Bill Text: NJ A2992 | 2010-2011 | Regular Session | Introduced
Bill Title: Requires notice to covered person under certain managed care plans of direction or referral to out-of-network provider.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2010-06-24 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A2992 Detail]
Download: New_Jersey-2010-A2992-Introduced.html
Sponsored by:
Assemblyman REED GUSCIORA
District 15 (Mercer)
SYNOPSIS
Requires notice to covered person under certain managed care plans of direction or referral to out-of-network provider.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning certain notifications under certain managed care plans 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. A health care provider participating in a carrier's network of providers under a managed care plan shall, at the time of directing or referring a covered person to another health care provider that is out-of-network for that plan, present to that covered person a written notice concerning the provider's direction or referral to the out-of-network provider.
b. The written notice provided by the directing or referring health care provider for the out-of-network direction or referral shall be in the following form, unless the Commissioner of Banking and Insurance, pursuant to subsection c. of this section, adopts a form containing substantially similar information by regulation:
OUT-OF-NETWORK NOTICE FORM
I, ________________________, am directing/referring you to
(directing/referring provider's name)
another health care provider, ____________________, who/that
(other provider's name)
is out-of-network from your health carrier's contracted network of providers. If you receive treatment or services from this out-of-network health care provider, you may incur additional, out-of-pocket costs that are not covered by the health carrier. You should promptly contact your health carrier or other benefits administrator to obtain information related to this direction/referral and any potential additional, out-of-pocket costs.
c. (1) The Commissioner of Banking and Insurance may, in consultation with the Commissioner of Health and Senior Services, adopt through regulation a written out-of-network notice form to be used by a directing or referring health care provider for any out-of-network notice required by subsection a. of this section. This form, if adopted, shall contain information that is substantially similar to the information presented in the form set forth in subsection b. of this section, and may contain additional information deemed necessary by the Commissioner of Banking and Insurance concerning an out-of-network direction or referral and the financial responsibilities of a covered person concerning this direction or referral.
(2) If the Commissioner of Banking and Insurance adopts an out-of-network notice form pursuant to this subsection, it shall be used by a directing or referring health care provider in place of the form set forth in subsection b. of this section.
d. (1) A directing or referring health care provider shall provide the out-of-network notice form pursuant to this section as a separate notice and in addition to any other provider notice to a covered person required under the law, including, but not limited to, a written disclosure form as set forth under P.L.1989, c.19 (C.45:9-22.4 et seq.).
(2) A directing or referring health care provider shall not be in violation of this section, and shall not be held liable in any manner, as a result of directing or referring a covered person without providing the notice as required by this section, if the directing or referring provider did not know or could not reasonably have known, at the time of making the direction or referral, that the direction or referral is to an out-of-network provider.
2. This act shall take effect on the first day of the fourth month next following enactment.
STATEMENT
This bill requires health care providers under managed care plans to give written notice to covered persons whenever that provider directs or refers the covered person to another health care provider that is out-of-network for that plan.
The written notice by the health care provider to the covered person for the out-of-network direction or referral shall be the exact form as set forth in the bill, unless replaced by a substantially similar form adopted through regulation by the Commissioner of Banking and Insurance in consultation with the Commissioner of Health and Senior Services. In either case, the form shall include information about the directing or referring provider and the out-of-network provider, and at least an indication about the potentially higher out-of-pocket costs for the covered person due to the receipt of treatment or services from the out-of-network provider.
The bill states that a directing or referring health care provider shall provide the out-of-network notice form as a separate notice and in addition to any other provider notice to a covered person required under the law. Such other notice includes, but is not limited to, the written disclosure form as set forth under P.L.1989, c.19 (C.45:9-22.4 et seq.) concerning, among other issues, so called "self-referrals" by providers for the performance of treatment or services at a different facility in which the providers may hold a financial interest.
A directing or referring health care provider shall not be in violation of the bill, and shall not be held liable in any manner, as a result of directing or referring a covered person without providing the notice as required by the bill, if the directing or referring provider did not know or could not reasonably have known, at the time of making the direction or referral, that the direction or referral is to an out-of-network provider.
