Bill Text: NJ S2099 | 2014-2015 | Regular Session | Introduced
Bill Title: Freezes managed care reimbursement rates for out-of-network health care providers until January 1, 2016.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2014-05-19 - Introduced in the Senate, Referred to Senate Commerce Committee [S2099 Detail]
Download: New_Jersey-2014-S2099-Introduced.html
Sponsored by:
Senator ROBERT W. SINGER
District 30 (Monmouth and Ocean)
Senator JOSEPH F. VITALE
District 19 (Middlesex)
SYNOPSIS
Freezes managed care reimbursement rates for out-of-network health care providers until January 1, 2016.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning reimbursement for out-of-network health care providers and supplementing P.L.1997, c.192 (C.26:2S-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. Notwithstanding any law, rule or regulation to the contrary, with respect to a carrier which offers a managed care plan that provides for both in-network and out-of-network benefits, for any covered, medically necessary health care services provided to a covered person on or before December 31, 2014, a carrier shall reimburse out-of-network health care providers using the same reimbursement structure that was used, and at the same rates that were provided to health care providers, on January 1, 2013.
b. A violation of this section shall be considered a violation of the "Health Care Quality Act," P.L.1997, c.192 (C.26:2S-1 et seq.) and a carrier that violates this section shall be subject to penalties as provided in section 16 of P.L.1997, c.192 (C.26:2S-16).
2. This act shall take effect immediately and be retroactive to January 1, 2014, and shall expire on January 1, 2016.
STATEMENT
This bill requires health insurance carriers that offer a managed care plan that provides for both in-network and out-of-network benefits to reimburse out-of-network health care providers using the same reimbursement structure that was used, and at the same rates that were provided to those health care providers, on January 1, 2013.
Certain health insurance carriers have recently decided to modify the reimbursement structure for out-of-network providers due to changes to the Prevailing Charges System. Instead of using that system to calculate out-of-network reimbursement rates, certain carriers have decided to use other databases, such as those of the Centers for Medicare and Medicaid Services or FAIR Health, effective January 1, 2014.
With the significant recent changes to the health care system due to the federal Patient Protection and Affordable Care Act, the sponsor intends to freeze out-of-network reimbursement rates until January 1, 2016 to allow time for health insurance carriers and providers to better understand the changes and shifts in the health care system and how changing the reimbursement structure will affect consumers.
