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- NJ Pathologists, CAP Fight for Network Adequacy
The New Jersey Society of Pathologists (NJSP) and the CAP worked closely with the New Jersey Physician Coalition to advocate for increased network adequacy requirements for health plans. The NJSP and the CAP introduced legislation that requires network adequacy in health plans for pathologists and other specialty physicians. The CAP has worked with the NJSP to ensure that New Jersey health plan networks are inclusive of pathologists to reduce surprise bill incidents for patients.
New Jersey Senate Bill 3518 requires health carriers to submit a network access plan to the state Commissioner of Banking and Insurance, or the Commissioner of Human Services, on the percentage of physicians participating in their network to ensure patients have meaningful access to in-network physician services. The bill outlines health care networks include pathologists, emergency physicians, anesthesiologists, radiologists, radiation oncologists, oncologists, pediatric oncologists, and hospitalists. The bill requires the commissioner to approve a health plan’s network only if the number of providers, medical specialties, and geographic parameters is sufficient for insured patients' access to care.
The CAP stands as an active proponent in securing network adequacy policies in the state of New Jersey and across the United States. Network adequacy is imperative to the market value of pathology services. State legislatures and regulators have a unique role to play to ensure health plans maintain robust networks of physicians for timely access to health services and care to patients. With the introduction of Senate Bill 3518, New Jersey pathologists and patients have the opportunity to discuss the importance of adequate health plans and guaranteed access to specialty providers to their legislators.
The CAP will continue to follow developments on the measure.