Bill Text: NJ A2067 | 2010-2011 | Regular Session | Introduced
Bill Title: Concerns patient billing by emergency medical services providers.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2010-02-08 - Introduced, Referred to Assembly Health and Senior Services Committee [A2067 Detail]
Download: New_Jersey-2010-A2067-Introduced.html
Sponsored by:
Assemblyman JOSEPH CRYAN
District 20 (Union)
Assemblywoman ANNETTE QUIJANO
District 20 (Union)
SYNOPSIS
Concerns patient billing by emergency medical services providers.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning billing for emergency medical services, amending P.L.1984, c.146, and supplementing Title 26 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.1984, c.146 (C.26:2K-7) is amended to read as follows:
1. As used in this act:
[a.] "Advanced life support" means an advanced level of pre-hospital, inter-hospital, and emergency service care which includes basic life support functions, cardiac monitoring, cardiac defibrillation, telemetered electrocardiography, administration of anti-arrhythmic agents, intravenous therapy, administration of specific medications, drugs and solutions, use of adjunctive ventilation devices, trauma care and other techniques and procedures authorized in writing by the commissioner;
"Basic life support" means a basic level of pre-hospital care which includes patient stabilization, airway clearance, cardiopulmonary resuscitation, hemorrhage control, initial wound care, fracture stabilization, and other techniques and procedures as defined in the EMT-Basic: National Standard Curriculum of the National Highway Traffic Safety Administration of the federal Department of Transportation.
"Basic life support provider" means an entity that is authorized to provide basic life support services in accordance with State statutes and regulations, including: a first aid, rescue, or ambulance squad; a hospital service cooperative; or any other entity approved by the commissioner for this purpose.
[b.] "Board of Medical Examiners" means the State Board of Medical Examiners;
[c.] "Board of Nursing" means the New Jersey Board of Nursing;
[d.] "Commissioner" means the Commissioner of [the State Department of] Health and Senior Services;
[e.] "Department" means the [State] Department of Health and Senior Services;
[f.] "Emergency service" means a program in a hospital staffed 24 hours a day by a licensed physician trained in emergency medicine;
[g.] "Hospital service
cooperative" means a cooperative organization of hospitals that: is a
nonprofit corporation exempt from federal taxation under section 501(e) of the
federal Internal
Revenue Code, 26 U.S.C. s.501(e); or provides certain services to its member
hospitals as a tax-exempt entity under section 501(c)(3) of the federal
Internal Revenue Code, 26 U.S.C. s.501(c)(3).
"Inter-hospital care" means those emergency medical services rendered by mobile intensive care units to emergency patients before and during transportation between emergency treatment facilities, and upon arrival within those facilities;
[h.] "Mobile intensive care paramedic" means a person trained in advanced life support services and certified by the commissioner to render advanced life support services as part of a mobile intensive care unit;
[i.] "Mobile intensive care unit" means a specialized emergency medical service vehicle staffed by mobile intensive care paramedics or registered professional nurses trained in advanced life support nursing and operated for the provision of advanced life support services under the direction of an authorized hospital;
[j.] "Pre-hospital care" means those emergency medical services rendered by mobile intensive care units to emergency patients before and during transportation to emergency treatment facilities, and upon arrival within those facilities.
(cf: P.L.1984, c.146, s.1)
2. Section 6 of P.L.1984, c.146 (C.26:2K-12) is amended to read as follows:
6. a. Only a hospital or a hospital service cooperative, which in either case is authorized by the commissioner, with an accredited emergency service may develop and maintain a mobile intensive care unit, and provide advanced life support services utilizing licensed physicians, registered professional nurses trained in advanced life support nursing, and mobile intensive care paramedics.
b. A hospital or a hospital service cooperative, which in either case is authorized by the commissioner pursuant to subsection a. of this section, shall provide mobile intensive care unit services on a seven-day-a-week basis.
c. The commissioner shall establish, in writing, criteria which a hospital or a hospital service cooperative shall meet in order to qualify for the authorization.
d. The commissioner may withdraw his authorization if the hospital, hospital service cooperative, or unit violates any provision of this act or rules or regulations promulgated pursuant thereto.
e. A mobile intensive care unit that is operated by a hospital or hospital service cooperative to provide advanced life support services, as a condition of authorization by the commissioner pursuant to this section and as prescribed by regulation of the commissioner, shall operate under an agreement with each basic life support provider that bills for its services and with which the mobile intensive care unit interfaces in the course of responding to a patient in need of advanced life support services, which agreement shall provide that if the patient is covered by the federal Medicare program established pursuant to Title XVIII of the "Social Security Act," Pub.L.89-97 (42U.S.C. s.1395 et seq.), the hospital or hospital service cooperative, as applicable, shall:
(1) submit a combined bill to the Medicare program that includes the charges for the services that the mobile intensive care unit provided to the patient and the charges of the basic life support provider for the services that it provided to the patient; and
(2) reimburse the basic life support provider for its share of the combined bill within the limits of the payment received by the hospital from the Medicare program.
f. A basic life support provider that responds to a patient in need of advanced life support services, shall operate in accordance with the provisions of subsection e. of this section and, for the purpose of effectuating those provisions, shall, as prescribed by regulation of the commissioner:
(1) bundle all of its charges for basic life support services and supplies into the basic rate that it charges for the provision of basic life support services; and
(2) agree not to charge the patient for any amount in excess of that for which the provider is reimbursed pursuant to subsection e. of this section.
(cf: P.L.1985, c.351, s.2)
3. (New section) In order to effectuate the purposes of subsection e. of section 6 of P.L.1984, c.146 (C.26:2K-12), each municipality in the State shall require that each basic life support provider with which the municipality arranges for the provision of basic life support services and which bills for its services, operate under a contractual agreement with the municipality that is designed to ensure the provider's compliance with the provisions of subsection f. of section 6 of P.L.1984, c.146.
4. The Commissioner of Health and Senior Services, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations to effectuate the purposes of this act.
5. This act shall take effect on the 180th day after enactment, but the Commissioner of Health and Senior Services may take such anticipatory administrative action in advance as shall be necessary for the implementation of this act.
STATEMENT
This bill requires that emergency medical services providers providing advanced life support (ALS) and basic life support (BLS), respectively, which interface with each other in the provision of services to Medicare patients, operate under joint billing agreements for those services.
The bill provides specifically as follows:
· A mobile intensive care unit (MICU) providing ALS services, as a condition of authorization by the Commissioner of Health and Senior Services pursuant to section 6 of P.L.1984, c.146 (C.26:2K-12) and as prescribed by regulation of the commissioner, is required to operate under an agreement with each BLS provider (i.e., an ambulance, first aid, or rescue squad) that bills for its services and with which the MICU interfaces in the course of responding to a patient in need of ALS services, which agreement is to provide that if the patient is covered by the federal Medicare program, the hospital must:
-- submit a combined bill to the Medicare program that includes the charges for the services that the MICU provided to the patient and the charges of the BLS provider for the services that it provided to the patient; and
-- reimburse the BLS provider for its share of the combined bill within the limits of the payment received by the hospital from the Medicare program.
· A BLS provider that responds to a patient in need of ALS services is to operate in accordance with the provisions of this bill and, for the purpose of effectuating those provisions, will, as prescribed by regulation of the commissioner:
-- bundle all of its charges for services and supplies into the basic rate that it charges for the provision of BLS services; and
-- agree not to charge the patient for any amount in excess of that for which the provider is reimbursed pursuant to this bill.
· In order to effectuate the purposes of the bill, each municipality in the State shall require that each BLS provider with which the municipality arranges for the provision of BLS services and which bills for its services, operate under a contractual agreement with the municipality that is designed to ensure the provider's compliance with the provisions of this bill.
· The bill also applies its provisions to a hospital service cooperative that is providing ALS or BLS services. A "hospital service cooperative" is defined as "a cooperative organization of hospitals that: is a nonprofit corporation exempt from federal taxation under section 501(e) of the federal Internal Revenue Code, 26U.S.C. s.501(e); or provides certain services to its member hospitals as a tax-exempt entity under section 501(c)(3) of the federal Internal Revenue Code, 26U.S.C. s.501(c)(3)."
· The bill takes effect on the 180th day after enactment, but authorizes the commissioner to take anticipatory administrative action in advance as necessary for its implementation.
