New Jersey - Volume VIII, Number 1 - January, 1999
New Jersey - Volume VIII, Number 1 - January, 1999
PIP RULES ON MEDICAL PROTOCOLS, DIAGNOSTIC TESTS ADOPTED
Rules proposed in September 1998 by the Department of Banking and Insurance (Statlaw, Vol. VII, No. 9) attempting to define PIP reimbursable diagnostic tests and establishing medical "care paths" and "decision point review" in connection with certain treatments of injuries arising from motor vehicle accidents, have been adopted in final form by the Department of Banking and Insurance ("Department"). The new rules apply to policies issued or renewed on or after March 22, 1999. The Department received over 21,000 written comments on the rule proposal, which was also the subject of a hearing and widespread challenge. The final rules contain numerous revisions, including: encouraging insurers to accept a comprehensive treatment plan in lieu of decision point review at specific intervals and approval of individual treatment plans in advance; confirmation that care paths are not fixed standards, that the patient’s general health or pre-existing condition must be considered, and that treatments must be based on patient need and professional judgment; requiring timely review and notification from insurers; addressing patients being moved from one care path to another; clarifying what constitutes a basic block of conservative therapy in certain care paths, with specific reference to special manipulation by osteopathic physicians and chiropractors; and addition of occupational therapists to the category of health care providers covered by the rules. The Department has reserved on whether to determine that thermography as well as tomography studies for TMJ disorder should remain on the list of diagnostic tests determined to yield no data of any significant value in the treatment of injuries from motor vehicle accidents. The Department wants to await adoption by the relevant professional boards of final rules on the validity of these tests.
STREET ADDRESS REQUIRED FOR PRACTICE IDENTIFICATION
The State Board of Medical Examiners ("Medical Board") has proposed a new rule requiring that all professional representations, including, but not limited to, letterhead stationery, business cards, and claim forms, identify the street address(es) of the physician’s professional practice location(s). A post office box, whether for general mailing or for billing purposes, may be listed on the professional representation, but must be accompanied by the street address. The Medical Board cites the investigatory problems created when a physician uses only a post office box as the practice address, particularly if the physician is operating from a mobile facility or as an "itinerant practitioner," examining patients on the premises of other physicians or practitioners.
RULE PROPOSED IMPLEMENTING MANDATORY MEDICAL MALPRACTICE INSURANCE OR LETTER OF CREDIT
Implementing the statute enacted last year, the Medical Board has published proposed requirements for complying with the mandate that physicians and podiatrists who maintain a New Jersey professional practice with responsibility for patient care be covered by malpractice insurance or a letter of credit. The minimum malpractice coverage would be $1 million per occurrence and $3 million per policy year, with extended reporting endorsement coverage for claims made policies ("tail coverage"). If such insurance coverage is unavailable (meaning that a physician cannot purchase such coverage at any cost, not just that the available coverage is considered by the physician to be unaffordable), the practitioner must obtain a letter of credit of at least $500,000 (replenished as needed to maintain the minimum sum) and must supply a copy of the letter of credit and other information to the Medical Board.