New Jersey Department
For Immediate Release: Oct. 28, 2005
For Further Information: Jaimee Gilmartin - (609) 292-5064
Office of Managed Care Transfers from Health to Insurance Department
TRENTON – New Jersey Banking and Insurance Acting Commissioner Donald Bryan and Health and Senior Services Commissioner Fred M. Jacobs, M.D., J.D., today announced the transfer of operations of the Office of Managed Care (OMC) from the New Jersey Department of Health and Senior Services (DHSS) to the New Jersey Department of Banking and Insurance (DOBI). The transfer complies with an order signed on June 30th by Acting Governor Richard J. Codey. The order went into effect Aug. 29th. The transfer will be completed by Oct. 31st.
Effective oversight of the managed care system is critical to the delivery of health care to millions of New Jersey policyholders. The transfer is intended to centralize and enhance the efficiency of the oversight of the managed care system and, by realizing administrative efficiencies, enhance the quality of care received by those policyholders. For example, carriers will no longer be required to make duplicate filings with two agencies. There will also be no confusion as to where consumers can log complaints against their health maintenance organizations (HMOs).
The Office of Managed Care is responsible for:
The OMC also investigates complaints regarding quality of care, access to services, and network adequacy made by consumers and health care providers about HMOs and other carriers offering managed care plans.
“The OMC is being integrated into the Department's existing organization,” said Acting Commissioner Bryan. “We anticipate that the transfer will prove beneficial for all parties concerned. Because virtually all of the entities that dealt with OMC and its organizational structure within DHSS also dealt with our Department and its organizational structure, no party should experience significant difficulty with the reorganization and integration of the OMC operations.”
“Individuals will now have a one-stop shop at the state level to help them resolve their differences with health insurers,” said Commissioner Jacobs. “The added coordination and streamlined process will make state government more responsive to New Jersey residents who need assistance.”
In general, the operations of OMC are being integrated into DOBI's Life & Health Insurance Division under the Valuation and Actuarial Bureaus, and Consumer Protection Services Division, Managed Care Complaints and Appeals.
Until further notice, documents and issues redirected to the Valuation Bureau within Life & Health may be sent to the attention of Holly Gaenzle at:
Department of Banking and Insurance
20 West State Street , 11th Floor
PO Box 325
Trenton , NJ 08625-0325
Main phone: (609) 292-5427
Fax: (609) 633-0527
Until further notice, documents and issues redirected to Managed Care Complaints and Appeals within Consumer Protection Services may be sent to the attention of Sylvia Allen-Ware at:
Consumer Protection Services
Department of Banking and Insurance
20 West State Street , 9th Floor
PO Box 329
Trenton , NJ 08625-0329
Main phone: (609) 292-7272
Fax: (609) 292-5865
The following documents and related issues should be redirected to the Valuation Bureau:
Applications for a certificate of authority as an HMO, and certification as an organized delivery system.
Contracts required to be filed in accordance with N.J.A.C. 8:38, 8:38A and 8:38B.
Periodic reports, including, for instance, external quality review organization (EQRO) reports.
Hospital termination notices.
Notices of Personnel changes and changes in Registered Agents.
The following documents and related issues should be redirected to Consumer Protection Services:
Provider and consumer complaints.
Requests for review by the Independent Utilization Review Organization (IURO).
Requests for information regarding the HMO Report Card should be directed to the Department's Life & Health Actuarial Bureau at the 7 th floor of the address above. The fax number for Life & Health Actuarial is (609) 777-0508.