Out-of-network legislation clears Assembly committee

The New Jersey state Assembly bills to address surprise out-of-network hospital bills are one step closer to becoming law, despite some remaining concerns for both payers and providers.

The two bills, sponsored by Assembly Democrats Craig Coughlin (D-Woodbridge), Gary S. Schaer (D-Passaic), Troy Singleton (D-Mount Laurel), Pamela Lampitt (D-Voorhees) and Grace Spencer (D-Newark), cleared the Financial Institutions and Insurance Committee on Monday.

Originally introduced earlier this year as a single bill, the two new pieces of legislation cover changes in the administrative process for hospitals during non-emergency procedures, as well as creating a new transparency tool to determine what providers are charging for care — known as the Health Price Index. If enacted, the out-of-network bill would rely on the state Department of Banking and Insurance to find an organization to collect and maintain the Health Price Index.

The out-of-network bill, which is similar to a bill making its way through the Senate, is raising concerns about the increased burden on health care professionals, while the creation of a new price tool is likely to increase the already too-high-cost of insurance plans.

The New Jersey Business and Industry Association supported the out-of-network bill, but has some concerns about the HPI.

“NJBIA continues to oppose creation of an HPI,” testified Mary Beaumont, vice president for health and legal affairs.  “Surcharges on health insurers and benefits plans will ultimately increase health care costs for New Jersey employers. Furthermore, it’s duplicative. Existing sources collect and provide in-network and out-of-network cost information from physicians, hospitals, health care facilities and insurers.”

Similar opposition can also be seen for the administrative burden on doctors from the out-of-network bill.

But the bills’ sponsor believes the physicians and health care professionals within the health system should be responsible for tracking the insurance information. Laws already exist for emergency situations to be treated as in-network, so elective procedures are typically where surprise bills appear.

“If they were given the choice between continuing with medical care that ultimately would lead to substantial out-of-pocket costs and considering other options that carry a lower price tag, the vast majority of reasonable New Jersey residents certainly would choose the latter. The problem, at present, is that they don’t have that choice,” said Schaer.

Sen. Joseph Vitale, who heads the health committee and reviewed a similar bill, applauded the Assembly bill.

“Along with my Assembly counterparts sponsoring the bill, I am now confident that we have a piece of legislation that will advance through both houses before the end of this legislative session,” Vitale (D-Woodbridge) said in a statement. “People are being forced to choose between paying off medical bills that they never expected to receive or paying their necessary everyday expenses like rent, mortgage and food. It’s not a fair choice to have to make. New Jersey consumers need to know what they’re getting into, before non-emergent out-of-network medical services are provided, so they can make informed choices rather than being arm-wrestled into damaging debt.”

The bills call for the following to be implemented by health care facilities:

  • Disclose whether the facility is in- or out-of-network.
  • Advise the patient to check with the doctor arranging the services to determine whether or not the doctor is in- or out-of-network.
  • Advise the patient if a change in network status has occurred between the time the appointment was made and the time of the procedure.
  • Advise that the patient contact his or her insurance carrier for further consultation regarding costs.
  • Make publicly available a list of standard charges for the items and services it provides
  • Follow a binding arbitration process to allow consumers a chance to fight surprise bills
  • Publish online the names, mailing addresses and telephone numbers of physicians working at the facility and hospital-based physician groups with which it has contracted to provide services, including anesthesiology, pathology and radiology.

The New Jersey Association of Health Plans released a statement supporting various aspects of the bill, but stated concerns with the peer review process, cost sharing for emergency services and the $1,000 threshold for arbitration — all of which were urged by hospitals and health care providers.

“We believe that the peer review process will add cost and prove to be of limited utility, as it is not likely to provide information not already available to the disputing parties.  We are also concerned about our experience with peer-review process, as we have seen that providers are reluctant to challenge their peers.  As a result, we do not support the proposal,” NJAHP said in the statement.

“While we continue to have concerns about a number of elements of the bill, especially the network audit section, which we see as redundant of existing regulatory requirements, overall, we are supportive of the bill.  Consumers, labor organizations, businesses, the State Health Benefits Program and other payers will benefit from the bill’s transparency measures and cost containment measures. It is time to put a stop to surprise bills for consumers and reign in the predatory price gouging practices by certain provider.”

Martin J. Milita, Jr. Esq., is senior director at Duane Morris Government Strategies, LLC.

Duane Morris Government Strategies (DMGS) supports the growth of organizations, companies, communities and economies through a suite of government and business consulting services. The firm offers a range of government relations and public affairs services, including lobbying, grant writing; development finance consulting, media relations management, grassroots campaigning and community outreach. Milita works at the firm’s Trenton and Newark New Jersey offices.

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NJ Bills Look To Boost Health Care Cost Transparency

The New Jersey Assembly Financial Institutions and Insurance Committee is set to  a two-bill package aiming to eliminate what lawmakers call surprise out-of-network health care charges through enhanced transparency and consumer protections.

During its joint meeting today, Monday November 23, 2015, the New Jersey Assembly Financial Institutions and Insurance Committee will consider the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act, spelled out in Bill A4444, and the New Jersey All-Payer Claims Database Act, summed up in A952.

Bill A4444 aims to increase transparency in health care services pricing, establish a system to resolve billing disputes and contain rising costs, according to the lawmakers. The database envisioned in Bill A952 would be housed within the Department of Banking and Insurance and would likewise boost transparency, as well help identify trends and help inform decisions and negotiations among consumers, providers and insurers, according to the bill’s statement.

“It is completely unreasonable and horribly unsafe to expect a patient lying on a hospital bed waiting to go into surgery to ask the anesthesiologist assigned to their care if they accept their insurance,” Sen. Joseph F. Vitale, D-Middlesex, one of A4444’s backers, said in a statement when the bill was introduced in May.

The bill’s other sponsors include Assemblymen Craig Coughlin, D-Middlesex, Gary S. Schaer, D-Passaic, and Troy Singleton, D-Burlington, as well as Assemblywomen L. Grace Spencer, D-Essex, and Pamela Lampitt, D-Camden.

Coughlin said at the time that the state’s insurance companies and providers had failed to negotiate good-faith contracts for far too long and used patients as their “bargaining chip” to maximize profits.

“This bill protects patients by taking them out of the fight and insulating them from balance billing while giving providers and insurance companies a path to compromise,” he said.

The Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act would require health care facilities and professionals to provide patients with written disclosure forms no fewer than 30 days prior to nonemergency or elective procedure.

The forms would clarify if the facility or doctor is in or out of the patient’s health benefits plan network; that the patient won’t incur out-of-pocket costs unless that person has specifically opted for out-of-network services; and that the patient’s costs for an out-of-network provider would be applicable to services from an out-of-network facility or by an out-of-network professional, according to the bills statement.

The health care provider would also have to explain the procedure and provide other information in layman’s terms, as well as publish an online list of in-network providers to be updated every 20 days.

Under the bill, insurance companies would also be required to publish on their websites a list, to be updated at least every 20 days, of all in-network providers and disclose the list to covered persons upon plan enrollment or as requested.

In the event of medically necessary emergency care administered by an out-of-network provider, the patient’s cost wouldn’t exceed those of in-network providers under the bill. In that same scenario, an insurance company could not be billed more than 250 percent of the median paid in-network commercial claim for a service.

The bill also outlines a binding arbitration process in the event of a bill dispute involving certain emergency and out-of-network billing services, although arbitration wouldn’t be an option for covered patients who knowingly selected an out-of-network provider for services available through their in-network providers.

Bill A952 was introduced in January by Singleton and Assemblymen Jack M. Ciattarelli, R-Somerset, and Joseph A. Lagana, D-Bergen.

The database outlined in the legislation would process, analyze and report health care data collected from health care facilities, professionals, insurance carriers and multiple state health programs, according to the bill. It also establishes provisions regarding the reimbursement of out-of-network health care providers by insurers that offer managed care plans.

 

Capitol Hill Monday-Highway Funding

Members return to Capitol Hill Monday with fiscal year 2016 appropriations on the agenda and a looming highway authorization deadline on the calendar. Congress faces a Friday deadline to complete work on the highway and infrastructure legislation because the current extension expires on Nov. 20 at midnight. Even though members were largely back in their districts last week, staff for House and Senate conferees appointed to a bicameral conference committee were working to resolve differences between the versions of the long-term highway and infrastructure authorization bills passed by both chambers. While both versions of the bill reauthorize the highway program for six years, they both provide funding only for the first three years, requiring Congress to come up with the remaining three years of financing. In addition, differences remain in the ways each chamber pays for the programs. Press reports indicate there is optimism that the bicameral committee will produce the conference report on a long-term bill that can be passed by both chambers and sent to the president for signature before the end of the week. Nevertheless, it is likely House and Senate leadership would move quickly to pass another short-term extension of current authorization until the conference committee can complete its work should unforeseen delays take place.

Appropriations for 2016 will also be on the agenda this week, even though the fiscal year is already well underway. Passage of the Bipartisan Budget Act in October established topline allocations for discretionary programs, a breakthrough that is allowing the stalled appropriations process to move forward. Now that a satisfactory budget framework has been established, House and Senate leadership are strategizing on how to complete appropriations work before a Dec. 11 expiration of current funding, but there does not yet appear to be any clear process for moving forward. Last week the Senate took up and unanimously passed its first appropriations bill this year, the Military Construction and Veterans Affairs bill. The House has already passed six of the 12 annual spending bills and was considering a seventh when it was abruptly pulled from the floor.

Chairmen of the House Appropriations Subcommittees whose bills have not yet been considered by the full House have scheduled “listening sessions” with representatives who do not serve on the Appropriations Committee to get input on the remaining spending measures, according to press reports. New Speaker of the House Paul Ryan has reportedly polled the members of his conference on whether to resume consideration of individual spending bills or proceed with an omnibus bill, and apparently there was widespread support for developing a single omnibus spending bill.

Even without an established year-end plan, the Senate is likely to move forward with its second appropriations bill this week. Senators resume legislative business on Monday with a vote on a judicial nominee. Following this vote, it is expected that Senate Majority Leader Mitch McConnell will schedule the Transportation, Housing and Urban Development, and Related Agencies (T-HUD) Appropriations Act for consideration during the remainder of the week. The bill approved by the Senate Appropriations Committee provides roughly $56 billion in discretionary spending for programs and functions within the Departments of Transportation and Housing and Urban Development.

The House returns on Monday with votes expected on 14 bills under suspension of the rules. Votes are also expected on motions to concur with Senate amendments to two bills, one related to disaster and recovery assistance programs and the other to commercial exploration of space resources.

On Tuesday, the House is expected to take up H.R. 511, the Tribal Sovereignty Act, subject to a rule. This legislation amends the National Labor Relations Act to provide that any enterprise or institution owned and operated by an Indian tribe and located on its lands is not considered an employer. This bill would prevent the National Labor Relations Board from exercising jurisdiction over tribal businesses operated on tribal lands. The House may also vote on a motion to go to conference with the Senate on legislation to reauthorize the Elementary and Secondary Education Act (ESEA). Press reports indicate that House and Senate committee chairmen and ranking members have resolved differences between the Senate- and House-passed versions of the bill and reached a preliminary agreement on a conference report. We can expect consideration of the education bill before Congress adjourns for the year in December.

During the remainder of the week, the House is expected to consider three pieces of legislation reported out of the Financial Services Committee, each subject to a rule: H.R. 1737, which would nullify guidance provided by the Consumer Financial Protection Bureau in 2013 regarding indirect auto lending; H.R. 1210, legislation to modify Qualified Mortgage rules established by the Dodd-Frank Act (P.L. 111-203); and H.R. 3189, which would require reforms at the Federal Reserve in an effort to increase transparency and accountability.

Congressional committees resume a busy hearing and markup schedule this week, with a number of high-profile events occurring on Tuesday. U.S. Attorney General Loretta Lynch will be making her inaugural appearance before the House Judiciary Committee on Tuesday morning for a Justice Department oversight hearing. (General Lynch’s scheduled October appearance before the committee was rescheduled.) The House Energy & Commerce Subcommittee on Communications and Technology also meets Tuesday morning to conduct oversight of the Federal Communications Commission. The Senate Health, Education, Labor and Pensions Committee is scheduled to consider President Obama’s nomination of Dr. Robert M. Califf to become the next commissioner of the U.S. Food and Drug Administration. A joint hearing of House and Senate Homeland Security Subcommittees will take place in the afternoon to examine ongoing issues at the troubled Secret Service. Also occurring on Tuesday, the House Judiciary Subcommittee on Regulatory Reform, Commercial and Antitrust Law is scheduled to consider the “State of Competition in the Pharmacy Benefits Manager and Pharmacy Marketplaces,” with representatives from local, corporate and online pharmacies scheduled to testify about increasing

The House Veterans Affairs Subcommittee on Health meets Tuesday morning for a legislative hearing on 10 veterans health bills, while the full Veterans Affairs Committee will meet Wednesday to discuss the VA’s Plan to Consolidate Community Care Programs, submitted to Congress on Oct. 30. The Subcommittee on Economic Opportunity meets Wednesday afternoon to review the VA’s On-the-Job Training and Apprenticeship Program. The Senate Veterans Affairs Committee also meets on Wednesday to review five pieces of legislation on veterans’ health and benefits.

There are again numerous House hearings this week focused on international activities in the Middle East and the campaign against the Islamic State. A joint hearing between the House Homeland Security and House Foreign Affairs Committees is scheduled for Wednesday morning to discuss terrorist sanctuaries. The hearing will likely also focus on the Russian passenger jet that crashed in the Sinai Peninsula last month and reports that a terrorist attack is the most likely cause of the disaster. The House Foreign Affairs Subcommittee on Terrorism, Nonproliferation and Trade will meet Tuesday afternoon on the topic of terrorist financing, while a House Judiciary Subcommittee on Immigration and National Security will meet Thursday to discuss the Syrian refugee crisis and its impact on the security of the U.S. Refugee Admissions Program. These hearings and other key congressional hearings are listed below.

Martin J. Milita, Jr. Esq., is senior director at Duane Morris Government Strategies, LLC.

Duane Morris Government Strategies (DMGS) supports the growth of organizations, companies, communities and economies through a suite of government and business consulting services. The firm offers a range of government relations and public affairs services from its Washington DC offices and multiple state capitols, including lobbying, grant writing; development finance consulting, media relations management, grassroots campaigning and community outreach. Mr. Milita works at the firm’s Trenton and Newark New Jersey offices.

Visit his blog at: https://martinmilita1.wordpress.com

Follow him on twitter: @MartinMilita1

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What Tuesday Means for New Jersey

There are only 18 Democratic governors left across the nation, and the survivors have some theories about why Democrats have been swept out of statehouses all over the country in recent years.

Many of the remaining Democrats are blaming an unpopular president.

In New Jersey on the other hand Democrats picked up four Assembly seats, widening their advantage to 52-28. The Senate is also controlled by Democrats.

State Republicans’ also have theories why New Jersey is bucking the national trend with remaining Republicans blaming an unengaged Governor Christie.

Overall, incumbents were widely re-elected to the Assembly with only a handful of Republican legislators losing to their Democratic challengers. Democrats picked up 4 seats bringing their total to 52, their largest majority in over 30 years. Republicans held onto 28 seats (down from 32). Below are brief summaries of races where at least one new individual was elected to the General Assembly.

–        First Legislative District: ATLANTIC (part) – CAPE MAY – CUMBERLAND (part) Counties

Republican incumbent Sam Fiocchi was defeated by Democrats R. Bruce Land. Democratic incumbent Bob Andrzejczak was re-elected.

–        Fifth Legislative District: CAMDEN (part) – GLOUCESTER (part) Counties

Democrats Arthur Barclay and Patricia Egan Jones handily defeated their Republican opponents, Kevin Ehret and Keith Walker. They will replace outgoing Democratic Assemblymen Gilbert Wilson and Angel Fuetes.

–        Eighth Legislative District: ATLANTIC (part) – BURLINGTON (part) – CAMDEN (part) Counties

Republican Joe Howarth joins his running mate incumbent Maria Rodriguez-Gregg in the Assembly. Both ran unopposed. Howarth is replacing retiring Republican Assemblyman Christopher Brown.

–        Eleventh Legislative District: MONMOUTH (part) Counties

Democrats Eric Houghtaling and Joann Downey narrowly beat their incumbent Republican competitors Mary Pat Angelini and Caroline Casagrande.

–        Sixteenth Legislative District: HUNTERDON (part) – MERCER (part) – MIDDLESEX (part) – SOMERSET (part) Counties

At the time of writing, Democrat Andrew Zwicker was leading incumbent Republican challenger Donna Simon by 29 votes, making it the tightest Assembly race. However, provisional ballots are still being counted, a process that will last until Friday November 6. From there, the losing candidate has until November 14 to file for a  recount. Republican incumbent Jack Ciattarelli was re-elected.

–        Twenty-Second Legislative District: MIDDLESEX (part) – SOMERSET (part) – UNION (part) Counties

Democrat James Kennedy was elected to replace retiring Democratic Assemblywoman Linda Stender. Democratic incumbent Jerry Green was re-elected.

–        Twenty-Fourth Legislative District: MORRIS (part) – SUSSEX – WARREN (part) Counties

Republican Gail Phoebus was elected to replace retiring Republican Assemblywoman Alison McHose. Incumbent Republican F. Parker Space was re-elected.

–        Thirty-First Legislative District: HUDSON (part) Counties

With no incumbents running for re-election in the district, Democrats Angela McKnight and Nicholas Chiaravalloti handily defeated their Republican opponents. They are replacing retiring Democratic Assemblymen Jason O’Donnell and Charles Mainor.

–        Thirty-Third Legislative District: HUDSON (part) Counties

Democrat Annette Chaparro was elected to replace retiring Democratic Assemblyman Carmelo Garcia. Incumbent Democrat Raj Mukherji was re-elected.

In terms of county elections below is a brief summary of newly elected individuals and ballot question results:

–        Atlantic County

Republican Maureen Kern was elected as the 2nd District’s Freeholder. The Republicans swept the elections in Atlantic County and were able to easily maintain their majority on the Board of Chosen Freeholders. Incumbents Dennis Levinson, James Curcio, Frank Formica, and James Bertino were re-elected.

–        Burlington County

Republicans Kate Gibbs and Ryan Peters were elected to the Board of Chosen Freeholders, defeating Democratic incumbents Aimee Belgard and Joanne Schwartz. As such, Democrats lost their majority on the board.

–        Camden County

Democrats Susan Angulo and William Moen Jr. join Democratic incumbents Jeffrey Nash and Jonathan Young Sr. on the Board of Chosen Freeholders. Camden also elected Democrat Gilbert “Whip” Wilson to the position of Sheriff, replacing outgoing Sheriff Charles Billingham.

–        Cumberland County

Newly elected Democrat James Quinn joins Cumberland’s Board of Chosen Freeholders. Incumbent Joseph Derella was re-elected. Overall, Democrats preserve their 4-3 majority.

–        Middlesex County

74% of individuals voted yes to the Public Question “Shall the governing body of the County of Middlesex prioritize funding to programs which provide transportation services for individuals in need of dialysis, chemotherapy or other regular medical services as a means of offsetting recent federal and state funding cuts?”

–        Morris County

Republican newcomers Christine Myers and Deborah Smith, and incumbent Republican John Cesaro were (re) elected to the Morris’ Board of Chosen Freeholders.

–        Passaic County

Democrats swept Passiac County’s Freeholder elections. Newly elected Cassandra Lazzara and incumbents John Bartlett and Hector Lora allowed Democrats to retain control of the board.

–        Salem County

Republican Melissa DeCastro and Democrat Charles V. Hassler remain in an extremely tight race, with DeCastro leading by 11 votes. At the time of writing, provisional ballots were being counted. Regardless of the outcome of this race, Republicans will retain control of the board.

So, the New Jersey Legislature now enters a lame-duck session after this week’s elections with several key questions still needing to be answered.

Among them: – Funding the New Jersey Pension- Horizon Blue Cross Blue Shield Omnicre- Out-of-Network, and most critically– Funding for the Transportation Trust Fund.

Serious conversations about raising New Jersey’s gas tax to head off a looming transportation-funding crisis were put on hold earlier this year, so lawmakers could focus on the Assembly elections that were just held in all 40 legislative districts earlier this week. But now with those contests in the rearview mirror, the talk in Trenton has shifted back to transportation.

Lawmakers from both parties said yesterday that they are willing to strike a bipartisan deal to renew the state’s Transportation Trust Fund, which pays for road, bridge, and rail improvements throughout the state, using revenue from the gas tax and other sources, including from borrowing.

The lawmakers also seem to be in agreement that any deal they strike on transportation funding will likely have to involve raising the state’s 14.5-cent gas tax to bring in new revenue, since all of the money coming in from the gas tax is going to pay down debt. The trust fund is also up against its borrowing limit and only has enough money to make it until the end of June 2016.

There are also signs of hope that lawmakers in the Senate, which is also controlled by Democrats, will find common ground on the transportation-funding issue as well. They recently came together to pass a resolution supporting a plan to share costs with the federal government on a new Hudson River train tunnel. But how to convince Christie, who has signed an anti-tax pledge as a GOP presidential candidate this year, to agree to a tax hike in the middle of his presidential campaign remains a big concern. When the issue came up during his monthly call-in radio show on NJ 101.5 FM earlier this week, Christie was noncommittal, saying only that he hasn’t dismissed a gas-tax hike outright.

Lastly, the State must deal with Governor Christie’s Cabinet/Staff Changes that include:

  • Richard Badolato was formally nominated as Commissioner of the Department of Banking and Insurance. He has served as Acting Commissioner since August of this year.
  • Ford Scudder, COO of Laffer Associates, will be nominated to the position of State Treasurer. Current Acting Treasurer, Robert Romano, will be responsible for management and operation of Treasury activities.
  • Richard Hammer, Assistant Commissioner of the New Jersey Department of Transportation, will become that department’s Acting Commissioner. He replaces Jamie Fox.

With it all, there remains the question of how committed Christie will be to solving New Jersey issues as long as he remains in the hunt as a presidential hopeful. Christie is pushing in New Hampshire, where the primary is not held until February.

Martin J. Milita, Jr. Esq., is senior director at Duane Morris Government Strategies, LLC.

Duane Morris Government Strategies (DMGS) supports the growth of organizations, companies, communities and economies through a suite of government and business consulting services. The firm offers a range of government relations and public affairs services, including lobbying, grant writing; development finance consulting, media relations management, grassroots campaigning and community outreach. Milita works at the firm’s Trenton and Newark New Jersey offices.

Visit his blog at: https://martinmilita1.wordpress.com

Follow him on twitter: @MartinMilita1

https://www.facebook.com/martin.milita

http://www.dmgs.com/

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