Bill Text: NJ S362 | 2010-2011 | Regular Session | Introduced
Bill Title: Requires managed care plans to pay health care claims based on assignment of benefits.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2010-02-08 - Withdrawn from Consideration [S362 Detail]
Download: New_Jersey-2010-S362-Introduced.html
STATE OF NEW JERSEY
214th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2010 SESSION
Sponsored by:
Senator LORETTA WEINBERG
District 37 (Bergen)
SYNOPSIS
Requires managed care plans to pay health care claims based on assignment of benefits.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel
An Act concerning assignment of health benefits under managed care plans and amending P.L.2001, c.367.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 2 of P.L.2001, c.367 (C.26:2S-6.1) is amended to read as follows:
2. a. With respect to a carrier which offers a managed care plan that provides for both in-network and out-of-network benefits, in the event that:
(1) a covered person is admitted by an out-of-network health care provider to an in-network health care facility for covered, medically necessary health care services[,]; or
(2) the covered person receives covered, medically necessary health care services from an out-of-network health care provider while the covered person is a patient at an in-network health care facility and was admitted to the health care facility by an in-network provider, the carrier shall reimburse the health care facility for the services provided by the facility at the carrier's full contracted rate without any penalty for the patient's selection of an out-of-network provider, in accordance with the in-network policies and in-network copayment, coinsurance or deductible requirements of the managed care plan.
b. The provisions of subsection a. of this section shall apply only if the covered person complies with the preauthorization or review requirements of the health benefits plan regarding the determination of medical necessity to access in-network inpatient benefits, as set forth in writing pursuant to section 5 of P.L.1997, c.192 (C.26:2S-5).
c. With respect to a carrier which offers a managed care plan that provides for both in-network and out-of-network benefits, in the event that the covered person assigns, through an assignment of benefits, his right to receive reimbursement for medically necessary health care services to an out-of-network health care provider, the carrier shall remit payment for the reimbursement directly to the health care provider in accordance with the provisions of this section and P.L.1999, c.154 (C.17B:30-23 et al.). Any payment made to the covered person rather than the health care provider under these circumstances shall be considered unpaid, and unless remitted to the health care provider within the time frames established by P.L.1999, c.154 (C.17B:30-23 et al.), shall be considered overdue and subject to an interest charge as provided in that act.
(cf: P.L.2001, c.367, s.2)
2. This act shall take effect on the 90th day next following enactment and shall apply to any health benefits plan in which the carrier has reserved the right to change the premium which is delivered, issued, executed or renewed on or after the effective date.
STATEMENT
This bill provides that a carrier which issues a managed care plan with an out-of-network benefit shall remit payment for reimbursement of a health care service directly to an out-of-network provider if that provider has been issued an assignment of benefits by the covered person. Payment shall be remitted pursuant to the provisions of the "Health Care Quality Act," P.L.1997, c.192 (C.26:25-1 et seq.) and P.L.1999, c.154 (C.17B:30-23 et al.), commonly referred to as the "prompt pay law." Any payment remitted to a covered person rather than the out-of-network provider under these circumstances shall be considered unpaid under the prompt pay law and, unless remitted to the health care provider within the time frames established under the prompt pay law, shall be considered overdue and subject to an interest charge as provided in that law.
