N.J. Admin. Code § 11:22-4.6 - Notice of change in documents

(a) A licensed organized delivery system shall not materially modify any matter or document furnished pursuant to N.J.A.C. 11:22-4.4 unless the system files with the Commissioner a notice of the change or modification, together with any additional information to explain the change or modification, at least 60 days prior to the use or adoption of the change, and a filing fee in the amount of $ 250.00. If the Commissioner fails to affirmatively approve or disapprove the change or modification within 60 days of submission of the notice and any supporting information required by the Commissioner, the notice of modification shall be deemed approved. The Commissioner may extend the 60-day review period for not more than 30 additional days by giving written notice of the extension before the expiration of the 60-day period. If a change or modification is disapproved, the Commissioner shall notify the system in writing and specify the reason for the disapproval.

(b) Prior to entering into any contract with a carrier, a licensed organized delivery system shall file a copy of the contract with the Commissioner for approval. The filing shall be made no later than 60 days prior to the date that the contract is intended to be in effect. The Commissioner shall either approve the contract or state in writing the reasons for disapproval within 60 days of receipt of the filing. Contracts shall be subject to the following standards:

1. The terms shall be fair and reasonable;

2. Charges or fees for service performed shall be reasonable;

3. Expenses incurred and payment received shall be allocated to the system in conformity with customary accounting practices consistently applied;

4. The books, accounts and records of each party to all such transactions shall be so maintained as to clearly and accurately disclose the precise nature and details of the transactions, including such accounting information as is necessary to support the reasonableness of the charges or fees to the respective parties; and

5. The system's net worth following any transaction shall be reasonable in relation to its outstanding liabilities and adequate to its financial needs.

(c) All contracts between a carrier and a licensed organized delivery system shall satisfy the following requirements:

1. The funds being transferred from the carrier to the organized delivery system shall be first utilized to pay for treatment or services, and attendant administrative costs, for which the system has contracted;

2. The carrier shall have the right to periodic inspection of the books and records of the organized delivery system with respect to the use of the funds received from the carrier under the terms of the contract;

3. Payments under the contract shall be made no less frequently than monthly and no payment to the organized delivery system shall be made by the carrier prior to the first day of the month to which the payment relates;

4. The terms under which the carrier may withhold payments shall be specified;

5. The information to be reported to, and the frequency of such reporting, by the ODS to the carrier for the carrier to determine any applicable credit to the carrier's reserves from the transfer of risk to the ODS shall be specified;

6. Contain a provision that the written agreement, including any written amendments thereto, constitutes the entire agreement between the parties; and

7. Any changes shall be null and void unless made by written amendment signed by the parties, and filed with and approved by the Commissioner.

Notes

N.J. Admin. Code § 11:22-4.6