviated by the bill’s provisions. Specifically, the bill requires insurers to provide unlimited benefits for inpatient and outpatient treatment of substance use disorders at in-network facilities. The bill further specifies that the services for the treatment of substance use disorders shall be prescribed by a licensed physician, licensed psychologist, or licensed psychiatrist and provided by licensed health care professionals or licensed or certified substance use disorder providers in licensed or otherwise State-approved facilities, as required by the laws of the state in which the services are rendered. The bill provides that the benefits, for the first 180 days per plan year of inpatient and outpatient treatment of substance use disorder, shall be provided when determined medically necessary by the covered person’s physician, psychologist or psychiatrist without the imposition of any prior authorization or other prospective utilization management requirements. The facility shall notify the insurer of both the admission and the initial treatment plan within 48 hours of the admission or initiation of treatment. If there is no in-network facility immediately available for a covered person, an insurer shall provide necessary exceptions to their network to ensure admission in a treatment facility within 24 hours.  Under the bill, providers of treatment for substance use disorders to persons covered under a covered insurance policy shall not require pre-payment of medical expenses during the 180 days in excess of applicable co-payment, deductible, or co-insurance under the policy. The benefits for outpatient visits shall not be subject to concurrent or retrospective review of medical necessity or any other utilization management review. The benefits for the first 28 days of an inpatient stay during each plan year shall be provided without any retrospective review or concurrent review of medical necessity and medical necessity shall be as determined by the covered person’s physician. The benefits for days 29 and thereafter of inpatient care shall be subject to concurrent review as defined in the bill, initiated no more frequently than every two weeks. The bill establishes a process for concurrent review and an appeal process pursuant to the Independent Health Care Appeals Program in the Department of Banking and Insurance. The benefits for the first 28 days of intensive outpatient or partial hospitalization services shall be provided without any retrospective review of medical necessity and medical necessity shall be as determined by the covered person’s physician. The benefits for days 29 and thereafter of intensive outpatient or partial hospitalization services shall be subject to a retrospective review of the medical necessity of the services. The bill specifies that benefits for inpatient and outpatient treatment of substance use disorder after the first 180 days per plan year shall be subject to the medical necessity determination of the insurer and may be subject to prior authorization or, retrospective review and other utilization management requirements. The medical necessity review shall utilize an evidence-based and peer reviewed clinical review tool to be designated through rulemaking by the Commissioner of Human Services in consultation with the Department of Health.  The benefits for outpatient prescription drugs used to treat substance abuse disorder shall be provided when determined medically necessary by the covered person’s physician, psychologist or psychiatrist without the imposition of any prior authorization or other prospective utilization management requirements. The bill defines a “substance use disorder” as defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and any subsequent editions and includes substance use withdrawal. “Concurrent review” is defined to mean inpatient care is reviewed as it is provided. Medically qualified reviewers monitor appropriateness of the care, the setting, and patient progress, and as appropriate, the discharge plans. The bill provides that the first 180 days per plan year of benefits shall be computed based on inpatient days. One or more unused inpatient days may be exchanged for two outpatient visits. All extended outpatient services such as partial hospitalization and intensive outpatient, shall be deemed inpatient days for the purpose of the visit to day exchange as provided in the bill. The bill stipulates that the Attorney General’s Office shall be responsible for overseeing any violations of law that may result from the bill, including fraud, abuse, waste, and mistreatment of covered persons. The bill also makes clear that the provisions requiring health insurance coverage do not apply to plans administered by the Department of Human Services. The bill also places certain restrictions on how opioids and other Schedule II controlled substances may be prescribed. In cases of acute pain, the bill provides that a practitioner shall not issue an initial prescription for an opioid drug in a quantity exceeding a five-day supply, and must be for the lowest effective dose of an immediate-releasing opioid drug. In cases of acute or chronic pain, prior to issuing an initial prescription of a Schedule II controlled dangerous substance or any other opioid drug in a course of treatment for acute of chronic pain, a practitioner shall: take and document the results of a thorough medical history, including the patient’s experience with non-opioid medication and non-pharmacological pain management approaches and substance abuse history; conduct, as appropriate, and document the results of a physical examination; develop a treatment plan, with particular attention focused on determining the cause of the patient’s pain; access relevant prescription monitoring information under the Prescription Monitoring Program; and limit the supply of any opioid drug prescribed for acute pain to a duration of no more than five days as determined by the directed dosage and frequency of dosage. No less than four days after issuing the initial prescription of an opioid drug that is subject to the 5-day limit, the practitioner, after consultation with the patient, may issue a subsequent prescription for the drug to the patient in any quantity that complies with applicable State and federal laws, provided that: the subsequent prescription would not be deemed an initial prescription under this section; the practitioner determines the prescription is necessary and appropriate to the patient’s treatment needs and documents the rationale for the issuance of the subsequent prescription; and the practitioner determines that issuance of the subsequent prescription does not present an undue risk of abuse, addiction, or diversion and documents that determination. The bill also requires, prior to issuing the initial prescription of a Schedule II controlled dangerous substance or any other opioid drug in a course of treatment for acute or chronic pain, and again prior to issuing the third prescription of the course of treatment, a practitioner shall discuss with the patient, or the patient’s parent or guardian if the patient is under 18 years of age and is not an emancipated minor, the risks associated with the drugs being prescribed, including but not limited to: the risks of addiction and overdose associated with opioid drugs and the dangers of taking opioid drugs with alcohol, benzodiazepines and other central nervous system depressants; the reasons why the prescription is necessary;  alternative treatments that may be available; and risks associated with the use of the drugs being prescribed, specifically that opioids are highly addictive, even when taken as prescribed, that there is a risk of developing a physical or psychological dependence on the controlled dangerous substance, and that the risks of taking more opioids than prescribed, or mixing sedatives, benzodiazepines or alcohol with opioids, can result in fatal respiratory depression. The practitioner shall include a note in the patient’s medical record that the patient or the patient’s parent or guardian, as applicable, has discussed with the practitioner the risks of developing a physical or psychological dependence on the controlled dangerous substance and alternative treatments that may be available. The Division of Consumer Affairs shall develop and make available to practitioner’s guidelines for the discussion required pursuant to the bill.  At the time of the issuance of the third prescription for a prescription opioid drug, the practitioner shall enter into a pain management agreement with the patient. When a Schedule II controlled dangerous substance or any other prescription opioid drug is continuously prescribed for three months or more for chronic pain, the practitioner shall: review, at a minimum of every three months, the course of treatment, any new information about the etiology of the pain, and the patient's progress toward treatment objectives and document the results of that review; assess the patient prior to every renewal to determine whether the patient is experiencing problems associated with physical and psychological dependence and document the results of that assessment; periodically make reasonable efforts, unless clinically contraindicated, to either stop the use of the controlled substance, decrease the dosage, try other drugs or treatment modalities in an effort to reduce the potential for abuse or the development of physical or psychological dependence and document with specificity the efforts undertaken; review the Prescription Drug Monitoring information in accordance with section 8 of P.L.2015, c.74 (C. 45:1-46.1); and (5) monitor compliance with the pain management agreement and any recommendations that the patient seek a referral. The bill clarifies in its definition of “practitioner” that the bill is not intended to alter the scope of practice of any health care practitioner. The bill exempts from the prescription limitations above the following: a patient who is currently in active treatment for cancer, receiving hospice care from a licensed hospice or palliative care, or is a resident of a long-term care facility, and any medications that are being prescribed for use in the treatment of substance abuse or opioid dependence. The bill provides that the any State-regulated health benefits plan, and every contract purchased by the School Employees’ Health Benefits Commission or State Health Benefits Commission, that provides coverage for prescription drugs subject to a co-payment, coinsurance or deductible shall charge a co-payment, coinsurance or deductible for an initial prescription of an opioid drug prescribed pursuant to this section that is either: (1) proportional between the cost sharing for a 30-day supply and the amount of drugs the patient was prescribed; or (2) equivalent to the cost sharing for a full 30-day supply of the opioid drug, provided that no additional cost sharing may be charged for any additional prescriptions for the remainder of the 30-day supply. The bill also would require certain health care professionals to receive training on topics related to prescription opioid drugs. Health care professionals who have the authority to prescribe opioid medications, including physicians, physician assistants, dentists, and optometrists (who have limited authority to prescribe only hydrocodone), will be required to complete one continuing education credit on topics that include responsible prescribing practices, alternatives to opioids for managing and treating pain, and the risks and signs of opioid abuse, addiction, and diversion. For advance practice nurses, who also have prescribing authority, their required six contact hours of continuing professional education in pharmacology related to controlled substances will include issues concerning prescription opioid drugs, including responsible prescribing practices, alternatives to opioids for managing and treating pain, and the risks and signs of opioid abuse, addiction, and diversion. Health care professionals who do not have prescribing authority but who frequently interact with patients who may be prescribed opioids, including pharmacists, professional nurses, and practical nurses, would also be required to complete one continuing education credit on topics that include alternatives to opioids for managing and treating pain and the risks and signs of opioid abuse, addiction, and diversion. The continuing education credits required under the bill will be part of a professional’s regular continuing education credits and will not increase the total number of continuing education credits required. The bill additionally provides that certified nurse midwives will be required to complete one credit of educational programs or topics related to prescription opioid drugs as part of the 30 contact hours in pharmacology training that is required for them to be authorized to prescribe drugs. The bill also requires the Commissioner of Health, in consultation with the Commissioner of Banking and Insurance, to submit reports to the Legislature and the Governor concerning implementation of the bill. One report is to be submitted six months, and the second report is to be submitted 12 months, after the date of enactment of the bill. Finally, the bill repeals several statutes, initially enacted in 1977 and 1985, which required coverage for the treatment of alcoholism. Because the bill expands that coverage to include treatment for all types of substance use disorder, including alcohol abuse, those sections of law specific to alcoholism are no longer required. The committee amendments to the bill: require that a facility providing inpatient or outpatient treatment of substance use disorder notify the patient’s health coverage provider of both the admission and the initial treatment plan within 48 hours of the admission or initiation of treatment; provide that insurers may initiate concurrent review of medical necessity of inpatient treatment every two weeks, rather than every three weeks, after the first 28 days of treatment; require that an initial prescription of an opioid drug for acute pain be for the lowest effective dose of an immediate-releasing opioid drug; clarify that provisions of the bill concerning health care practitioners’ prescribing apply to prescriptions of Schedule II controlled dangerous substance or any other opioid drug in a course of treatment for acute or chronic pain, excluding the five-day restriction on initial prescriptions, which applies only to acute pain; require that a practitioner include a note in a patient’s medical record, rather than a written acknowledgement, that the patient or the patient’s parent or guardian, as applicable, has discussed with the practitioner the risks of developing a physical or psychological dependence on the controlled dangerous substance and alternative treatments that may be available; clarify that the bill’s definition of “practitioner” applies only to those professionals acting within their licensed scope of practice; and provide that health insurance contracts that provide coverage for prescription drugs subject to a co-payment, coinsurance or deductible shall charge a co-payment, coinsurance or deductible for an initial prescription of an opioid drug prescribed pursuant to this section that is either: (1) proportional between the cost sharing for a 30-day supply and the amount of drugs the patient was prescribed; or (2) equivalent to the cost sharing for a full 30-day supply of the opioid drug, provided that no additional cost sharing may be charged for any additional prescriptions for the remainder of the 30-day supply.  Effective Date May 15, 2017.

REGULATORY ACTIVITY:

• New Jersey has published their schedule for indemnity benefits exclusive of amputation and enucleation effective January 1, 2017.

REGULATORY ACTIVITY:

• Published its schedule of disabilities and maximum benefits exclusive of amputations and enucleation
• New Jersey has adopted Medical Protocols for their PIP program.  The effective date is October 17, 2016; the operative date is April 17, 2017.
• New Jersey just enacted legislation that requires providers to transmit and for payers to be able to receive medical bills electronically.  The bill is effective on the day it was signed into law November 14thn 2016 however, compliance is delayed by 18 months to give the state time to adopt guidelines and for payers to be in compliance with those guidelines.  It also exempts providers that bill less than 25 bills per month from compliance with electronic submission.  It is anticipated that the state will adopt the IAIABC e-billing guidelines which we are already in compliance.  The bill does not require payers to submit the medical bills to the state electronically so all it does is require electronic submission and acceptance of a medical bill.