Healthcare Disclosure and Transparency Act expected to be posted next month

TRENTON – The long discussed “Healthcare Disclosure and Transparency Act” will be posted for a vote in committee in four

TRENTON – The long discussed “Healthcare Disclosure and Transparency Act” will be posted for a vote in committee in four weeks, according to the bill’s sponsor, Assemblyman Gary Schaer, (D-36), Passaic, who took testimony on the proposed legislation this morning. 

The bill’s intent is to make the billing process for patients more transparent, and would also establish rules on fee collection by out-of-network health care providers.

The bill would require physicians to make records relating to fee collection available for inspection by the Department of Banking and Insurance for a period of seven years. The legislation also allows a physician or facility delivering out-of-network services to waive a covered person’s financial responsibility if he or she has a financial hardship and the waivers aren’t being granted excessively.

Schaer’s bill also would require providers of health benefits plans to disclose, in writing, the reimbursement methodology for out-of-network services, and also establish a website to serve as “an information clearinghouse” for patients to obtain information to assist them with their health care needs. The website would be required to have information that would help patients make decisions about their health care.

The bill also prohibits an in-network health care facility from billing a covered person for any service provided while the patient is still hospitalized. In-network or out-of-network providers would also be restricted from billing in excess of the person’s copayment, deductible, or coinsurance if a patient is receiving emergency or urgent care services.

Schaer has been working on the bill (A2751) for two years, and said he has heard over 120 hours of testimony prior to today. He said more revisions would be made based on today’s testimony.

The bill received mixed reviews from testifiers, including Christine Stearns of the New Jersey Business and Industry Association, as well as Mary Ellen Peppard of the New Jersey Chamber of Commerce.

“The BIA is committed to finding reasonable solutions that would try to strike a fair balance,” Stearns said, adding that they hope to make sure premiums remain affordable for small businesses while ensuring providers continue to get fair compensation.

“Anecdotally, from talking to members, they want to be able to offer a health insurance plan with an out-of-network benefit to their employees because that’s what their employees want,” Stearns said.

Peppard and Stearns, along with many others, applauded the proposed transparency guidelines related to the website.

Ed Devaney, the chief operations officer at Mountainside Hospital in Montclair, testified about the difficulty of dealing with out-of-network plans. Devaney said that at Mountainside, the anesthetic services were out-of-network with certain health care providers, leaving the hospital to pick up some of the bills, which in turn affected future rate negotiations.

“In recognizing the hospital was required to cover shortfalls, the insurance plans used that as leverage in rate negotiations,” Devaney said.

A2751 also does not describe any penalties for health care industry professionals who do not follow the legislation.

Schaer said he has heard “significant concern” about the lack of a penalty. Although criminal penalties are unlikely to be added, the next time the bill is introduced, there will likely be some civil penalty written into the legislation, according to the testimony delivered today.

The bill was a hot topic of discussion in Trenton on Wednesday, when Assembly Republicans Jon Bramnick (R-21), Westfield, and Dave Rible (R-11), Wall, called a Statehouse press conference expressing concerns with the proposed legislation.

“The bill under discussion tomorrow has flaws that need to be corrected,” Rible said in a press release on Wednesday. “Based on the provision of this bill that requires a doctor to make three good faith and timely attempts at collecting payment from a patient and keeping records for seven years, I also believe it is more appropriate to name it the ‘Patient Collection Act.’ We need to let doctors practice medicine and respect their expertise in their specialty instead of having medical treatment decisions being made by a carrier’s accountant.”

Schaer responded to the comments during the hearing on Thursday by saying his office is always open and if anyone had concerns about the legislation they should call him. Schaer said it’s “not a perfect bill,” but hopes that over the next four weeks, the bill can be amended with the help of all interested parties.

Schaer also asked Ward Sanders of the New Jersey Association of Health Professionals if the legislation would become problematic due to the amount of paperwork.

“For most physicians, this is not a problem,” Sanders said. However, he added that due to the nature of the work, it might become burdensome for certain specialists. Sanders said his organization would submit suggestions to the committee. 

Healthcare Disclosure and Transparency Act expected to be posted next month