N.J. Stat. § 45:9-22.4

Current through L. 2024, c. 80.

Section 45:9-22.4 - Definitions

For the purposes of P.L. 1989, c.19 (C.45:9-22.4 et seq.), P.L. 2009, c. 24(C.45:9-22.5a et seq.), and P.L. 2017, c. 111(C.45:9-22.5c et al.):

"Alternative payment entity" means an entity authorized to receive compensation for the provision of health care on a basis that entails the assumption of financial risk, including but not limited to an organized delivery system licensed pursuant to P.L. 1999, c. 409(C.17:48H-1 et seq.).

"Alternative payment model" means a model of payment operated by Medicare, Medicaid, or a health insurance carrier that:

(1) has been filed with the Department of Health pursuant to section 3 of P.L. 2017, c. 111(C.45:9-22.5c);

(2) provides for payment for covered professional services earned by participating health care practitioners and health care services based on approved quality measures; and

(3)

(a) requires an alternative payment entity to bear financial risk for monetary losses under the alternative payment model;

(b) is a medical home; or

(c) is an accountable care organization authorized by the Medicare Shared Savings Program pursuant to 42 U.S.C. s. 1395jjj or the Center for Medicare and Medicaid Innovation described at 42 U.S.C. s. 1315a.

"Alternative payment model standards" means institutional and specialty-specific goals under an alternative payment model related to patient safety, use of approved quality measures, and any other applicable quality of care goals, and operational performance, which may incorporate specific patient management tasks, care redesign initiatives, and patient safety and quality of care objectives.

"Approved quality measure" means an objective measure of quality that:

(1) is identified and submitted by a nationally recognized specialty board of certification or equivalent certification board, or other similar stakeholder;

(2) has been submitted for publication in applicable specialty-appropriate, peer-reviewed journals, with sufficient information to allow an individual with reasonable knowledge of the health care industry to understand the methods for developing and selecting the measure, including clinical and other data supporting the measure;

(3) has been adopted or endorsed by a consensus organization, including but not limited to the National Quality Forum or Ambulatory Care Quality Alliance, including measures that have been submitted by a physician specialty, and that the United States Department of Health and Human Services identifies as having used a consensus-based process for developing such measures;

(4) is included in an annual list of approved quality measures by the Centers for Medicare & Medicaid Services, or on a similar list developed by the Department of Health; or

(5) is collected and reported using a qualified clinical data registry approved for the purpose of reporting the measure by the Centers for Medicare & Medicaid Services.

"Health care service" means a business entity which provides on an inpatient or outpatient basis: testing for or diagnosis or treatment of human disease or dysfunction; or dispensing of drugs or medical devices for the treatment of human disease or dysfunction. Health care service includes, but is not limited to, a bioanalytical laboratory, pharmacy, home health care agency, rehabilitation facility, nursing home, hospital, or a facility which provides radiological or other diagnostic imagery services, physical therapy, ambulatory surgery, or ophthalmic services.

"Hospital and physician incentive plan" means a compensation arrangement established pursuant to sections 2 through 4 of P.L. 2017, c. 46(C.26:2H-12.80 through C.26:2H-12.82) between a general acute care hospital licensed pursuant to P.L. 1971, c.136 (C.26:2H-1 et seq.) and a physician or physician group.

"Immediate family" means the practitioner's spouse and children, the practitioner's siblings and parents, the practitioner's spouse's siblings and parents, and the spouses of the practitioner's children.

"Participant" means an entity identified by a Tax Identification Number through which one or more practitioners may bill a health insurance carrier or other payor that is operating an Alternative Payment Model, which alone or together with one or more participants compose an alternative payment model.

"Practitioner" means a physician, chiropractor or podiatrist licensed pursuant to Title 45 of the Revised Statutes.

"Significant beneficial interest" means any financial interest; but does not include ownership of a building wherein the space is leased to a person at the prevailing rate under a straight lease agreement, payments made by a hospital to a physician pursuant to a hospital and physician incentive plan, or any interest held in publicly traded securities.

N.J.S. § 45:9-22.4

Amended by L. 2017, c. 111,s. 1, eff. 2/1/2018.

Amended by L. 2017, c. 46,s. 1, eff. 5/1/2017.

L.1989, c.19, s.1; amended 1991, c.187, s.83.