SENATE, No. 114
STATE OF NEW JERSEY
213th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2008 SESSION
Sponsored by:
Senator LORETTA WEINBERG
District 37 (Bergen)
Assemblywoman VALERIE VAINIERI HUTTLE
District 37 (Bergen)
Assemblywoman AMY H. HANDLIN
District 13 (Middlesex and Monmouth)
Assemblywoman NANCY F. MUNOZ
District 21 (Essex, Morris, Somerset and Union)
Assemblywoman ERIC MUNOZ
District 21 (Essex, Morris, Somerset and Union)
Co-Sponsored by:
Assemblyman Conners, Assemblywoman Watson Coleman and Senator Baroni
SYNOPSIS
Requires managed care plans to pay health care claims based on assignment of benefits.
CURRENT VERSION OF TEXT
As reported by the Assembly Financial Institutions and Insurance Committee on January 4, 2010, with amendments.
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 1in the form of a check payable to the health care provider, or in the alternative, to the health care provider and the covered person as joint payees, with a signature line for each of the payees. Payment shall be made1 in accordance with the provisions of this section and P.L.1999, c.154 (C.17B:30-23 et al.). Any payment made 1only1 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 1[90th] 365th1 day next following enactment and shall apply to any health benefits plan in which the carrier has reserved the right to change the premium 1and1 which is 1[delivered, issued, executed or renewed] in effect1 on or after the effective date.