8 I Spring 2018 www.anjc.info Legislative Update TECHNIQUE Council S C H O L ARSHIP WI N N E R S Legislation that has been slowly going through the legislature over the past eight years has finally passed both houses and now is on Governor Murphy’s desk for his signature. The legislation had the backing of Assembly Speaker Coughlin, who is also the sponsor of the legislation, and of the governor. The “Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act,” passed the state Assembly and Senate by votes of 48-21 and 21-13. During his March budget address, Governor Murphy addressed the out-of-network issue, stating that the legislation could save the state tens of millions of dollars and improve care for all New Jersey residents. The governor has suggested in budget documents that changes to the laws governing bills for unplanned medical care by physicians outside a patient’s health insurance network could help the state trim nearly $119 million from the cost of insuring state workers next year, which is a savings that he is planning to incorporate in the budget for fiscal year 2019. Republicans, who did not vote for the legislation, support ending the problem with surprise billing, but they would not support this particular legislation because they felt it would make New Jersey less appealing for physicians to practice. The legislation would require health- care facilities, prior to non-emergency and elective procedures to: •  Disclose to patients whether the healthcare facility is in-network or out-of-network; •  Advise patients if a facility is in-net- work and if the patient will incur any out-of-pocket costs; •  Inform patients that, if the facility is out-of-network, the patient will have a financial responsibility applicable to healthcare services provided at an out-of-network facility; •  Healthcare facilities would be required to make available to the public a list of the facility’s standard charges for items and services it provides; •  Healthcare professionals, verbally or through a website, have to disclose to covered patients the health benefits plans in which they are participating providers as well as the facilities with which they are affiliated, prior to non-emergency services at the time of an appoint- ment. If the healthcare professional is out-of-network, the bill also requires health care professionals to: 1.  Inform patients that they are out-of-network and that the estimated amount to be billed for services is available upon request; 2.  Disclose to patients, in writing if requested, the amount the health- care professional will bill absent of unforeseen medical circumstances that may arise when the medical service is provided; and 3.  Advise patients that they will have a financial responsibility applicable to healthcare services provided by an out-of-network professional in excess of their copayment, deductible, or coinsurance, and that they may be responsible for any costs in excess of those allowed by their health benefits plan. The legislation places the responsibility on healthcare professionals to provide to patients, as practicable, contact information of any health care providers scheduled to perform anesthesiology, lab, pathology, radiology or assistant surgeon services in connection with the care to be provided, and to recommend that the patient contact their carrier to learn more about any costs associated with these services. Should a primary care physician or internist perform an unscheduled procedure in his or her office, it would be permissible to provide the required notice verbally at the time of the service. Health insurance carriers would be required to update their websites within 20 days of the addition or termination of a provider from the carrier’s network or a change in a physician’s affiliation with a facility. With respect to out-of-network services, the legislation requires healthcare carriers to provide covered persons in each health benefits plan offered with: By Jon Bombardieri ANJC Government Affairs Counsel OUT-OF-NETWORK LEGISLATION