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A1712
ASSEMBLY, No. 1712
STATE OF NEW JERSEY
222nd LEGISLATURE
�
PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION
Sponsored by:
Assemblywoman VERLINA REYNOLDS-JACKSON
District 15 (Hunterdon and Mercer)
Assemblyman WAYNE P. DEANGELO
District 14 (Mercer and Middlesex)
Assemblyman ANTHONY S. VERRELLI
District 15 (Hunterdon and Mercer)
Co-Sponsored by:
Assemblyman Sampson, Assemblywomen Speight, Donlon,
Peterpaul, Assemblyman Tully and Assemblywoman Park
SYNOPSIS
���� Establishes certain medical billing requirements
concerning specific nature of charges or expenses for health care services.
CURRENT VERSION OF TEXT
���� Introduced Pending Technical Review by Legislative
Counsel.
��
An Act
concerning medical billing requirements and supplementing Title 45 of the
Revised Statutes.
����
Be It
Enacted
by the Senate and General Assembly of the
State of New Jersey:
����� 1.�� a.�
As used in this section:
�����
��Adjudication�
means the process by which a carrier reviews a health care claim and provides
an explanation of benefits reimbursement to a provider.
����� "Carrier"
means an entity that contracts or offers to contract to provide, deliver,
arrange for, pay for, or reimburse any of the costs of health care services
under a health benefits plan, including: an insurance company authorized to
issue health benefits plans; a health maintenance organization; a health,
hospital, or medical service corporation; a multiple employer welfare
arrangement; the State Health Benefits Program and the School Employees� Health
Benefits Program; or any other entity providing a health benefits plan.� Except
as provided under the provisions of this act, �carrier� shall not include any
other entity providing or administering a self-funded health benefits plan.
����� �Episode
of care� means the medical care ordered to be provided for a specific medical
procedure, condition, or illness.
����� "Health
benefits plan" means a benefits plan which pays or provides hospital and
medical expense benefits for covered services, and is delivered or issued for
delivery in this State by or through a carrier.� For the purposes of this act,
�health benefits plan� shall not include the following plans, policies or
contracts: Medicaid, Medicare, Medicare Advantage, accident only, credit,
disability, long-term care, TRICARE supplement coverage, coverage arising out
of a workers' compensation or similar law, automobile medical payment
insurance, personal injury protection insurance issued pursuant to P.L.1972,
c.70 (C.39:6A-1 et seq.), a dental plan as defined pursuant to section 1 of
P.L.2014, c.70 (C.26:2S-26) and hospital confinement indemnity coverage.
����� �Health
care facility� means a health care facility licensed pursuant to P.L.1971,
c.136 (C.26:2H-1 et al.).
����� �Health
care professional� means an individual, acting within the scope of the
individual�s licensure or certification, who provides professional services in,
or under contract with, a health care facility.
����� �Health
care provider� or �provider� means a health care professional or health care
facility.
����� �Health
care service� means the preadmission, outpatient, inpatient, and post discharge
care provided in or by a health care facility, and such other items or services
as are necessary for such care, including but not limited to medical devices,
which are provided for the purpose of health maintenance, diagnosis, or
treatment of human disease, pain, injury, disability, deformity, or physical
condition, including, but not limited to, nursing service, home care nursing,
and other paramedical service, ambulance and other medical transport services,
dental and vision services, service provided by an intern, resident in training
or physician whose compensation is provided through agreement with a health
care facility, laboratory service, medical social service, drugs, biologicals,
supplies, appliances, equipment, bed and board, including services provided by
a health care professional in private practice.
����� ��Plain
language� means language that is easily understood by the average patient and
that includes uniform definitions of standard insurance and medical terms, to
be determined and developed by the Department of Health.
����� �Self-funded
health benefits plan� or �self-funded plan� means a self-insured health
benefits plan governed by the provisions of the federal �Employee Retirement
Income Security Act of 1974,� 29 U.S.C. s.1001 et seq.
����� ��Sensitive
services� means health care services related to sexual assault, pregnancy,
family planning, sexually transmitted diseases, domestic violence and substance
or alcohol abuse, and any other services that may be determined to be sensitive
services by the Department of Health, in consultation with the Department of
Banking and Insurance.�����
����� b.�� (1)
A health care provider shall, within 30 days after a claim for a health care
service is adjudicated by a carrier, provide to the patient or to the patient's
survivor or legal guardian, as appropriate, a statement or bill of the charges
or expenses for the health care services the patient received from the provider
if the patient owes all or a portion of the amount due for the health care
service.� The statement or bill provided to the patient or to the patient�s
survivor or legal guardian shall contain conspicuous language stating that a
plain language statement or bill is available upon written request and shall be
provided to the patient within 10 days after the written request is received.�
The plain language statement or bill shall detail the specific nature of the
charges or expenses for the health care services that the patient received from
the provider.
����� (2)� The
plain language statement or bill required by this section shall:
����� (a)� not
describe a billed charge using only a medical billing code or a general term
such as "miscellaneous charges," "supply charges," or
"other charges";
����� (b)� list
the specific services received and expenses incurred by date and health care
provider;
����� (c)� not
refer to drug code numbers without also using the appropriate brand name or
generic name for each drug;
����� (d) conspicuously
display the telephone number of the health care facility's patient liaison
responsible for expediting the resolution of any billing dispute between the
patient, or the patient's survivor or legal guardian in accordance with
subsection c. of this section; and
����� (e)� provide
information on free or reduced cost financial assistance health care programs
offered by the provider and available to patients.
����� Notwithstanding
the requirements of this paragraph, a plain language statement or bill shall
not contain information about sensitive services unless subsequently requested
by the person who is legally authorized to consent to care.
����� (3)� After
delivery of the initial statement or bill, any subsequent statement or bill
provided to a patient or to the patient's survivor or legal guardian, as
appropriate, relating to the same episode of care shall include all the
information required by paragraph (2) of this subsection if requested by the
patient or the patient�s survivor or legal guardian, with any revisions clearly
delineated.
����� (4)� A
health care provider shall:
����� (a)� transmit
the statement or bill by mail or, upon request, by secure e-mail, via a secure
online portal; and
����� (b)� not
bill or otherwise charge a patient for preparation of a statement or bill
required by this section.
����� c.�� Each
health care facility shall establish policies and procedures for reviewing and
responding to questions from a patient concerning the patient's statement or
bill.� A response shall be provided no more than 10 business days after the
date a question is received.
����� d.�� The
Division of Consumer Affairs in the Department of Law and Public Safety, in
consultation with the Department of Banking and Insurance, shall adopt rules
that specify the requirements for health care providers to develop and provide plain
language billing statements in accordance with this section.� The division shall
ensure that the rules are consistent with P.L.2018, c.32 (C.26:2SS-1 et seq.).�
The rules shall specify, at a minimum, the following:
����� (1)� the
contents of the statements, including the patient's rights and payment
obligations pursuant to the patient's health benefit plan;
����� (2)� disclosure
requirements specific to health care facilities, including the terms used to
differentiate in-network and out-of-network services and health care providers;
and
����� (3)� requirements
to ensure that carriers, health care facilities, and health care providers use
language that is consistent with the disclosures required by P.L.2018, c.32
(C.26:2SS-1 et seq.).
����� e.�� The
Department of Health, in consultation with the Department of Banking and
Insurance and the Division of Consumer Affairs in the Department of Law and
Public Safety, shall adopt rules that specify the requirements for health care
facilities to develop and provide plain-language billing statements in
accordance with this section.� The Department of Health shall ensure that the
rules are consistent with P.L.2018, c.32 (C.26:2SS-1 et seq.).� The rules shall
specify, at a minimum, the following:
����� (1)� the
contents of the statements, including the patient's rights and payment
obligations pursuant to the patient's health benefit plan;
����� (2)� disclosure
requirements specific to health care facilities, including the terms used to
differentiate in-network and out-of-network services and health care providers;
and
����� (3)� requirements
to ensure that carriers, health care facilities, and health care providers use
language that is consistent with the disclosures required by P.L.2018, c.32
(C.26:2SS-1 et seq.).
���� 2.��� This act shall take
effect immediately and shall apply to health care services performed on and
after the first day of the 18th month next following promulgation of the
implementing regulations.
STATEMENT
���� This bill establishes certain
medical billing requirements concerning the specific nature of charges or
expenses for health care services.
���� The bill requires a health
care provider to provide to the patient or to the patient's survivor or legal
guardian, as appropriate, a statement or bill detailing the specific nature of
the charges or expenses for the health care services the patient received from
the provider, if the patient owes all or a portion of the amount due for the
received health care service.� If the patient owes all or a portion of the
amount due for the health care service, then the health care provider must
provide the statement or bill within 30 days after a claim for the health care
service is adjudicated by a carrier. �If a statement or bill is sent to the
patient, the statement or bill provided must contain conspicuous language
stating that a plain language statement or bill is available upon written
request, which will be provided to the patient within 10 days after the written
request is received.� The description of billed charges in the plain language
statement or bill will detail, with certain exceptions, the specific nature of
the charges or expenses for the health care services the patient received from
the provider, among other requirements.