health care facilities

The New Jersey Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (the “Law”), New Jersey’s “surprise” medical billing law, went into effect on August 30, 2018.  Among other things, it requires licensed health care professionals in New Jersey (including, but not limited to, physicians, physician assistants and nurse practitioners) that bill health benefits plans issued or delivered in New Jersey (“NJ Health Plans”) to make certain patient disclosures regarding participation in such plans.  Additional patient disclosures are required for health care professionals who are out-of-network with a patient’s NJ Health Plan.

The Law also sets forth a “baseball-style” arbitration procedure to resolve disputes between health care professionals and NJ Health Plans over claims for reimbursement for (1) out-of-network emergency or urgent care services, and (2) “inadvertent” out-of-network services (such as on-call, radiology and anesthesiology services).

Please see our recently issued Health Law Alert on this matter for details on compliance with the Law, including the patient disclosure requirements and the arbitration process.