A3423

An Act concerning stroke care, amending P.L.2004, c.136, repealing sections 3 and 4 of P.L.2004, c.136, and supplementing various parts of the statutory law.

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

1. Section 2 of P.L.2004, c.136 (C.26:2H-12.28) is amended to read as follows:

2. The Commissioner of Health shall designate hospitals that meet the criteria set forth in this [act] section as primary or comprehensive stroke centers or acute stroke ready hospitals.

a. A hospital shall apply to the commissioner for designation and shall demonstrate to the satisfaction of the commissioner that the hospital [meets the criteria set forth in section 3 or 4 of this act for] has been certified as a primary or comprehensive stroke center or as an acute stroke ready hospital, respectively, by the Joint Commission, the American Heart Association, or another organization that provides such certifications as may be approved by the commissioner. A facility designated as a primary or comprehensive stroke center prior to the effective date of P.L. , c. (pending before the Legislature as this bill) shall retain such designation by obtaining, and providing the commissioner with documentation of, the appropriate certification within one year of the effective date of P.L. , c. (pending before the Legislature as this bill).

b. The commissioner shall designate as many hospitals as primary stroke centers as apply for the designation, provided that the hospital meets the [criteria set forth in section 3 of this act. In addition to the criteria set forth in section 3 of this act, the commissioner is encouraged to take into consideration whether the hospital contracts with carriers that provide coverage through the State Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) and the NJ FamilyCare Program, established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.)] certification requirements set forth in subsection a. of this section.

c. The commissioner shall designate as many hospitals as comprehensive stroke centers as apply for the designation, provided that the hospital meets the [criteria set forth in section 4 of this act] certification requirements set forth in subsection a. of this section.

d. The commissioner shall designate as many hospitals as acute stroke ready hospitals as apply for the designation, provided that the hospital meets the certification requirements set forth in subsection a. of this section.

e. The commissioner may suspend or revoke a hospital's designation as a stroke center or acute stroke ready hospital, after notice and hearing, if the commissioner determines that the hospital is not in compliance with the requirements of this act.

f. The commissioner shall encourage primary and comprehensive stroke centers to coordinate, by written agreement, with acute stroke ready hospitals throughout the State to provide appropriate access to care for acute stroke patients. Agreements made pursuant to this subsection shall include: (1) transfer agreements for the transport to and acceptance of stroke patients by stroke centers for the provision of stroke treatment therapies an acute stroke ready hospital is unable to provide; and (2) any communication criteria and protocols as shall be necessary to effectuate the agreement.

g. The Commissioner of Health shall prepare, maintain, and make available on the Department of Health website a list of facilities designated as primary stroke centers, comprehensive stroke centers, and acute stroke ready hospitals. A current copy of the list shall be transmitted to each emergency services provider, as defined in subsection e. of section 3 of P.L. , c. (C. ) (pending before the Legislature as this bill), no later than June 1 of each year.

h. (1) Primary and comprehensive stroke centers and acute stroke ready hospitals shall annually submit to the department data concerning information and statistics for stroke care that align with the stroke consensus metrics jointly developed and approved by the American Heart Association and the American Stroke Association.

(2) Data submitted pursuant to paragraph (1) of this subsection shall be complied by the department into a Statewide stroke database, which shall be made available on the department website.

(3) Data submitted pursuant to paragraph (1) of this subsection shall not contain or be construed to require disclosure of confidential or personal identifying information.

(cf: P.L.2012, c.17, s.193)

2. (New section) a. In order to ensure the implementation of a strong Statewide system of stroke care, there is established in the Department of Health the Stroke Care Advisory Panel, which, subject to subsection c. of this section, shall consist of 11 members, as follows: the Commissioner of Health, or a designee, who shall serve ex officio; the Director of the Office of Emergency Medical Services in the Department of Health, or a designee, who shall serve ex officio; and nine public members to be appointed by the Governor. The public members shall include representatives from the American Stroke Association, primary and comprehensive stroke centers, an acute stroke ready hospital, hospitals located in urban and rural areas of the State, physicians, and volunteer and non-volunteer emergency services providers. Public members shall serve for a term of two years and shall be eligible for reappointment.

b. The Stroke Care Advisory Panel established under this section shall organize as soon as practicable but no later than 60 days after the effective date of this act, and, except as provided in subsection c. of this section, shall select a chairperson and a vice-chairperson from among its members. The chairperson shall appoint a secretary who need not be a member of the panel. The panel shall meet no less than four times per year and at such other times as may be necessary to discharge its duties. Members shall serve without compensation but shall be reimbursed for necessary expenses incurred in the performance of their duties within the limits of funds appropriated for that purpose. The Department of Health shall provide staff services to the panel.

c. The chairperson, vice-chairperson, any public members of the Stroke Advisory Panel constituted in the Department of Health as of the effective date of P.L. , c. (C. ) (pending before the Legislature as this bill) may choose to remain on the Stroke Care Advisory Panel for up to one year following the effective date of P.L. , c. (C. ) (pending before the Legislature as this bill). Thereafter, the public members and shall be eligible for reappointment pursuant to subsection a. of this section, and the chairperson and vice-chairperson shall be eligible for re-selection for their positions pursuant to subsection b. of this section.

d. The Stroke Care Advisory Panel established pursuant to this section shall continue any duties and responsibilities vested in the Stroke Advisory Panel constituted in the Department of Health as of the effective date of P.L. , c. (C. ) (pending before the Legislature as this bill). In addition, the Stroke Care Advisory Panel shall be charged with assessing the stroke system of care in New Jersey and identifying and recommending means of improving the provision of stroke care. In addition to any other actions or recommendations as it finds necessary and appropriate, the panel shall:

(1) analyze the Statewide stroke database maintained pursuant to paragraph (2) of subsection h. of P.L.2004, c.136 (C.26:2H-12.28) to identify potential interventions to improve the provision of stroke care in the State, with a focus on identifying and improving care in underserved regions and populations of the State;

(2) encourage the sharing of information and data among health care providers on ways to improve the quality of care to stroke patients in the State;

(3) facilitate the communication and analysis of health information and data among the health care professionals providing care for individuals with stroke;

(4) enhance coordination and communication between hospitals, primary and comprehensive stroke centers, acute stroke ready hospitals, and other support services necessary to assure access to effective and efficient stroke care;

(5) develop evidence-based treatment guidelines regarding the transitioning of patients to community-based follow-up care in hospital outpatient, physician office, and ambulatory clinic settings for ongoing care after hospital discharge following acute treatment for stroke;

(6) establish a data oversight process and implement a plan for achieving continuous quality improvement in the quality of care provided under the Statewide system for stroke response and treatment; and

(7) develop model protocols for the assessment, treatment, and transport of stroke patients for use by emergency services providers, which shall include best practice standards for the triage and transport of acute stroke patients.

e. No later than one year after the date of organization, and annually thereafter, the Stroke Care Advisory Panel shall submit a report to the Governor and, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), to the Legislature, detailing its activities, findings, and proposals for legislative, executive, or other action to improve and enhance the Statewide stroke system of care.

3. (New section) a. The Office of Emergency Medical Services in the Department of Health shall adopt a nationally recognized standardized stroke triage assessment tool, which shall be made available on the Department of Health website and shall be transmitted to each emergency services provider in the State no later than June 1 of each year.

b. Each emergency services provider in the State shall develop and implement a stroke triage assessment tool that is substantially similar to the standardized stroke triage assessment tool adopted pursuant to subsection a. of this section.

c. Each emergency services provider in the State shall establish pre-hospital care protocols related to the assessment, treatment, and transport of stroke patients, which shall include, but not be limited to, plans for the triage and transport of acute stroke patients to the nearest primary or comprehensive stroke center or, when appropriate, acute stroke ready hospital, within a specified timeframe following the onset of symptoms.

d. Each emergency services provider in the State shall incorporate training on the assessment and treatment of stroke patients in its training requirements for emergency services personnel.

e. As used in this section, "emergency services provider" means a local law enforcement agency, emergency medical services unit, fire department or force, emergency communications provider, volunteer fire department, duly incorporated fire or first aid company, or volunteer emergency, ambulance, or rescue squad association or organization or company which provides emergency services.

4. (New section) a. A carrier which offers a managed care plan in this State shall provide coverage for telemedicine services for patients with acute stroke delivered to a covered person in a health care facility to the same extent that the services would be covered if they were provided through an in-person consultation.

b. The contract may:

(1) provide for a deductible, co-payment, or coinsurance for an acute stroke care service provided through telemedicine, provided that it does not exceed the deductible, co-payment, or coinsurance applicable to an in-person consultation;

(2) limit coverage to acute stroke care services provided by health care providers in the health benefits plan’s network; and

(3) require originating site health care providers to document the reasons the acute stroke care services are being provided by telemedicine rather than in person.

c. Nothing in this section shall be construed to:

(1) prohibit the contract from providing coverage for only those acute stroke care services that are medically necessary, subject to the terms and conditions of the covered person’s health benefits plan; or

(2) require the contract to reimburse the distant site health care provider if the distant site health care provider has insufficient information to render an opinion.

d. As used in this section:

“Health care facility” means the same as defined in section 2 of P.L.1971, c.136 (C.26:2H-2).

“Telemedicine” means the diagnosis, consultation, or treatment of the symptoms of acute stroke through the use of live interactive audio and video over a secure connection that complies with the requirements of the “Health Insurance Portability and Accountability Act of 1996,” Pub.L.104-191, and any applicable regulations promulgated pursuant thereto. Telemedicine shall not include the use of audio-only telephone, e-mail, or facsimile.

5. (New section) a. The State Health Benefits Commission shall ensure that every contract purchased by the commission that provides hospital and medical expense benefits shall provide coverage for telemedicine services for patients with acute stroke delivered to a covered person in a health care facility to the same extent that the services would be covered if they were provided through an in-person consultation.

b. The contract may:

(2) limit coverage to acute stroke care services provided by health care providers in the health benefits plan’s network; and

(3) require originating site health care providers to document the reasons the acute stroke care services are being provided by telemedicine rather than in person.

c. Nothing in this section shall be construed to:

(2) require the contract to reimburse the distant site health care provider if the distant site health care provider has insufficient information to render an opinion.

d. As used in this section:

“Health care facility” means the same as defined in section 2 of P.L.1971, c.136 (C.26:2H-2).

6. (New section) a. The School Employees’ Health Benefits Commission shall ensure that every contract purchased by the commission that provides hospital and medical expense benefits shall provide coverage for telemedicine services for patients with acute stroke delivered to a covered person in a health care facility to the same extent that the services would be covered if they were provided through an in-person consultation.

b. The contract may:

(2) limit coverage to acute stroke care services provided by health care providers in the health benefits plan’s network; and

(3) require originating site health care providers to document the reasons the acute stroke care services are being provided by telemedicine rather than in person.

c. Nothing in this section shall be construed to:

(2) require the contract to reimburse the distant site health care provider if the distant site health care provider has insufficient information to render an opinion.

d. As used in this section:

“Health care facility” means the same as defined in section 2 of P.L.1971, c.136 (C.26:2H-2).

7. The Commissioner of Health and the Commissioner of Banking and Insurance shall, pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), promulgate rules and regulations as may be necessary to implement this act.

8. The following sections are repealed:

Section 3 of P.L.2004, c.136 (C.26:2H-12.29); and

Section 4 of P.L.2004, c.136 (C.26:2H-12.30).

9. This act shall take effect immediately, and sections 4, 5, and 6 shall apply to contracts entered into on or after the effective date of this act.

STATEMENT

This bill establishes various requirements to revise and improve the Statewide system of stroke care by recognizing a new category of certified stroke care facilities, establishing a Statewide stroke care database, mandating stroke care standards and protocols for emergency services providers, establishing a Stroke Care Advisory Panel, and mandating insurance coverage for telemedicine.

Specifically, the bill revises the requirements for designating primary and comprehensive stroke centers, and permits the designation of new acute stroke ready hospitals, by providing that the Commissioner of Health (“commissioner”) is to designate any facility that has obtained the requisite certification from the Joint Commission, the American Heart Association, or any other organization approved by the commissioner that provides certifications for such facilities. Under current law, the commissioner is tasked with determining which facilities meet the requirements to be designated as a primary or comprehensive stroke center in accordance with certain criteria set forth in statute; the bill repeals the provisions detailing these criteria. Stroke care facilities designated pursuant to current law may retain that designation by obtaining and submitting documentation of the appropriate certification to the commissioner within one year after the effective date of the bill.

The bill requires the commissioner to encourage designated stroke centers to enter into written agreements with acute stroke ready hospitals to provide for the transfer of patients to stroke centers for care that is unavailable at an acute stroke ready hospital. The commissioner will be required to prepare, maintain, and make available on the Department of Health (“DOH”) website a list of designated stroke care facilities, which is to be transmitted to each emergency services provider in the State no later than June 1 of each year.

Stroke centers and acute stroke ready hospitals will be required to annually submit to DOH data concerning information and statistics for stroke care, which DOH will compile into a Statewide stroke database that will be available on the DOH website. The submitted data will not contain any confidential or personal identifying information.

The bill additionally establishes the Stroke Care Advisory Panel in DOH, which is to incorporate the duties, responsibilities, and membership of the Stroke Advisory Panel currently constituted in DOH. The 11-member panel will consist of the commissioner and the Director of the Office of Emergency Medical Services in DOH, or their designees, who will serve ex officio, and nine public members to be appointed by the Governor. The public members are to include representatives from the American Stroke Association, primary and comprehensive stroke centers, an acute stroke ready hospital, hospitals located in urban and rural areas of the State, physicians, and volunteer and non-volunteer emergency services providers. The public members will serve for a term of two years and will be eligible for reappointment. The public members serving on the current DOH advisory panel will be authorized to remain as public members on the panel created under the bill for up to one year, and will be eligible for reappointment.

The advisory panel is to organize as soon as practicable but no later than 60 days after the effective date of the bill, and select a chairperson and a vice-chairperson from among its members, except that the chairperson and vice-chairperson of the current DOH advisory panel will be authorized to continue in those roles on the advisory panel created under the bill for up to one year, and will be eligible for reappointment to those roles. The chairperson will appoint a secretary who need not be a member of the advisory panel. The advisory panel will meet no less than four times per year and at such other times as may be necessary to discharge its duties. Members will serve without compensation but will be reimbursed for necessary expenses incurred in the performance of their duties within the limits of funds appropriated for that purpose. DOH will provide staff services to the panel.

In addition to the duties and responsibilities of the current DOH advisory panel, the panel created under the bill will be charged with assessing the system of stroke care in New Jersey and identifying and recommending means of improving the provision of stroke care, including analyzing the Statewide stroke database established under the bill; encouraging information and data sharing among health care providers and facilities; developing evidence-based treatment guidelines for transitioning of patients to community-based follow-up care; establishing a data oversight process and implementing a plan for achieving continuous quality improvement in the quality of care provided; developing model protocols for the assessment, treatment, and transport of stroke patients for use by emergency services providers; and proposing ways to enhance the provision of stroke care in regions and communities of the State that are underserved by the current system of stroke care. The advisory panel is to submit an annual report to the Governor and the Legislature detailing its activities, findings, and proposals to improve and enhance the Statewide stroke system of care.

The bill requires the Office of Emergency Medical Services in DOH to adopt a nationally recognized standardized stroke triage assessment tool, which is to be made available on the Department of Health website and transmitted to each emergency services provider no later than June 1 of each year. Emergency services providers are to develop and implement a stroke triage assessment tool that is substantially similar to the standardized stroke triage assessment tool. Emergency services providers are to additionally establish pre-hospital care protocols related to the assessment, treatment, and transport of stroke patients, which are to include, but not be limited to, plans for the triage and transport of acute stroke patients to the nearest primary or comprehensive stroke center or, when appropriate, acute stroke ready hospital, within a specified timeframe following the onset of symptoms. Emergency services providers will additionally be required to incorporate training on the assessment and treatment of stroke patients in their training requirements for emergency services personnel. As used in the bill, "emergency services provider" means a local law enforcement agency, emergency medical services unit, fire department or force, emergency communications provider, volunteer fire department, duly incorporated fire or first aid company, or volunteer emergency, ambulance, or rescue squad association or organization or company which provides emergency services.

The bill additionally requires health insurance carriers, the State Health Benefits Program, and the School Employees’ Health Benefits Program to provide coverage for telemedicine for patients with acute stroke delivered to a covered person in a health care facility to the same extent that the services would be covered if they were provided through an in-person consultation. As used in the bill, “telemedicine” means the diagnosis, consultation, or treatment of the symptoms of acute stroke through the use of live interactive audio and video over a secure connection that complies with the requirements of the “Health Insurance Portability and Accountability Act of 1996,” Pub.L.104-191. Telemedicine will not include the use of audio-only telephone, e-mail, or facsimile.

The bill specifies that a carrier, or the State programs, may charge a deductible, co-payment, or coinsurance for acute stroke care services provided through telemedicine, limit coverage to health care providers in the health benefits plan’s network, and require originating site health care providers to document the reasons the acute stroke care services are being provided by telemedicine rather than in person.