Bill Text: NJ S2536 | 2014-2015 | Regular Session | Introduced
Bill Title: Requires health care provider participating in carrier network to give notice to covered person of provider's referral to out-of-network provider.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2014-10-27 - Introduced in the Senate, Referred to Senate Commerce Committee [S2536 Detail]
Download: New_Jersey-2014-S2536-Introduced.html
Sponsored by:
Senator JOSEPH F. VITALE
District 19 (Middlesex)
Senator JIM WHELAN
District 2 (Atlantic)
SYNOPSIS
Requires health care provider participating in carrier network to give notice to covered person of provider's referral to out-of-network provider.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning certain notifications under managed care plans providing out-of-network benefits, and supplementing P.L.1997, c.192 (C.26:2S-1 et al.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. Any health care provider participating in a carrier's network of providers under a managed care plan that provides for both in-network and out-of-network benefits, other than a point-of-service plan as set forth in section 10 of P.L.1997, c.192 (C.26:2S-10), shall, at the time of offering a covered person a referral to another health care provider in accordance with the terms of the managed care plan, present to that covered person a written notice concerning the referral, whenever that referral is to any out-of-network provider.
b. The written notice provided by the health care provider for the out-of-network referral shall include:
(1) a disclosure, prepared by the health care provider, that is consistent with the provisions of section 4 of P.L.1997, c.192 (C.26:2S-4), explaining the financial responsibility of the covered person concerning any applicable deductibles, copayments, and coinsurance for the receipt of out-of-network health care services, and include a comparison with the covered person's financial responsibility for receipt of services in-network; and
(2) a list, prepared by the health care provider, of in-network heath care providers, if any, that are available to the covered person within a reasonable geographic area that provide the same health care service or range of services as the out-of-network provider to which the provider is referring the covered person.
2. This act shall take effect on the first day of the fourth month next following enactment.
STATEMENT
This bill requires a health care provider, under a managed care plan that provides for both in-network and out-of-network benefits, to give written notice to a covered person whenever that provider refers the covered person to any out-of-network provider. Under the bill, which supplements the "Health Care Quality Act," P.L.1997, c.192 (C.26:2S-1 et al.), a "health care provider" includes, but is not limited to, any physician or other health care professional licensed pursuant to Title 45 of the Revised Statutes, or any hospital or other health care facility licensed pursuant to Title 26 of the Revised Statutes.
The written notice by the health care provider to the covered person for the out-of-network referral shall include: (1) a disclosure explaining the financial responsibility of the covered person concerning any applicable deductibles, copayments, and coinsurance for the receipt of out-of-network health care services, and include a comparison with the covered person's financial responsibility for receipt of services in-network; and (2) a list of in-network health care providers, if any, that are available to the covered person within a reasonable geographic area that provide the same health care service or range of services as the out-of-network provider to which the provider is referring the covered person.
This written notice requirement as to out-of-network providers shall not apply to health care providers when providing services to covered persons under a point-of-service plan, as set forth under section 10 of P.L.1997, c.192 (C.26:2S-10), as a point-of-service plan does not require any form of referral or prior authorization in order for a covered person to access an out-of-network provider.
