New Jersey § 26:2s-8

§ 26:2s-8.

A carrier which offers a managed care plan shall establish a policy governing removal

of health care providers from the provider network which includes the following: a. The carrier shall inform a participating health care provider of the carrier's

removal policy at the time the carrier contracts with the health care provider to

participate in the provider network, and at each renewal thereof. b. If a licensed health care professional's participation will be terminated prior

to the date of the termination of the contract, the carrier shall provide the health

care professional with 90 days’ written notice of the termination and notice of a

right to a hearing. If requested by the health care professional, the carrier shall provide the reasons

for the termination in writing, and shall hold a hearing within 30 days of the date

of the request. The hearing shall be conducted by a panel appointed by the carrier, which panel

shall be comprised of a minimum of three persons, at least one of whom is a clinical

peer in the same discipline and the same or similar specialty as the health care professional

being reviewed. The panel shall make a decision that: (1) the health care professional shall be

terminated, or (2) the health care professional shall be reinstated or provisionally

reinstated, subject to conditions set forth by the panel. The panel's determination shall be in writing and shall be made in a timely manner. Participation in this process shall not be deemed to be an abrogation of the health

care professional's legal rights. The notice required and opportunity for a hearing pursuant to this subsection shall

not apply in those cases when the contract expires and is not renewed, the termination

is for breach of contract, in the opinion of the medical director, the health care

professional represents an imminent danger to an individual patient or the public

health, safety or welfare, or there is a determination of fraud. c. If the carrier finds that a health care professional represents an imminent danger

to an individual patient or to the public health, safety or welfare, the medical director

shall promptly notify the appropriate professional State licensing board. Notification to the State Board of Medical Examiners shall be subject to the provisions

of section 5 of P.L.1989, c. 300 ( C.45:9-19.5 ).