ASSEMBLY, No. 114
STATE OF NEW JERSEY
Introduced Pending Technical Review by Legislative Counsel
PRE-FILED FOR INTRODUCTION IN THE 1996 SESSION
By Assemblyman JONES and Assemblywoman GILL
An Act concerning the regulation of physicians and supplementing Titles 30 and 45 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A physician licensed pursuant to the provisions of Title 45 of the Revised Statutes who provides medical services to a beneficiary of the Medicare program established pursuant to Title XVIII of the federal Social Security Act, Pub.L.89-97 (42 U.S.C. §1395 et seq.) whose annual income is less than the limits provided for such beneficiary's eligibility for "Pharmaceutical Assistance to the Aged and Disabled" pursuant to section 2 of P.L.1975, c.194 (C.30:4D-21) shall not charge or collect from the beneficiary any amount in excess of the reasonable charge for that service as determined by the United States Secretary of Health and Human Services.
b. A beneficiary of the Medicare program shall present an identification card, issued by the Department of Human Services pursuant to subsection b. of section 3 of P.L. , c. (C. )(now pending before the Legislature as this bill) to the physician at the time that services are rendered, in order to be eligible for benefits under the provisions of this act.
c. The State Board of Medical Examiners shall assess a civil penalty pursuant to section 12 of P.L.1978, c.73 (C.45:1-25) of up to $2,500 for a first offense and up to $5,000 for each subsequent offense against a physician who knowingly and willingly charged the beneficiary in a manner not in compliance with the provisions of this act.
d. In addition to any civil penalties the board shall assess, the board shall order a physician who is not in compliance with this act to repay the victim the amount of excess payments made and received, plus interest on that amount at the maximum legal rate from the date payment was made until the date repayment is made. The board shall also issue a letter of reprimand to a physician who is not in compliance with the provisions of this act.
2. A physician who treats beneficiaries of the Medicare program established pursuant to Title XVIII of the Social Security Act, Pub. L.89-97 (42 U.S.C.§1395 et seq.) shall post a sign in his office which sets forth the following:
a. The rights of Medicare patients pursuant to section 1 of this act.
b. The address and telephone number of the Department of Human Services, which is the State agency designated to receive patients' complaints relating to overcharges prohibited under this act.
3. a. The Commissioner of Human Services shall establish procedures for the printing and distribution of the sign which is required to be posted by a physician who treats beneficiaries of the Medicare program established pursuant to Title XVIII of the Social Security Act, Pub.L.89-97 (42 U.S.C.§1395 et seq.) under section 2 of P.L. , c. (C. )(now pending before the Legislature as this bill).
b. The commissioner shall establish procedures for the determination of eligibility and the issuance of an identification card, in coordination with the "Pharmaceutical Assistance for the Aged and Disabled" program (PAAD), established pursuant to P.L.1975, c.194 (C.30:4D-20 et seq.), for beneficiaries of the Medicare program who meet the income eligibility requirements of section 1 of P.L. , c. (C. )(now pending before the Legislature as this bill). The identification card shall be valid for two years. A beneficiary of the PAAD program shall use his pharmaceutical identification card for this purpose.
c. The commissioner shall promptly report all patient complaints relating to overcharges to the State Board of Medical Examiners pursuant to section 2 of P.L. , c. (C. )(now pending before the Legislature as this bill) which are received by the Department of Human Services.
d. The commissioner, in cooperation with the Director of the Division on Aging in the Department of Community Affairs, shall disseminate information about the provisions of P.L. , c. (C. ) (now pending before the Legislature as this bill) and applications for identification cards to hospitals, physicians and senior citizens through the county offices on aging.
4. a. All penalties collected pursuant to P.L. ,c. (C. )(now pending before the Legislature as this bill) shall be deposited in a special non-lapsing fund in the Department of Human Services which is designated as the "Senior Citizen Balance Billing Fund." The fund shall be dedicated for use by the Commissioner of Human Services to offset any administrative costs incurred by the department in determining eligibility and issuing identification cards for beneficiaries of the Medicare program established pursuant to Title XVIII of the Social Security Act, Pub. L.89-97 (42 U.S.C. § 1395 et seq.) who are eligible for participation under the provisions of P.L. , c. (C. ) (now pending before the Legislature as this bill).
b. Within one year after the effective date of P.L. , c. (C. ) (now pending before the Legislature as this bill) and annually thereafter, the Commissioner of Human Services shall report to the Legislature on the amount collected and the use of the fund.
5. Pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), the Commissioner of Human Services shall adopt rules and regulations necessary to carry out the purposes of sections 3 and 4 of P.L. ,c. (C. )(now pending before the Legislature as this bill).
6. This act shall take effect 60 days after enactment.
STATEMENT
This bill requires a physician who agrees to treat Medicare patients to accept what the Medicare program pays without billing the patient for the uncovered balance. This requirement applies to Medicare patients whose annual incomes are at or below the income limits provided for under the Pharmaceutical Assistance to the Aged and Disabled (PAAD) program, which are $15,700 for single persons and $19,250 for married persons.
In order to receive benefits under this bill, a Medicare beneficiary must obtain an identification card to be issued by the Department of Human Services (DHS), and present it to the physician at the time that services are rendered. Beneficiaries under this program who are also beneficiaries under PAAD shall use their PAAD card for this purpose.
Physicians who do not comply with the provisions of the bill shall be subject to a fine of up $2,500 for the first offense and up to $5,000 for each subsequent offense. The physician shall also repay the victim the amount of excess payments made and received, plus interest on that amount at the maximum legal rate from the date payment was made until the date repayment is made. The State Board of Medical Examiners shall also issue a letter of reprimand to a physician who is not in compliance with this bill. The monies collected from the fines shall be deposited in the "Senior Citizen Balance Billing Fund" established by the bill in DHS, to be used to offset any administrative costs incurred by the department in determining eligibility and issuing identification cards. The Commissioner of Human Services shall report to the Legislature annually regarding the amount collected and the use of the fund.
The bill requires physicians who treat Medicare beneficiaries to post approved signs in their office setting forth the rights of Medicare patients and showing the address and telephone number of the DHS. The bill also directs the Commissioner of Human Services, in cooperation with the Director of the Division on Aging in the Department of Community Affairs, to disseminate information about the provisions of the bill to hospitals, physicians and senior citizens through the county offices on aging.
Requires physicians who agree to treat Medicare patients to accept what the program pays without balance billing for certain eligible patients.