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On Monday, June 20, 2016, the Assembly Financial Institutions and Insurance Committee will consider the latest version of legislation addressing the ever-increasing healthcare costs for “surprise” medical bills. The bill, A-1952, is the same version (A-4444/S-20) the committee released in 2015, but which did not pass before the end of the legislative session.  NJBIA appreciates the hard work of the sponsors, Assemblymen Coughlin, Schaer, Singleton and Senator Vitale, and continues our support of meaningful out-of-network reform legislation.

Proposed amendments by the sponsors remove both peer mediation and “baseball style” arbitration from the dispute resolution process, and instead require the arbitrator to decide on an amount that falls between 90 to 200 percent of the Medicare reimbursement rate.

The amendments also add new requirements related to price transparency and disclosure by healthcare providers and insurance carriers so it’s easier for consumers to understand potential out-of-network costs; require all in-network hospitals to ensure their contracted doctors and other healthcare professionals are also in-network with the same health plans as the hospital in order to minimize the occurrence of “surprise” bills; and establish additional network adequacy audits for Medicaid health benefits plans.   You can view the proposed amendments here.

We recognize that some in the healthcare provider community continue to have concerns with the legislation, and that there are many different sides to the issue.  In trying to balance the interests of all our members, NJBIA has been a supporter of out-of-network reform for many years because of the direct impact it will have on healthcare costs.

The committee will also consider A-2866, establishing a Healthcare Price Index (HPI) to make health care data available for researchers.  NJBIA has concerns with creating an HPI because it is similar to an “all-payer claims database,” will be costly to establish and sustain, and is funded through an annual surcharge assessed on all health benefits plans and third party administrators administering a health benefits plan in the State.  Estimates for the planning, development and implementation of the HPI are approximately $7 million, with an ongoing annual operating cost of approximately $4 to $5 million.

We welcome your thoughts and comments on this legislation.  Please reach out to Mary Beaumont at mbeaumont@njbia.org.

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