On Friday, June 1, 2018, New Jersey Governor Phil Murphy signed the “Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act,” a bill intended to reduce the prevalence of unforeseen out-of-network charges across the State of New Jersey through the creation of several new requirements for healthcare providers (the “Act”). The Act is scheduled to become effective on August 30, 2018. As such, New Jersey health care facilities and professionals should act immediately to put adequate systems in place to ensure compliance with the Act, thereby minimizing the likelihood of any potential losses or penalties.
As discussed in our previous article on the Act, the Act contains provisions that will impact most New Jersey health care providers. Most notably, the Act requires New Jersey health care professionals and facilities to disclose a plethora of additional information to patients related to procedure costs, billing processes and provider network status. For example, health care professionals (e.g., physicians) will now have to disclose to patients in writing or through an internet website the health benefits plans in which such health care professional is a participating provider and the facilities with which the health care professional is affiliated prior to the provision of non-emergency services. The health care professional will also have to provide this information verbally or in writing, at the time of an appointment. Additionally, if the health care professional does not participate in the patient’s health benefits plan, the health care professional is obligated to make additional disclosures to the patient, including, upon request, the amount or estimated amount the health care professional will bill the covered person for the services. Unless the patient “knowingly, voluntarily and specifically selected an out-of-network provider to provide services” following such disclosures, said out-of-network provider is prohibited from charging the patient any out-of-pocket expenses above those which would have been payable had the provider been in-network. Moreover, bills, charges or attempts to collect above the applicable co-payment, deductible or co-insurance amount constitute a violation of the Act.
The Act also addresses how New Jersey health care providers may bill inadvertent out-of-network services or in situations deemed to be an “emergency or urgent basis” under the Emergency Medical Treatment and Active Labor Act (EMTALA). Specifically, if a covered person receives inadvertent out-of-network services, then the health care professional performing those services shall not bill the covered person in excess of any deductible, copayment, or coinsurance amount. Additionally, if a covered person receives medically necessary services at an in-network or out-of-network health care facility on an emergency or urgent basis, then the health care professional performing those services shall not bill the covered person in excess of any deductible, copayment, or coinsurance amount, applicable to in-network services pursuant to the covered person’s health benefits plan.
The Act applies only to state-regulated insurance plans, which account for less than half of the insured population in New Jersey. However, other health plans, such as those used by self-insured employers or unions, may “opt in” and choose to be subject to the Act.
The Act carries with it a number of penalties for non-compliance. These can range from $1,000 per violation per day for health care facilities, up to $25,000 per occurrence, and $100 per violation per day, up to $2,500 for each occurrence, for all other persons or providers. As such, it is important that all New Jersey health care providers act now to ensure they are compliance with the new requirements in advance of the August 30th deadline.
Frier Levitt helps health care providers understand these requirements and assists with the creation and implementation of policies and practices to reduce the risk of losses or penalties due to non-compliance. Contact Frier Levitt today to speak to an attorney.
