Bill Text: NJ A930 | 2012-2013 | Regular Session | Introduced
Bill Title: Requires health care professionals to notify patients of end of health benefits coverage during course of treatment in certain circumstances.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2012-01-10 - Introduced, Referred to Assembly Health and Senior Services Committee [A930 Detail]
Download: New_Jersey-2012-A930-Introduced.html
STATE OF NEW JERSEY
215th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2012 SESSION
Sponsored by:
Assemblywoman CELESTE M. RILEY
District 3 (Cumberland, Gloucester and Salem)
SYNOPSIS
Requires health care professionals to notify patients of end of health benefits coverage during course of treatment in certain circumstances.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel
An Act concerning notification by health care professionals of status of health benefits coverage and supplementing chapter 1 of Title 45 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A health care professional licensed pursuant to Title 45 of the Revised Statutes who provides to a patient an ongoing course of treatment for which coverage is provided on an in-network basis under a managed care plan, shall notify the patient in writing whenever the health care professional has actual knowledge that the patient no longer qualifies for coverage for that course of treatment under the plan. For the purposes of this act, "managed care plan" means a health benefits plan that integrates the financing and delivery of appropriate health care services to covered persons by arrangements with participating providers, who are selected to participate on the basis of explicit standards, to furnish a set of health care services and financial incentives for covered persons to use the participating providers and procedures provided for in the plan.
b. If the health care professional fails to satisfy the requirements of subsection a. of this act, the health care professional shall offer to the patient to continue the treatment under the same in-network rate as provided under the managed care plan, subject only to the applicable copayments or deductibles as provided for under the plan.
c. A health care professional
who violates this act may be subject to a civil penalty of $250 for each
violation. The penalty shall be sued for and collected by the Division of
Consumer Affairs in the
Department of Law and Public Safety pursuant to the "Penalty Enforcement Law of
1999," P.L.1999, c.274 (C.2A:58-10 et seq.).
2. This act shall take effect on the 90th day following enactment.
STATEMENT
This bill requires a health care professional licensed pursuant to Title 45 of the Revised Statutes, who provides to a patient an ongoing course of treatment for which coverage is provided on an in-network basis under a managed care plan, to notify the patient in writing whenever the health care professional has actual knowledge that the patient no longer qualifies for coverage for that course of treatment under the plan. For the purposes of this act, "managed care plan" means a health benefits plan that integrates the financing and delivery of appropriate health care services to covered persons by arrangements with participating providers, who are selected to participate on the basis of explicit standards, to furnish a set of health care services and financial incentives for covered persons to use the participating providers and procedures provided for in the plan.
The bill also provides that if the health care professional fails to satisfy the requirement to notify the patient that the treatment no longer qualifies for coverage, the health care professional shall offer to the patient to continue the treatment under the same in-network rate as provided under the managed care plan, subject only to the applicable copayments or deductibles as provided for under the plan.
Finally, the bill provides that a health care professional who violates the bill's provisions may be subject to a civil penalty of $250 for each violation. The penalty shall be sued for and collected by the Division of Consumer Affairs in the Department of Law and Public Safety pursuant to the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.).
