New Jersey Administrative Code
Title 13 - LAW AND PUBLIC SAFETY
Chapter 42 - BOARD OF PSYCHOLOGICAL EXAMINERS
Subchapter 7 - ACCEPTABLE PROFESSIONAL PRACTICE
Section 13:42-7.6 - Managed health care plans
Current through Register Vol. 56, No. 6, March 18, 2024
(a) For purposes of this section, "managed health care plans" include, but are not limited to, plans involving wholly or partially pre-paid medical/psychological services. By way of example, these include plans commonly described as health maintenance organizations, preferred provider organizations, competitive medical/psychological plans, individual practice associations, or other similar designations.
(b) A licensee may enter into a plan agreement which provides interim remuneration to licensees by making provisional allocation of percentages of plan-member fees, whether denominated as reserves, pools, withholds, holdbacks, etc., for the purpose of funding all portions of the health services plan.
(c) A licensee may participate in a plan which requires a purchase of shares for the purpose of providing start-up funds, provided that any profits of the plan are paid solely in accordance with the principles listed in this section and the licensee complies with the following professional requirements:
(d) A licensee who is not a full or regular member of a managed health care plan may contract with a plan to render services to an insured person referred by the plan, provided that the licensee retains the authorities listed in (c)1 through 4 above.
(e) The licensee shall submit the bill for services rendered in one of the following ways: