Out of Network Disclosure

State of New Jersey DEPARTMENT OF HEALTH 

On June 1, 2018, N.J.S.A. 26:2SS-1, et seq., also known as the “Out-Of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act” (the Act), was signed by Governor Murphy. The Department is required by the Act to promulgate rules and disclosure forms to be distributed to insured patients. This memo and the attached forms are intended to assist general acute care hospitals, satellite emergency departments, hospital based ambulatory surgery centers and freestanding ambulatory surgery centers, collectively referred to as “facility” or “facilities,” in understanding and meeting their obligations under the Act, until the rules and disclosure forms can be adopted through rulemaking. 

While the Department is in the process of developing the rules and final forms, the appropriate disclosure form of the four disclosure forms in the attachment entitled “Facility Disclosures” should be placed on facility letterhead and used as the disclosure form required under the Act based on a patient’s insurance provider.

The disclosure shall be made for a non-emergency or elective service on an insured patient in the following manners: 

1. Via Telephone – The facility representative scheduling an appointment for an individual by way of a phone call shall verbally disclose, and then provide a copy of the disclosure form to the patient prior to the date of the appointment. The facility shall receive the signed disclosure form from the patient prior to providing any services and shall maintain the signed disclosure form as part of the patient’s medical record. 
2. In Person – The facility staff member scheduling an in-person appointment at a facility shall provide the patient with a copy of the disclosure form and, at the patient’s request, shall go over the disclosure form with the patient. The facility shall retain the signed disclosure form as part of the patient’s medical record. 
3. Electronic Scheduling – An electronic scheduling system must include a mechanism that provides the patient with the appropriate disclosure form, include a manner in which a record of the patient’s acknowledgment of the form is recorded for the medical record, as well as a means for the patient to print out or obtain an electronic copy of the acknowledged disclosure form. 

In addition to the information which must be provided on the disclosure forms, facilities are required by the Act to post the following information on their website: 

1. A list of the health benefits plans in which the facility is a participating provider; 
2. A statement that physician services provided in the facility are not included in the facility’s charges; 
3. A statement that physicians who provide services in the facility may or may not participate with the same health benefits plans as the facility; 
4. A statement advising the insured patient to check with the physician arranging for the facility services to determine the health benefits plans in which the physician participates; 
5. A statement that the insured person should contact his or her insurance carrier for further consultation on any coverage, copayment, deductible and coinsurance amounts; 
6. The name, mailing address, and telephone number of all hospital-based physician groups with which the facility has contracted to provide services; and 
7. The name, mailing address, and telephone number of all physicians employed by the facility and whose services may be provided at the facility, and the health benefits plans in which those physicians participate.

In addition, the facility’s standard charges shall be made available to the public in a form consistent with federal guidelines implementing section 2718(e) of the Public Service Health Act. 

Please contact Michael Kennedy or Eugene Brenycz at (609) 292-5960 with any questions regarding this document.