New Jersey § 52:17b-196

§ 52:17b-196.

The Legislature finds and declares that: a. Active, robust and fully competitive markets for health care and dental services

provide the best opportunity for the residents of this State to receive high-quality

health care and dental services at an appropriate cost; b. A substantial amount of health care and dental services in this State is purchased

for the benefit of patients by health and dental insurance carriers engaged in the

financing of health care and dental services or is otherwise delivered subject to

the terms of agreements between carriers and physicians and dentists; c. Carriers are able to control the flow of patients to physicians and dentists through

compelling financial incentives for patients in their health and dental benefits plans

to utilize only the services of physicians and dentists with whom the carriers have

contracted; d. Carriers also control the health care and dental services rendered to patients

through utilization management and other managed care tools and associated coverage

and payment policies; e. Carriers are often able to virtually dictate the terms of the contracts that they

offer physicians and dentists and commonly offer these contracts on a take-it-or-leave-it

basis; f. The power of carriers to unilaterally impose provider contract terms jeopardizes

the ability of physicians and dentists to deliver the superior quality health care

and dental services traditionally available in this State; g. Physicians and dentists do not have sufficient market power to reject unfair provider

contract terms offered by carriers that impede their ability to deliver medically

appropriate care without undue delay or difficulties; h. Inadequate reimbursement and other unfair payment terms offered by carriers adversely

affect the quality of patient care and access to care by reducing the resources that

physicians and dentists can devote to patient care and decreasing the time that physicians

and dentists are able to spend with their patients; i. Inequitable reimbursement and other unfair payment terms also endanger the health

care infrastructure and medical progress by diverting capital needed for reinvestment

in the health care delivery system, curtailing the purchase of state-of-the-art technology,

the pursuit of medical research, and expansion of medical services, all to the detriment

of the residents of this State; j. The inevitable collateral reduction and migration of the health care work force

will also have negative consequences for the economy of this State; k. Empowering independent physicians and dentists to jointly negotiate with carriers

as provided in this act will help restore the competitive balance and improve competition

in the markets for health care and dental services in this State, thereby providing

benefits for consumers, physicians and dentists and less dominant carriers; l. This act is necessary and proper, and constitutes an appropriate exercise of the

authority of this State to regulate the business of insurance and the delivery of

health care and dental services; m. The pro-competitive and other benefits of the joint negotiations and related joint

activity authorized by this act, including, but not limited to, restoring the competitive

balance in the market for health care services, protecting access to quality patient

care, promoting the health care infrastructure and medical progress, and improving

communications, outweigh any potential anti-competitive effects of this act; and n. It is the intention of the Legislature to authorize independent physicians and

dentists to jointly negotiate with carriers and to qualify such joint negotiations

and related joint activities for the State-action exemption to the federal antitrust

laws through the articulated State policy and active supervision provided under this

act.