PO Box 360
Trenton, NJ 08625-0360

For Release:
Monday, April 18, 2016

Cathleen D. Bennett
Acting Commissioner

For Further Information Contact:
Office of Communications
(609) 984-7160

Department of Health Proposes Amendment and New Rule at N.J.A.C. 8:43G-5 Establishing Notice Posting and Training Requirements for the Independent Health Care Appeals Program (IHCA Program)

The Office of Certificate of Need and Healthcare Facility Licensure within the Division of Certificate of Need and Licensing within the Health Systems Branch of the Department of Health (Department), in consultation with the Department of Banking and Insurance (DOBI) and the State Board of Medical Examiners (BME), and with the approval of the Health Care Administration Board, is proposing an amendment and a new rule at N.J.A.C. 8:43G-5 to require hospitals to post notice about the Independent Health Care Appeals Program (IHCA Program) in the Department of Banking and Insurance (DOBI). 

The IHCA Program provides an independent review of health insurance carriers’ final decisions to deny, reduce or terminate covered persons’ benefits based on medical necessity or appropriateness of services.  An amendment to the law creating the IHCA Program in 2012 (2012 IHCAP amendment) requires the DOBI to promulgate rules prescribing the size, content, and format of a notice about the IHCA Program. The 2012 IHCAP amendment also obliges the Department, in consultation with the DOBI and the BME, to promulgate rules requiring Department-licensed general hospitals to post the IHCA Program notice in conspicuous places in their waiting rooms and to ensure that “appropriate hospital staff” are made aware of the IHCA Program and are able to provide information to patients and their family members, or other persons on a patient’s behalf, about how to contact the IHCA Program.

In mid-2014, the DOBI promulgated rules prescribing the size, content, and format of the IHCA Program notice, which is available on the DOBI website at http://www.dobi.nj.gov/ihcapappeals. The proposed amendment and new rule in the Hospital Licensing Standards at N.J.A.C. 8:43G-5 would implement the Department’s obligation to promulgate rules requiring hospitals to post the IHCA Program notice and to ensure that staff are aware of, and are able to inform patients about, the IHCA Program.

The proposal appears in the April 18, 2016 issue of the New Jersey Register.  The public has until June 17, 2016 to comment on the proposal.

Persons wishing to comment on the proposal must submit written comments either (1) electronically by June 17, 2016 to https://nj.gov/health/legal/ecomments.shtml or (2) by regular mail postmarked on or before June 17, 2016 to Joy L. Lindo, Director, Office of Legal and Regulatory Compliance, New Jersey Department of Health, PO Box 360, Trenton, NJ 08625-0360.

LexisNexis provides free online access to the New Jersey Register at http://www.lexisnexis.com/njoal. An unofficial copy of the proposal is also available from the Department’s website at https://nj.gov/health/legal/open.shtml.

Last Reviewed: 4/18/2016