Singleton-Sweeney Bill Would Provide Transparency for Out-of-State Transfers and Referrals, Protect Against Surprise Billing
Trenton – Acting to protect patients and their families against unexpected costs for transfers to out-of-state health care facilities, a Senate committee today approved the “Patient Protection Act,” a bill sponsored by Senator Troy Singleton and Senate President Steve Sweeney requiring that patients are informed in advance of financial liabilities and care options.
“A transfer to an out-of-state facility can be a distressing experience for patients and their families,” said Senator Singleton (D-Burlington). “They should be provided with all the information they need to make the right decisions and to prepare for the change, including costs and other options. They should not be hit with unexpected expenses and inconveniences at the last minute or after the fact.”
The bill, S-3816/A-5369, was approved by the Senate Health, Human Services and Senior Citizens Committee with a vote of 7-2.
“Patients have rights that should be recognized and respected,” said Senator Sweeney (D-Gloucester/Salem/Cumberland). “They and their families should be fully informed in advance about decisions that have a direct impact on the type of care they will receive, what it will cost and how it will affect their quality of life.”
The Patient Protection Act would require health facilities and professionals to provide the following information to patients prior to being transferred or referred out-of-state, including:
- The patient’s right to receive care at a facility of his or her choice and with a provider of his or her choice;
- Clinical rationale for the out-of-state transfer or referral;
- Location of the out-of-state facility or professional;
- Availability of clinically appropriate services at New Jersey facilities and/or with professionals within the State;
- The nature of the relationship between the transferring facility or the referring professional and the out-of-state facility or out-of-state professional if the patient is being transferred or referred to an affiliated out-of-state facility or professional; and
- In instances of trauma, cardiac and stroke cases, an explanation as to why the patient is not being transferred to a Level 1 or Level 2 Trauma center, cardiac, or stroke center in New Jersey.
The bill also stipulates that facilities, prior to transfer, must facilitate communication between the patient and the health insurance carrier or self-funded health benefits plan sponsor to inform the patient about the network status of the out-of-state facility or provider, and any out-of-pocket costs for which the patient would be responsible.
The measure would also require licensed health care professionals to notify a patient’s health insurance carrier or self-funded health benefits plan sponsor prior to referring the patient to an out-of-state facility.