A2851

An Act concerning practitioner referrals to out-of-State health care services 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. If a practitioner refers a patient, or directs an employee of the practitioner to refer a patient, to an out-of-State health care service, and the practitioner has a business relationship with the out-of-State health care service, the practitioner shall provide the patient with a written disclosure, as provided in subsection b. of this section, at or prior to the time that the referral is made, and post a copy of the disclosure in a conspicuous public place in the practitioner’s medical office and on the practitioner’s or the practitioner’s professional corporation’s website, if applicable. The disclosure that is posted by the practitioner in the office and on the website need not contain the specific information regarding participation in the network of a patient’s health plan as provided in subsection b. of this section, but shall list those health plans in which the out-of-State health services is a participating provider.

b. The written disclosure shall be in the following form and contain the applicable information required in the form:

P.L. , c. (pending before the Legislature as this bill) requires that a practitioner provide his patients with this disclosure form if the practitioner or the practitioner’s professional corporation may have a business relationship with an out-of-State health care service, prior to referring his patient to that health care service.

The law also requires that this disclosure include a list of health care service providers located within the county and contiguous counties in New Jersey that offer the same service for which the referral is being made, and indicate whether the out-of-State health care service will be considered to be, and reimbursed at, an out-of-network level by your health plan or other third party payer. This disclosure shall also include information related to any additional transportation costs that may be incurred by the patient or another party as a result of the referral to an out-of-State health care service.

Accordingly, please be advised that ______________ [name of practitioner or practitioner’s professional corporation, as applicable] has a business relationship with the following out-of-State health care service(s) to which I [or the professional corporation] refer patients:

[list applicable health care services]

· The business relationship involves ________________ [describe the nature of the business relationship].

· You may, of course, seek treatment at a health care service provider of your own choice, and you may be able to access this service within the State of New Jersey. Health care service providers located in this county and contiguous counties in the State that are licensed to provide this health care service include: [list applicable health care services and their addresses].

· Please be further advised that the health care service to which you are being referred ___DOES ___DOES NOT participate in your health plan or other third party’s provider network. If the health care service does not participate in your network, reimbursement for the services by your health plan or other third party payer will be at an out-of-network level, and may result in higher costs to you than if you received the health care service at a network provider. Please contact your health plan or other third party payer for additional information related to differences in reimbursement for in-network and out-of-network providers.

· There may an increased cost associated with the out-of-State referral as compared to a referral to a comparable health care service located in New Jersey. [provide information about the cost differential, if any]

· If the health care service that is the subject of the referral involves an overnight stay, your recovery may be affected by the location of the health care service, in terms of the ability of family and friends to provide needed support during and after hospitalization, and with respect to post-hospitalization care or rehabilitation. You may discuss this aspect of the referral with your practitioner.

c. As used in this act:

“Business relationship” means any financial relationship between a practitioner or a practitioner’s professional corporation and a health care service, including, but not limited to: an employment, investment, or independent contractor relationship; any relationship involving payments made by or between the parties; or a relationship involving an exchange of any item or service of value by or between the parties.

“Cost differential” means the difference in total cost, regardless of the person or entity responsible for or making payment, associated with accessing the out-of-State health care services, as compared with accessing the health care service at a location within the county or contiguous counties of the practitioner’s office where the patient was seen or treated and from which the referral is made. Cost differential shall include amounts associated with transportation to the out-of-State health care service, including ambulance transport, when necessary.

“Health care service” means a business entity that provides on an inpatient or outpatient basis: testing for, diagnosis, or treatment of human disease or dysfunction; or dispensing of drugs or medical devices for the treatment of human disease or dysfunction. Health care service includes, but is not limited to, a bioanalytical laboratory, pharmacy, home health care agency, rehabilitation facility, nursing home, hospital, or a facility that provides radiological or other diagnostic imagery services, physical therapy, ambulatory surgery, or ophthalmic services.

“Out-of-State health care service” means any health care service that bills for its services in the name of a business entity located out-of-State, regardless of whether the location at which health care services are provided, and to which the patient is referred, is located within the State.

“Practitioner” means a physician or podiatrist licensed to practice in this State pursuant to Title 45 of the Revised Statutes.

d. A practitioner who violates the provisions of this act shall be subject to disciplinary action by the State Board of Medical Examiners pursuant to section 12 of P.L.1978, c.73 (C. 45:1-25).

2. The State Board of Medical Examiners may adopt rules and regulations, pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), to carry out the purposes of this act.

3. This act shall take effect on the 90th day after enactment.

STATEMENT

This bill seeks to ensure that when patients are referred by their practitioners to health care services located, or owned by an entity that is located, outside this State, the patients are notified of any business relationships that the practitioner may have with the out-of-State health care entity to which the patient is referred and other relevant information that the patient should consider.

Specifically, the bill provides that a practitioner (a physician or podiatrist), who refers his patients to an out-of-State health care service in which the practitioner has a business relationship, shall provide the patient with a written disclosure of that relationship at or prior to the time that the referral is made, and post a copy of the disclosure in a conspicuous public place in the practitioner’s medical office and on the practitioner’s or the practitioner’s professional corporation’s website, if applicable. The bill defines “out-of-State health care service” to mean any health care service that bills for its services in the name of a business entity located out-of-State, regardless of whether the location at which health care services are provided, and to which the patient is referred, is located within the State.

The written disclosure shall be in the following form:

New Jersey law requires that a practitioner provide his patients with this disclosure form if the practitioner or the practitioner’s professional corporation may have a business relationship with an out-of-State health care service, prior to referring his patient to that health care service.

The law also requires that this disclosure include a list of health care service providers located within the county and contiguous counties in New Jersey that offer the same service for which the referral is being made, and indicate whether the out-of-State health care service will be considered to be, and reimbursed at, an “out-of-network” level by your health plan or other third party payer. This disclosure shall also include information related to any additional transportation costs that may be incurred by the patient or another party as a result of the referral to an out-of-State health care service.

· The business relationship involves ________________ [describe the nature of the business relationship]

· Please be further advised that the health care service to which you are being referred ___DOES ___DOES NOT participate in your health plan or other third party’s provider network. If the health care service does not participate in your network, reimbursement for the services by your health plan or other third party payer will be at an “out-of-network” level, and may result in higher costs to you than if you received the health care service at a “network” provider. Please contact your health plan or other third party payer for additional information related to differences in reimbursement for in-network and out-of-network providers.

The bill defines “business relationship” to mean any financial relationship between a practitioner or a practitioner’s professional corporation and a health care service, including, but not limited to: an employment, investment, or independent contractor relationship; any relationship involving payments made by or between the parties; or a relationship involving an exchange of any item or service of value by or between the parties.

A practitioner who violates the provisions of this bill shall be subject to disciplinary action by the State Board of Medical Examiners pursuant to section 12 of P.L.1978, c.73 (C.45:1-25).

The bill takes effect on the 90th day after enactment.