N.J. Admin. Code § 11:24B-5.4

Current through Register Vol. 56, No. 21, November 4, 2024

Section 11:24B-5.4 - Termination and continuity of care standards for provider agreements with hospitals

(a) Provider agreements shall specify the term of the contract, reasons for which the contract may be terminated by one or more parties to the contract, procedures for notice and effectuation of such termination, and opportunities, if any, to cure any deficiencies prior to termination.

1. If the reason(s) for which a provider may be terminated from the ODS' network is different from the reason(s) for which a provider may be removed from participation in a carrier's panel, the contract shall so specify this.

2. If the contract permits a provider to elect not to participate in a carrier's panel without also terminating the provider agreement with the ODS, the contract shall contain a provision setting forth the standards and procedures for this.

(b) The provider agreement may specify that the contract may be terminated without cause, so long as non-cause termination is permitted by either party subject to reasonable prior notice.

(c) The contract shall specify that if a hospital's status as a participating provider is terminated, regardless of who initiates the termination, or the reason for the termination, the hospital shall continue to abide by the terms of the contract for a period of at least four months from the effective date of the termination with respect to at least those covered persons enrolled with a carrier that is an HMO. The obligation shall apply to any health benefits plan underwritten by the HMO, regardless of the characterization of the health benefits plan (for example, regardless of whether the health benefits plan is for Medicare, Medicaid, a point-of-service plan, or a closed panel plan).

N.J. Admin. Code § 11:24B-5.4