New Jersey - Volume VI, Number 3 - March, 1997

HEALTH MAINTENANCE ORGANIZATION RULES ADOPTED

The New Jersey Departments of Health & Senior Services and Banking & Insurance have adopted final rules governing health maintenance organizations (HMOs) that operate in the state, replacing rules that are over 20 years old. The rules govern the financial and insurance aspects of HMOs, as well as consumer and provider interests. They set minimum standards for provider agreements; continuation of coverage; medical director qualifications; mandatory health care services, including emergency services and medical screening examinations; provider networks; QA and UM (denials and limits on coverage must be made by a physician); and appeals (including "non-retribution" language to protect providers when filing a complaint on behalf of a patient). HMOs must tell the state and members about their use of financial incentives and disincentives in provider compensation arrangements (specific contract terms need not be disclosed but a provider is neither prohibited nor compelled to disclose compensation terms to the patient). "Gag clauses" regarding advising patients of available treatment options, are prohibited. The operative dates vary. For more information, contact KACS.

NJ UNIFORM PRESCRIPTION BLANK LAW ENACTED

To help stem widespread trafficking in forged and altered prescriptions for drugs, a statute was enacted January 6, 1997, to require the use of uniform prescription blanks for all prescriptions written in New Jersey. As of July 5, 1997 (or later, if sufficient prescription blanks are not yet available) all licensed prescribers in the state (including health care facilities) must use non-reproducible, non-erasable safety paper New Jersey Prescription Blanks, bearing the precscriber's license number, for written prescriptions for controlled dangerous substances, prescription legend drugs or other prescription items. The prescription blanks must be secured from an approved vendor. The prescriber must keep a record of the receipt of the prescription blanks and must promptly notify the Office of Drug Control after becoming aware that any prescription blanks in the prescriber's possession have been stolen. Beginning on July 5, 1997, a prescription cannot be filled by a pharmacist unless the prescription is issued on the approved prescription blank. However, for the first 90 days, a pharmacist who receives a prescription not issued on an approved prescription blank can fill the prescription after requesting verification, in writing or orally, of the prescription from the prescriber. Nothing, however, will prevent a licensed prescriber from transmitting to a pharmacist by telephone or other electronic means, a prescription, as otherwise authorized by law, if the prescriber provides his or her DEA registration number or prescriber's license number, as appropriate, to the pharmacist at the time the prescription is transmitted.

RIGHT TO PRE-HEARING DEPOSITIONS UPHELD

In an unreported case, a New Jersey Appeals Court upheld a lower court's order allowing an embattled physician to take depositions of his accusers before he submits to a medical staff hearing on a hospital's denial of his re-appointment. The court found that the right to counsel is meaningless without a corresponding right to discover useful evidence, both through document discovery and depositions. Physicians faced with such hearings should consider seeking both types of discovery