S2536

An Act concerning early intervention services and supplementing P.L.1993, c.309 (C.26:1A-36.6 et seq.).

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. a. As used in this section:

“Health care facility” means a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.)

“Health care professional” means an individual licensed or certified to provide health care services pursuant to Title 45 or Title 52 of the Revised Statutes.

“Health care provider” means a health care facility or health care professional.

b. In no case shall a health care provider providing services under the early intervention services program:

(1) issue a bill to a patient for services provided under the early intervention services program more than one year after the date the services were provided; or

(2) attempt to collect from a patient on a bill for services provided under the early intervention services program if the bill was issued more than one year after the date the services were provided.

c. (1) Nothing in this section shall be construed to prohibit a health care provider from, at any time, seeking payment or reimbursement for services provided under the early intervention services program from a patient’s health benefits plan.

(2) Notwithstanding the provisions of paragraph (1) of this subsection, in the event a health benefits plan denies a claim for reimbursement or provides partial reimbursement for a service provided under the early intervention services program, the health care provider may not bill the patient for, or otherwise attempt to collect from the patient, the balance of the claim, if:

(a) the claim was submitted to the health benefits plan more than one year after the date the service was provided; or

(b) the claim was submitted to the health benefits plan within one year after the date the service was provided, but more than 18 months elapsed since the date the service was provided.

2. The Commissioner of Health may adopt rules and regulations, pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), to implement the provisions of this act.

3. This act shall take effect immediately.

STATEMENT

This bill prohibits health care providers from billing patients for services provided under the early intervention services program more than one year after the service was provided, and prohibits providers from attempting to collect from a patient on a bill for early intervention services if the bill was issued more than one year after the service was provided.

Nothing in the bill will prohibit a health care provider from, at any time, seeking reimbursement for the service from the patient’s health benefits plan; provided that, if the health benefits plan denies the claim or provides only partial reimbursement, the health care provider will be prohibited from billing the patient for the balance of the claim if: 1) the claim was submitted to the health benefits plan more than one year after the date the service was provided; or 2) the claim was submitted to the plan within one year from the date the service was provided, but more than 18 months elapsed since the date the service was provided.

The early intervention services program is a Statewide program that provides specialized services and supports, from birth through age two, to infants and toddlers experiencing physical, cognitive, communication, social, emotional, or adaptive developmental delays or disabilities.

It has been suggested that some early intervention services providers have issued bills to patients years after the early intervention service was originally provided. This practice can result in administrative headaches and affordability issues for parents who are already navigating the complexities of caring for a child with special needs, as the parent then needs to negotiate with an insurance provider or find the money to cover the bill long after the child has exited the early intervention services program. It is the sponsor’s intent to help these families avoid the burden of these unexpected medical bills.