New Jersey’s Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (“NJ Law”) creates a statutory framework that attempts to protect consumers from medical bills for out-of-network services that they had no choice in selecting, often referred to as “surprise bills” in similar legislation in other jurisdictions.
This Client Alert, which is Part 2 of a two-part series, compares the provisions of the NJ Law to New York’s Emergency Medical Services and Surprise Bills Law (Financial Services Law, Article 6) and California’s Surprise Bill Law (Assembly Bill 72), two recently adopted statutes that sought to address the surprise bills issue, which has garnered significant national attention, and were the subject of prior Epstein Becker Green Client Alerts. (Part 1 of this series focused on regulatory issuances by the New Jersey Division of Consumer Affairs and the New Jersey Department of Banking and Insurance in response to the NJ Law.)
The NJ Law tracks some of the key provisions found in the earlier New York and California surprise bill laws, such as exclusion of Medicare Advantage plans and Medicaid managed care plans. But the NJ Law differs in a few respects. Notably, the NJ Law does not actually use the term “surprise bill,” unlike the New York and California provisions. Like New York (but unlike California), the NJ Law includes coverage for emergency services and provides significant disclosure requirements for health care facilities and health care professionals. In addition, the NJ Law also includes an “opt in” provision that allows self-funded Employee Retirement Income Security Act of 1974 (“ERISA”) health plans to elect to be subject to the NJ Law’s arbitration and certain other provisions. Providers, plans, and insurers operating in other states, especially in those states where legislation has been proposed and debated but not yet enacted, should take careful note of the provisions of these laws as a model that other states or Congress may soon adopt.