On November 23, the Financial Institutions and Insurance
Committee of the New Jersey State Assembly recommended the passage
of legislation aimed at increasing pricing transparency for
healthcare services and establishing a mechanism to resolve certain
out-of-network reimbursement disputes.
Bill number A952, the "New Jersey
All-Payer Claims Database Act," is a companion to bill number A4444, the "Out-of-network
Consumer Protection, Transparency, Cost Containment and
Accountability Act" (previously discussed
here). The new bill intends to establish binding arbitration as
the means for resolving payment disputes among insurance carriers
and out-of-network healthcare providers in connection with
reimbursement for services provided by such out-of-network
providers. Under the proposed legislation, out-of-network providers
and insurance carriers will be required to submit reimbursement
disputes to binding arbitration if negotiations among the parties
regarding reimbursement fail.
The proposed legislation will also require the New Jersey
Department of Banking and Insurance (DOBI) to publish on its
website a list of arbitration decisions rendered during each
calendar year. With respect to each arbitration decision, the list
will identify the arbitration award amount, whether the prevailing
party was an insurance carrier or an out-of-network healthcare
provider, and the practice area of the provider involved.
DOBI's list of arbitration decisions will not include any
identifying information related to any healthcare provider,
insurance carrier or patient involved in any arbitration
decision.
The proposed legislation in bill number A952 was first introduced
in the State Assembly earlier this year and has faced criticism.
Many healthcare providers have argued that binding arbitration
favors insurance carriers who will be involved in arbitration
proceedings more frequently and, therefore, will be more familiar
with the procedures. The next stop for the bill is the full State
Assembly and the State Senate for a vote.
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