DISCLAIMER
The New Jersey Hospital Association’s (NJHA) Out-of-Network Implementation Toolkit (hereinafter “materials”) are intended to be tools that hospitals may use to implement and comply with the “Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act.” The information provided in these materials should not be relied upon or regarded as legal advice. No specific representation is made, nor should be implied, nor shall NJHA or any other party involved in creating, producing or delivering this material be liable in any manner whatsoever for any direct, incidental, consequential, indirect or punitive damages arising out of your use of these materials. NJHA makes no warranties or representations, express or implied, as to the accuracy or completeness of the information contained or referenced herein. This publication is provided “AS IS” WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESSED OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, OR NON-INFRINGEMENT. Some jurisdictions do not allow the exclusion of implied warranties, so the above exclusion may not apply to you. All images and information contained in these materials are copyrighted and otherwise proprietary. No use of this information is permitted without the prior written consent of NJHA. If you have other questions or concerns, please contact NJHA’s Legal Affairs at 609.275.4089.
NJHA Out-of-Network Implementation Toolkit
Governor Murphy signed the “Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act” (“OON”) June 1, 2018. The law is effective Aug. 29 and requires general acute care hospitals, satellite emergency departments, hospital-based off-site ambulatory facilities that perform ambulatory surgical procedures and ambulatory surgery facilities to provide certain information to consumers, including making available to the public a listing of the facility’s standard charges for items and services provided, in a form that is consistent with federal guidelines.
While the law provides consumer protections that the New Jersey Hospital Association (NJHA) has long supported, it is important to recognize that the law impacts consumers differently based on the type of insurance they have. The only plans definitively covered by the law are health plans that are fully insured and issued in New Jersey as well as the State Health Benefits Plan and the School Employees’ Health Benefits Plan. In the case of a self-funded plan, the plan sponsor may opt in and elect to subject itself to the law; however, it is not required to opt in. Therefore, the only provisions of the law that apply to members of self-funded plans that have elected not to opt-in are disclosure and arbitration requirements.
This toolkit contains:
- Provider Website Requirements: A checklist of the information that must appear on a hospital’s website including sample language to accompany the postings.
- Patient Notice Requirements Checklist and Script Language: A checklist of information that must be shared with a patient when scheduling an appointment and customizable script to assist with ensuring that specific information is discussed.
- Voluntary Out-of-Network Selection Acknowledgement: A form that may be shared with patients that knowingly and voluntarily choose to use an out-of-network provider.
- DOH Patient Disclosure Notices - NEW: On February 8, 2019, the New Jersey Department of Health issued disclosure forms it requires hospitals, satellite emergency departments and ambulatory surgery centers to use to comply with the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act. Accordingly, NJHA has replaced the disclosure templates in our OON toolkit with the DOH-required forms.
- Physician Awareness Message: A summary of the law that may be shared with your employed and contracted physicians to notify and inform them about the law’s provisions.
- Media/Community Talking Points: Suggested talking points that may assist in informing and educating local media and community representatives about the law.
- Consumer Resources: Resources to assist consumers with understanding medical bills.
