N.J. Admin. Code § 11:3-4.6

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

Section 11:3-4.6 - Medical protocols

(a) Pursuant to 39:6A-3.1 and 39:6A-4, the Commissioner designates the care paths, set forth in the subchapter Appendix incorporated herein by reference, as the standard course of medically necessary treatment, including diagnostic tests, for the identified injuries.

(b) Where the care path indicates a decision point either by a hexagon in the care path itself or by reference in the text to a second opinion, referral for a second independent consultative medical opinion, development of a treatment plan or mandatory case management, the policy shall provide for a decision point review in accordance with 11:3-4.7.

(c) Treatments that vary from the care paths shall be reimbursable only when warranted by reason of medical necessity.

(d) The care paths do not apply to treatment administered during emergency care.

LAW REVIEW AND JOURNAL COMMENTARIES:

What's Next for No Fault? Gerald H. Baker, 159 N.J.L.J. 267 (2000).

N.J. Admin. Code § 11:3-4.6