Bill Text: NJ A4913 | 2022-2023 | Regular Session | Amended
Bill Title: Requires carriers to offer health care providers more than one method of payment for reimbursement.
Sponsorship: Partisan Bill (Democrat 8)
Status: (Passed) 2024-01-08 - Approved P.L.2023, c.247. [A4913 Detail]
Download: New_Jersey-2022-A4913-Amended.html
[Second Reprint]
ASSEMBLY, No. 4913
STATE OF NEW JERSEY
220th LEGISLATURE
INTRODUCED DECEMBER 5, 2022
Sponsored by:
Assemblyman HERB CONAWAY, JR.
District 7 (Burlington)
Assemblyman STERLEY S. STANLEY
District 18 (Middlesex)
Co-Sponsored by:
Assemblyman Moen
SYNOPSIS
Requires carriers to offer health care providers more than one method of payment for reimbursement.
CURRENT VERSION OF TEXT
As amended by the General Assembly on May 25, 2023.
An Act concerning reimbursement for health care providers and covered persons and supplementing P.L.1999, c.155 (C.17B:30-26 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
2[1. a. 1[A payer shall remit payment for a claim to a health care provider solely through either a check or an electronic funds transfer in compliance with the federal "Health Insurance Portability and Accountability Act of 1996," Pub.L.104-191. No payer shall remit payment for a claim to a health care provider using a method not authorized pursuant to this subsection] Any payer offering a health benefits plan or dental plan issued, amended, or renewed on or after the effective date of this act between a payer, or its contracted vendor, and a health care provider for the provision of health or dental care services to a covered person shall offer all reasonably available methods of payment from the payer or its contracted vendor to the health care provider, which shall include, but not be limited to, payment by check and electronic funds transfer. A health benefits plan or dental plan shall not contain a restriction mandating payment by credit card1.
b. 1[No payer or carrier shall reimburse a covered person using a virtual credit card] A payer shall offer all reasonably available methods of payment from the payer or its contracted vendor to an out-of-network provider, which shall include, but not be limited to, payment by check or electronic funds transfer. A payer or its contracted vendor shall not restrict the method of payment to an out-of-network provider providing out-of-network covered services to a virtual credit card payment.
c. At least twice per contract period or per every 12 month period, whichever is shorter, and when initiating or changing payment methods to a health care provider, a payer, or its contracted vendor, shall:
(1) notify the health care provider of the fees associated with all available payment methods; and
(2) provide the health care provider with clear instructions as to how to select each payment method.
The notifications and instructions required pursuant to this subsection shall be provided to a health care provider by means other than the contract offered to the health care provider.
d. A payer shall be prohibited from using a health care provider's preferred method of payment as a factor when making a decision on whether to provide credentials to a provider.
e. The provisions of this act shall not be waived by contract, and any contractual clause in conflict with the provisions of this act or that purport to waive any requirements of this act after the effective date of this act are void.
f. Any violation of this act shall be subject to enforcement by the Department of Banking and Insurance. A payer, or contracted vendor of the payer, that violates the provisions of this act shall be subject to a civil penalty of not less than $500 per day and shall reimburse a health care provider for attorney's fees, merchant terminal fees, and credit card processing fees incurred to compel compliance with this act. A civil penalty imposed pursuant to this subsection shall be collected by the department pursuant to the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.)1.
1[c.] g.1 As used in this section1[, "virtual credit card"] :
"Credit card"1 means a single-use 1or virtual1 credit card 1[exclusively]1 provided in an electronic 1[or] ,1 digital1, facsimile, physical, or paper1 format1.
"Health care provider" means an individual licensed or otherwise authorized pursuant to Title 45 or Title 52 of the Revised Statutes to practice a health care profession that is regulated by the Division of Consumer Affairs; a health care facility licensed pursuant to P.L.1971, c.136, (C.26:2H-1 et seq.) which shall include, but not be limited to, hospitals, ambulatory care facilities and long term care facilities; a health maintenance organization authorized to operate pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.); a payer or health insurer that offers a managed care plan regulated pursuant to P.L.1997, c.192 (C.26:2S-1 et seq.); a State or county psychiatric hospital; a State developmental center; a staffing registry; and a home care services agency as defined pursuant to section 1 of P.L.1947, c.262 (C.45:11-23).
"Payer" means an insurance company; health service corporation; hospital service corporation; medical service corporation; dental service corporation; dental plan organization; or health maintenance organization authorized to issue medical or dental contracts, policies, or plans in this State, and shall also include contracted vendors of any such entities1.]2
21. a. Any network agreement entered into, amended, or renewed on or after the effective date of this act between a carrier, or the carrier's contracted vendor, and a health care provider for the provision of health or dental care services to a covered person shall not mandate only one form of payment to the health care provider including, but not limited to, payment by credit card, electronic funds transfer, or check.
b. A carrier, or the carrier's contracted vendor, shall not restrict the method of payment to an out-of-network health care provider providing out-of-network covered services to only one form of payment including, but not limited to, payment by credit card, electronic funds transfer, or check.
c. If one of the available payment methods has a fee associated with it, a carrier, or the carrier's contracted vendor, shall, prior to initiating its first payment to an in-network, or out-of-network health care provider, or upon changing the payment methods available to a health care provider:
(1) notify the health care provider that there may be fees associated with a particular payment method, and that the carrier, or the carrier's contracted vendor, shall disclose any fees beyond what the health care provider would normally pay to process a payment using that particular payment method; and
(2) provide the health care provider with clear instructions on the carrier's, or the carrier's contracted vendor's, website, or through means other than the contract offered to the health care provider, as to how to select each payment method.
d. If a health care provider requests a change in the available payment method, a carrier, or the carrier's contracted vendor, shall implement the change to the payment method selected by the health care provider within 30 business days, subject to federal and State verification measures to prevent fraud and abuse.
e. A carrier shall be prohibited from using a health care provider's preferred method of payment as a factor when deciding whether to provide credentials to a health care provider.
f. The provisions of this act shall not be waived by contract, and any contractual clause in conflict with the provisions of this act or that purport to waive any requirements of this act after the effective date of this act are void.
g. Any violation of this act may be subject to enforcement by the Department of Banking and Insurance. The department shall provide the carrier notice and an opportunity to be heard, and upon a finding of a violation of the act, shall impose a civil penalty pursuant to the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.), and shall order the carrier to reimburse a health care provider for any documented fees or charges reasonably incurred as a result of violation.
h. As used in this section:
"Carrier" means an insurance company; health service corporation; hospital service corporation; medical service corporation or health maintenance organization authorized to issue health benefit plans in this State, and a dental service corporation or dental plan organization authorized to issue dental plans in this State.
"Credit card" means a single-use or virtual credit card provided in an electronic, digital, facsimile, physical, or paper format.
"Health care provider" means an individual or entity which, acting within the scope of its licensure or certification, provides a covered service defined by the health benefits or dental plan. Health care provider includes, but is not limited to, a physician, dentist, or other health care professional licensed pursuant to Title 45 of the Revised Statutes, and a hospital or other health care facility licensed pursuant to Title 26 of the Revised Statutes.2
2. This act shall take effect on the 1[90th] 180th1 day after the date of enactment and shall apply to 2[claims submitted] contracts issued, amended, or renewed2 on or after that date.
