Out of state, not out of mind: Bill would close out-of-network loophole

By Anjalee Khemlani
Trenton | Apr 23, 2019 at 1:01 pm

Assemblyman Nick Chiaravalloti is planning to introduce legislation in May that would plug a loophole in the out-of-network law that has been affecting patients transferred out of state.

Chiaravalloti (D-Bayonne) said the law doesn’t require transparency when patients are being transferred out of state for care, and out-of-network charges are applied there.

The bill draft, obtained by ROI-NJ, calls for greater transparency from all health care facilities licensed in the state, except for pediatric facilities.

Health care professionals would be required to document in the patient records and notify patients of

  • The patient’s right to receive care at a facility of choice;
  • Clinical rationale for the out-of-state transfer;
  • Location of the out-of-state facility;
  • Availability of clinically appropriate services at nearby New Jersey facilities;
  • The nature of the relationship if the patient is being transferred or referred to an affiliated facility; and
  • In instances of trauma, stroke or cardiovascular diagnoses, an explanation as to why the patient is not being transferred to a facility in New Jersey.

The bill also requires patients be provided information from their insurance providers as to their potential out-of-pocket costs for an out-of-state facility, and requires health facilities to disclose to patients their relationships with out-of-state providers the patients are being referred to.

This is particularly important with the recent merger activity in South Jersey with some hospitals tied to health systems in Pennsylvania.

“When I heard that a patient, who asked to be transferred to a nearby, high-quality New Jersey hospital, was told they had to be transferred to a Philadelphia hospital that was farther away, I wanted to ensure that could never happen again,” Chiaravalloti said.

“It is ridiculous to think a patient could be sent to Pennsylvania simply because they are in a hospital that is part of an out-of-state healthcare system. Healthcare decisions should be based on the best interest of the patient.”

Despite existing state and federal laws, there are still out-of-network charges patients face in situations such as these, Chiaravalloti said.

“To ensure that health care consumers are able to make well-informed health care decisions, patients should be informed of their right to select the facility in which they receive their care before being transferred to another state,” he said. “Patients should have all the information about why they are being transferred, and their financial responsibilities associated with the transfer — only then can a patient make an informed choice.”

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Anjalee Khemlani | akhemlani@roi-nj.com | AnjKhem