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Sponsors of Bill to Stop Surprise Out-of-Network Medical Costs Push On

Legislators involved in effort ask advocates and opponents to submit changes, plan stakeholder meeting at summer’s end

out-of-network sponsors
From left: Assemblymen Craig Coughlin (D-Middlesex) and Troy Singleton (D-Burlington), Sen. Joseph F. Vitale (D-Middlesex) and Assemblyman Gary S. Schaer (D-Bergen and Passaic).

There are times after suffering a setback that legislators say they’ll keep working on a bill -- and that’s the last they’re heard from on that topic. That’s not going to be the case with an effort to curb unexpected out-of-network charges on consumer hospital bills.

In fact, one of the bill’s sponsors, Assemblyman Craig Coughlin (D-Middlesex) sent an email this week to various healthcare trade groups and advocates, inviting them to suggest specific changes to the bill, along with an explanation of those changes.

Coughlin sent the message on behalf of fellow sponsors Sen. Joseph F. Vitale (D-Middlesex) and Assemblymen Gary S. Schaer (D-Bergen and Passaic) and Troy Singleton (D-Burlington).

The email signals just how serious the bills’ sponsors are about passing the Out-of-Network Consumer Protection, Transparency, Cost Containment, and Accountability Act -- in the face of widespread opposition from hospitals and doctors.

The current version of the bill (S-20/A-4444) has several components, all of which the sponsors say they’re committed to including in some form in the final legislation. That potentially puts the bill and its sponsors on a collision course with some providers, who are adamantly opposed to some of those elements.

The bill would require arbitration to resolve payment disputes between out-of-network providers and those paying the bills. It also would build a statewide database of in-network healthcare payments that could be used to determine arbitration awards. Further, the bill would require providers to disclose to consumers the cost of a procedure before it is undertaken, as well as prevent them from waiving copayments as a way of attracting out-of-network patients.

Coughlin said he solicited suggestions from stakeholders to build as strong a consensus as is possible around what he describes as a “really important and meaningful bill.”

“I think it’s important to do what you say, when we said we were going to work meaningfully over the summer,” Coughlin said, adding that the sponsors’ goal is “to get to a bill that is as acceptable as can be given the varying interests of the all of the various stakeholders.”

Coughlin has asked for responses by August 21, with the goal of having a stakeholder meeting the week of August 31. To signal just how serious he and his cosponsors are about coming up with a better bill, he underlined this sentence in the email: “Suggestions to simply delete provisions of the bill without offering viable alternatives will not be entertained.”

“We are committed to all of the elements because we think that they’re all important in protecting consumers,” Coughlin said. “If they have an alternative to (each element) that still achieves that end, we would listen to that.”

The bill was advancing rapidly in June before it hit a roadblock in the Senate Commerce Committee. It also faces a challenge in the Assembly, where Speaker Vincent Prieto (D-Hudson) will likely be key to whether the bill advances. His district is in Hudson County, the home of CarePoint Health, the for-profit chain that has been among the most vocal is expressing opposition to some elements of the bill.

Coughlin said he’s kept Prieto in the loop this summer. “He knows that we sent (the email) out and he is interested in the bill. He recognized that were going forward, and we’ll take it from there.”

CarePoint CEO Dennis Kelly was one of the few providers to put forward an alternative proposal, calling for the state to directly set reimbursement rates. CarePoint has been criticized for going outside of some insurance networks, which critics say has led to price gouging. The organization has said that it was a necessary strategy to receive reimbursements that will cover its costs.

Doctors’ groups have been particularly adamant in opposing the mandatory arbitration system detailed in the bill, which is based on a similar approach used in Illinois.

The Medical Society of New Jersey, the state’s largest doctors’ group, will continue to work with the sponsors, according to a statement from CEO Larry Downs.

“MSNJ is committed to improving transparency between patients and insurers about benefit payments for healthcare services,” Downs said. “We will give our full input to the Legislature and our partners in healthcare to improve the system for the benefit of patients.”

Vitale said the sponsors will “double down” on the bill in the fall, and expressed confidence that they will write a bill that will pass.

“We have received plenty of feedback both in a constructive and not-so-constructive manner,” Vitale said.

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