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NEW JERSEY STATUTE PERMITS HOSPITALS TO CONDITION NON-EMERGENCY TREATMENT

NEW JERSEY STATUTE PERMITS HOSPITALS TO CONDITION NON-EMERGENCY TREATMENT UPON PAYMENT UNLESS THE PATIENT CAN PROVE ELIGIBILITY FOR CHARITY CARE OR OTHER BENEFIT PROGRAMS OR PRIVATE INSURANCE

By: Marion K. Littman

New Jersey law requires acute care hospitals in the state to provide treatment to patients regardless of their ability to pay. N.J.S.A. 26:2H-18.64; N.J.A.C. 43G-4.1(a)(2). While this does not permit patients who have the ability to pay to demand free care, it has been difficult for hospitals to implement this distinction, particularly when patients and their families refuse to provide financial information to document that they are entitled to charity care before receiving non-emergency care. A recently enacted New Jersey statute addresses this problem. It provides that

“A person who is seeking health care services at a hospital as a patient for a non-emergency or elective procedure who does not furnish proof of health insurance coverage for the services or eligibility for charity care or reduced charge charity care in accordance with [New Jersey law], or for any other program of benefits funded by the State, shall be required to provide sworn financial information sufficient to determine eligibility for any such program of benefits. Notwithstanding any other provision of law to the contrary, if the person does not provide the required financial information or the hospital determines that the person is ineligible for any of the aforementioned benefits, the hospital shall be entitled to conclude an arrangement with the person, or an individual acting on the person’s behalf, to receive payment from or on behalf of that person as a condition of the provision of health care services to that person.”

N.J.S.A. 26:2H-18.63(e), P.L. 2001, c.296 [emphasis added].

Thus, if a patient is seeking non-emergency or elective care, the patient can be required, as a condition of receiving the care, to either:

A. Provide proof of insurance or eligibility for Medicaid or charity care; or

B. Provide sworn financial information showing eligibility for such benefits; or

C. Make arrangements with the health care facility for payment for the services.

June 7, 2002