As you know, the latest “Out-of-Network” bill, A-1952, passed through the Assembly Appropriations Committee on October 27, despite opposition from our Society, MSNJ, the Hospital Association, and all other provider groups who testified against it.
The following is an update on what this development means to our patients and our ability to provide them with highest-quality medical care anywhere.
A-1952 is the latest iteration of an onerous, insurance-driven legislation that we have been opposing since 2010 when Gary Schaer (D-Passaic) proposed his bill capping OON reimbursements to a multiple of Medicare (In its worst form, the bill restricted OON emergency billing to 150% of Medicare). A-1952 caps at 250% of Medicare.
The most familiar version of this bill was A-4444/S-20, which we successfully stopped from passing out of Assembly and Senate committees from 2012 -2015.
Last June, A-1952 was reported out of the Assembly Financial Institutions (AFI) Committee, whose Chair, Craig Coughlin (D-Woodbridge), is also a sponsor of the bill. Fortunately, S-20, the Senate counterpart to A-1952, failed to clear the Commerce Committee.
At no time has an OON bill been voted upon by a full Assembly or Senate floor.
What is required for A-1952 to become law?
When a bill is introduced for consideration in either the Assembly or Senate (first reading), it is typically assigned to a committee for review, public comment, and amendment. A-1952 went through this process last Spring, when it was referenced to and reported out of AFI. It was then second referenced to Appropriations for review of fiscal impact. Public hearing on this was held on Oct 27, and the bill was again reported out of committee.
A-1952 can now be considered by the entire Assembly (second reading), although amendments can now be proposed by members.
Once A-1952 reaches its final form with incorporated amendments, it can be considered by the full Assembly floor (third reading) for a vote. Passage requires a majority of at least 41 votes. In the Assembly, there are 52 Democrats and 28 Republicans.
Meanwhile, a similar process has to occur in the Senate Committees and Senate floor, with 21 votes for majority. In the Senate, there are 24 Democrats and 16 Republicans.
The Assembly and Senate versions must be identical, through a process known as reconciliation.
After final passage through both houses, the bill lands on the Governor’s desk. Here, it can be vetoed outright, conditionally vetoed (sent back for amendments), or approved.
In all, there are approximately 12 steps that a bill has to go through in order to become law. A-1952 has gone through three of these. This is worrisome because 1. No other OON bill has progressed so far, and 2. The bill was rammed through two committees despite vigorous objections that previously managed to halt the bill.
Of note, Governor Christie has provided assurances of his opposition to A-1952. Unfortunately, his term ends in January of 2018.
What Happens Now?
1. NJNS has actively engaged Assembly Speaker Prieto (D-Hudson/Bergen) regarding the negative consequences of A-1952. We met with him on Nov 1 for this purpose. The Speaker can control further amendments to the bill, scheduling of a full vote, or even whether second and third readings occur.
Even though the Speaker has not committed to posting A-1952 for a vote, he is under enormous political pressure to do so. His advice to us was simple and direct – if we want his help on this matter, we will have to help him. How? By contacting as many legislators as possible to let them know how A-1952 will adversely affect New Jersey citizens. These legislators are continually visited by insurance carrier lobbyists proclaiming the predatory practices of OON providers. It is now up to us to tell the other side of this story. Surprisingly, these legislators have not been hearing it outside of occasional committee hearings.
2. We providers need to reach out to our legislators, on an on-going and individual basis, to inform them that A-1952 is bad policy that will only hurt the residents of NJ by reducing quality and access to needed specialists. This is a call to action! We need to become engaged. It is time to wake up our colleagues (neurosurgeons and others) and ask them to email their legislators why preserving OON is important, especially with emergency care. Routine email contact is essential. When legislators assemble in caucus, they do discuss what their constituents are saying. Word will get around that they are getting emails against A-1952.
We will separately email a list of Assembly and Senate legislators, arranged by district, with email addresses. This should simplify the process of contacting our respective lawmakers.
3. Meanwhile, NJNS has been formulating a more proactive stance in the battle, rather than our historically defensive postures (that have not been effective during this legislative session).
a) A new OOB bill has been drafted that incorporates the transparency mandates of A-1952, while eliminating its onerous price caps. Assemblyman Raj Mukherji (D-Jersey City) has introduced this bill, A-4228. It has received first reading but has not yet been assigned to a committee.
b) On November 21, the Coalition will host a press conference on A-4228 at the Trenton State House. Mukherji will be there, along with Senator Tom Keane (Minority Leader). We have approached other lawmakers, whose support we can count on, to attend as well.
4. NJNS has been delving further into ERISA-governed health plans, especially as they pertain to TPA cost-containment provisions that rob our self-funded plans (including SHBP) of hundreds of millions of dollars every year. Our goal is to demonstrate to lawmakers (and union leadership) that elimination of these provisions can save the state far more than can be achieved by restricting OON, without public health consequences. This is important, because a key driver of the OON issue is budgetary. Sponsors of A-1952 often cite the cost, to New Jersey, of OON billing, with the newest OLS report estimating that cost to be more than $800 million a year.
We have to offer an alternative means for legislators to achieve yearly cost reductions. In our efforts, we have enlisted the help of Herb Conaway (D- Burlington), Chairman of the Assembly Health and Senior Services Committee, along with OLS, which has attempted to retrieve ASO contracts between SHBP and Horizon/Aetna. Republicans on the AFI Committee have also offered assistance.
It is time for the insurance companies to be placed on the defensive. Attached is a summary of the ERISA issue.
On another subject, it is time for a membership drive and dues request. As before, the effectiveness of our efforts in Trenton relies on how extensively out Society represents the state’s neurosurgical workforce. Our numbers are few, but our voices carry a great deal of respect given the nature of our profession. As such, we hope to add each and every one of you to the membership roster.
Membership dues remain the same as last year.
Active members (in practice more than 3 years) – $2500.
Active members (in practice 3 years or less) – $1500
Retired members – $1500
Membership dues can be paid from corporate accounts. Checks should be made out to “New Jersey Neurosurgical Society” and mailed to:
Anthony D’Ambrosio, MD, Treasurer.
1200 E Ridgewood Ave, Ste. 200
Ridgewood, NJ, 07450
Thank you in advance for your time.
RW Raab, MD