ASSEMBLY HEALTH COMMITTEE

STATEMENT TO

ASSEMBLY, No. 1889

with committee amendments

STATE OF NEW JERSEY

DATED: DECEMBER 16, 1996

      The Assembly Health Committee reports favorably and with committee amendments Assembly Bill No. 1889.

      As amended by the committee, this bill provides for the direct billing of patients by clinical laboratories. It prohibits clinical laboratories from presenting a bill for services to any person other than the person who is the recipient of the services, or that person's legal representative. However, the clinical laboratory may bill the appropriate third party payer, health care facility, clinic or program for the services, as provided in the bill. The bill provides that any amounts collected in violation of this billing requirement shall be refunded to the payer on a timely basis. The direct billing provided for in this bill means that laboratories shall request payment directly from either the patient or a financially responsible third party, rather than the health care provider who requested the test. The bill also requires the clinical laboratory, upon the request of the health care provider who requested the test, to notify that provider of the amount billed to the patient.

      The bill also requires a clinical laboratory to annually provide a health care provider with a list of its schedule of fees and charges for laboratory services rendered to the health care provider's patients and to promptly provide the health care provider with an updated list of its schedule of fees and charges whenever any changes are made to the list. Finally, the bill provides that nothing in the bill shall be construed to prevent a health care provider from including a charge for the interpretation of a laboratory test as part of the health care provider's office visit fee.

      The committee amendments:

      -- include the requirements that a clinical laboratory shall notify the health care provider about the amount billed the patient and shall annually provide health care providers with a list of its schedule of fees and charges;

      -- clarify that the provisions of the bill shall not be construed to prevent a health care provider from including a charge for the interpretation of a laboratory test as part of the provider's office visit fee;

      -- clarify that the provisions of the bill shall not affect a contractual agreement between a clinical laboratory and a third party payer regarding presentation of a bill for payment directly to that third party payer;

      -- provide that the clinical laboratory shall notify the health care provider who requested the test of the amount billed to the patient, only upon the provider's request; and

      -- provide that the clinical laboratory shall include with the list of its schedule of fees and charges for laboratory services provided to a health care provider a form to be used by the health care provider to request billing information pursuant to section 1 of the bill.

      Other committee amendments are intended to clarify the language of the bill regarding required clinical laboratory billing practices.

      As reported by the committee, this bill is identical to Senate Bill No. 1000 (1R) Aca (Codey), which the committee also reported on this date.