DISCLAIMER

The New Jersey Hospital Association’s (NJHA) Federal/State Surprise Billing Requirements Toolkit (Materials) is intended to serve as tools that member hospitals may use to implement and comply with the requirements of both the New Jersey “Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act” and the federal “No Surprises Act.”  Member hospitals should not regard any information provided in these Materials as specific legal advice, and they should consult with their own legal counsel for additional guidance as appropriate. NJHA and any other party involved in creating, producing, or delivering these Materials shall not be liable for any direct, incidental, consequential, indirect, or punitive damages arising out of the use of these Materials. The further distribution of these Materials is prohibited without the prior written consent of NJHA.

The information contained within the Materials is provided to assist members’ compliance efforts to protect consumers from surprise medical bills as required by law effective Jan. 1, 2022.  However, it must be noted that the federal law requirements were issued as interim final rules—that are subject to change and are only

NJHA FEDERAL/STATE SURPRISE BILLING TOOLKIT

Beginning Jan. 1, 2022, providers must be compliant with the No Surprises Act (NSA) and its implementing regulations. The intent of the NSA, much like the New Jersey Out-of-Network law that was signed in 2018, is to protect patients from surprise medical bills.

Given that, there are several similarities between the two laws including:

• Patient protection disclosure notice requirements
• Patients notice and consent requirements for billing
• A baseball style arbitration process.

The law acknowledged that several states had passed legislation to protect against surprise medical bills and made efforts to not conflict with those state laws. However, the law has created a bifurcated system that providers will have to navigate very carefully.

To assist members with compliance the New Jersey Hospital Association created a toolkit of resources to help navigate the requirements of the federal law, state law and the intersection between the two.

The toolkit currently includes:

• Comparison of State and Federal Disclosure Methods:  An overview of the disclosures required under the No Surprises Act and New Jersey’s Out-of-Network law and the various methods in which they must be presented to consumers.
• Disclosure Notices Regarding Surprise Billing Protections: Customizable forms to help consumers understand how they are protected against surprise medical bills.
• Notice and Consent For Patient Billing: An overview of the restrictions on billing patients above their in-network cost-sharing with information on where to access the required documentation that must be provided in order to bill.
• Balance Billing Restrictions: A list of the providers and services restricted from balance billing under federal and state law.
• Good Faith Estimate Procedural Requirements: An overview of the format, timing and other procedural requirements related to the federal good faith estimate requirements.
• Putting the Pieces Together: Your Guide To Surprise Medical Bills – Part A
• Putting the Pieces Together: Your Guide To Surprise Medical Bills – Part B
• Survey: In order to better assist our members, NJHA requests your feedback on these resources.

This toolkit will be expanded and revised as needed based on the changing environment. Please check back for updates.