SENATE, No. 2368

STATE OF NEW JERSEY

213th LEGISLATURE

 

INTRODUCED NOVEMBER 24, 2008

 


 

Sponsored by:

Senator JEFF VAN DREW

District 1 (Cape May, Atlantic and Cumberland)

 

Co-Sponsored by:

Senator Whelan

 

 

 

 

SYNOPSIS

     Prohibits hospital from charging patient or third party payer for costs associated with certain hospital-acquired conditions.

 

CURRENT VERSION OF TEXT

     As introduced.

  


An Act concerning hospital charges and supplementing Title 26 of the Revised Statutes.

 

     Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

     1.    As used in this act:

     “Hospital” means a general hospital licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).

     “Hospital-acquired condition” means an event, injury, or infection, which occurs during the provision of health care services at the hospital and could reasonably have been prevented through the application of evidence-based guidelines.

 

     2.    a.  A hospital shall not charge or otherwise seek to obtain payment from a patient or third party payer for costs associated with a hospital-acquired condition, or treatment for a hospital-acquired condition, as identified by the United States Secretary of Health and Human Services pursuant to section 5001(c) of the federal “Deficit Reduction Act of 2005,” Pub.L.109-171, and specified by rule of the federal Centers for Medicare and Medicaid Services, for which the federal Medicare program established pursuant to Title XVIII of the "Social Security Act," Pub.L.89-97 (42 U.S.C. s.1395 et seq.) will not reimburse the hospital on or after October 1, 2008.

     b.    In addition to any hospital-acquired condition to which the provisions of subsection a. of this section apply, the commissioner may by regulation prohibit a hospital from charging or otherwise seeking to obtain payment from a patient or third party payer for costs associated with a hospital-acquired condition that has not been specified by rule of the federal Centers for Medicare and Medicaid Services.

     c.     A hospital that is denied reimbursement by a third party payer in accordance with the provisions of this section may appeal that denial to the third party payer.

     d.    A hospital shall be required to notify its patients of the provisions of this section on a form and in a manner to be prescribed by regulation of the commissioner.

 

     3.    The Commissioner of Health and Senior Services, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations to effectuate the purposes of this act.

 

     4.    This act shall take effect on the 180th day after enactment, but the Commissioner of Health and Senior Services may take such anticipatory administrative action in advance thereof as shall be necessary for the implementation of the act.

STATEMENT

 

     This bill is designed to provide financial incentives to enhance ongoing hospital efforts to assure quality of care and minimize preventable errors or conditions.

     Specifically, the bill prohibits a general hospital from charging or otherwise seeking to obtain payment from a patient or third party payer for costs associated with a hospital-acquired condition, or treatment for a hospital-acquired condition, as identified by the United States Secretary of Health and Human Services pursuant to section 5001(c) of the federal “Deficit Reduction Act of 2005,” Pub.L.109-171, and specified by rule of the federal Centers for Medicare and Medicaid Services (CMS), for which the federal Medicare program will not reimburse the hospital on or after October 1, 2008.

     The bill defines “hospital-acquired condition” to mean an event, injury, or infection, which occurs during the provision of health care services at the hospital and could reasonably have been prevented through the application of evidence-based guidelines.

     These hospital-acquired conditions currently include, as specified by CMS in its Inpatient Prospective Payment System Fiscal Year 2008 Final Rule:

·   objects left in the body during surgery;

·   air embolism;

·   blood incompatibility;

·   catheter-associated urinary tract infection;

·    pressure ulcers;

·   vascular catheter-associated infection;

·   surgical site infection - mediastinitis after coronary artery bypass graft surgery; and

·   falls and trauma – fractures, dislocations, intracranial injuries, crushing injuries, and burns.

     CMS is authorized by Pub.L.109-171 to periodically revise the list of hospital-acquired conditions, and it is anticipated that the list will be expanded to include other conditions.

     The bill further provides as follows:

     --  In addition to any hospital-acquired condition specified by rule of CMS, the commissioner may by regulation prohibit a hospital from charging or otherwise seeking to obtain payment from a patient or third party payer for costs associated with a hospital-acquired condition that has not been specified by rule of CMS.  This provision will allow the commissioner to add other hospital-acquired conditions based upon consultation with, and recommendations by, third party payers, public health officials, hospitals, advocacy groups, or private citizens.

     --  A hospital that is denied reimbursement by a third party payer in accordance with the provisions of this bill may appeal that denial to the third party payer.

     --  A hospital is required to notify its patients of the provisions of this bill on a form and in a manner to be prescribed by regulation of the commissioner.

     --  The bill takes effect on the 180th day after enactment, but authorizes the commissioner to take anticipatory administrative action in advance as necessary for its implementation.

costs associated with certain hospital-acquired conditions.