S1512

An Act establishing a task force to study tiered health insurance networks.

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

1. There is established the "New Jersey Task Force on Tiered Health Insurance Networks." The purpose of the task force is to study the recent trend towards tiered health insurance networks, identify the impact of tiered health insurance networks on consumers, hospitals, providers, and the health care delivery system, and make recommendations for legislation and strategies to create more effective and efficient policies regarding tiered health insurance networks in the State and to ensure that tiered networks operate in the public interest. The task force shall consider:

a. the competitive environment in the health insurance marketplace in New Jersey and the market share of the insurance companies in the market;

b. whether current protections concerning disclosures and enrollment of consumers are adequate for tiered networks;

c. whether current network adequacy rules need to be revised to address tiered networks and, if so, in what manner;

d. the effects of tiered networks on hospitals, particularly urban “safety net” hospitals, and measures the State should take to address any concerns that are identified;

e. the potential for the State government, as one of the largest providers of health insurance coverage in the State, to influence the manner in which tiered networks function in the State to reflect the State’s policy goals;

f. how the process of creating tiered provider networks can be made more transparent, fair and equitable for both providers and consumers;

g. the role of the Department of Health in assessing the effect tiered networks might have on the financial security of hospitals, particularly urban and “safety net” hospitals;

h. the National Association of Insurance Commissioners’ “Health Benefit Plan Network Access and Adequacy Model Act;”

i. the recommendations of the New Jersey Commission on Rationalizing Health Care Resources in that commission’s Final Report issued on January 24, 2008;

j. whether current network adequacy regulations are adequate to ensure that there is a diversity of health care facilities located throughout the State in the tiered networks, including essential community providers and hospitals which provide significant levels of care to low-income, uninsured, and vulnerable populations, so that tiered networks do not discriminate against underserved or high-risk populations;

k. whether potential limitations on access to out-of-State hospitals in tiered networks is in the public interest and how network adequacy regulations can fairly address access to those facilities; and

l. any other considerations the task force deems appropriate towards improving the State’s policies concerning tiered health insurance networks.

2. a. The task force shall consist of 19 members as follows:

(1) The Commissioners of Human Services, Health, and Banking and Insurance, and the Attorney General, or their designees, who shall serve ex officio;

(2) two members of the Senate, to be appointed by the President of the Senate, who shall each be of different political parties; and two members of the General Assembly, to be appointed by the Speaker of the General Assembly, who shall each be of different political parties; and

(3) 11 public members, who shall be appointed by the Governor no later than the 60th day after the effective date of this act, as follows: one person upon the recommendation of the New Jersey Hospital Association; one person upon the recommendation of the Hospital Alliance of New Jersey; one person upon the recommendation of the New Jersey Primary Care Association; one person upon the recommendation of the Medical Society of New Jersey; one person upon the recommendation of the New Jersey Business and Industry Association; one person upon the recommendation of the New Jersey State AFL-CIO; one person upon the recommendation of the New Jersey Association of Health Plans; one person upon the recommendation of The Center for State Health Policy at Rutgers, The State University of New Jersey; and three members of the public who have a demonstrated expertise in issues relating to the work of the task force.

b. The Commissioner of Banking and Insurance or the commissioner's designee shall serve as chairperson of the task force. The task force shall organize as soon as practicable following the appointment of its members and shall select a vice-chairperson from among the members. The chairperson shall appoint a secretary who need not be a member of the task force.

c. The public members shall serve without compensation, but shall be reimbursed for necessary expenses incurred in the performance of their duties and within the limits of funds available to the task force.

d. The task force shall be entitled to call to its assistance and avail itself of the services of the employees of any State, county or municipal department, board, bureau, commission or agency as it may require and as may be available to it for its purposes.

e. The task force may meet and hold hearings at the places it designates during the sessions or recesses of the Legislature.

f. The Department of Banking and Insurance shall provide staff support to the task force.

g. Vacancies in the membership of the task force shall be filled in the same manner provided for the original appointments.

3. The task force shall report its findings and recommendations to the Governor and the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), along with any legislative bills that it desires to recommend for adoption by the Legislature, no later than 12 months after the date of organization of the task force.

4. This act shall take effect immediately and shall expire upon the issuance of the task force report.

STATEMENT

This bill establishes the "New Jersey Task Force on Tiered Health Insurance Networks." The purpose of the task force is to study the recent trend towards tiered health insurance networks, identify the impact of tiered health insurance networks on consumers, hospitals, providers, and the health care delivery system, and make recommendations for legislation and strategies to create more effective and efficient policies regarding tiered health insurance networks in the State and to ensure that tiered networks operate in the public interest. The task force shall consider:

(1) the competitive environment in the health insurance marketplace in New Jersey and the market share of the insurance companies in the market;

(2) whether current protections concerning disclosures and enrollment of consumers are adequate for tiered networks;

(3) whether current network adequacy rules need to be revised to address tiered networks and, if so, in what manner;

(4) the effects of tiered networks on hospitals, particularly urban “safety net” hospitals, and measures the State should take to address any concerns that are identified;

(5) the potential for the State government, as one of the largest providers of health insurance coverage in the State, to influence the manner in which tiered networks function in the State to reflect the State’s policy goals;

(6) how the process of creating tiered provider networks can be made more transparent, fair and equitable for both providers and consumers;

(7) the role of the Department of Health in assessing the effect tiered networks might have on the financial security of hospitals, particularly urban and “safety net” hospitals;

(8) the National Association of Insurance Commissioners’ “Health Benefit Plan Network Access and Adequacy Model Act;”

(9) the recommendations of the New Jersey Commission on Rationalizing Health Care Resources in that commission’s Final Report issued on January 24, 2008;

(10) whether current network adequacy regulations are adequate to ensure that there is a diversity of health care facilities located throughout the State in the tiered networks, including essential community providers and hospitals which provide significant levels of care to low-income, uninsured, and vulnerable populations, so that tiered networks do not discriminate against underserved or high-risk populations;

(11) whether potential limitations on access to out-of-State hospitals in tiered networks is in the public interest and how network adequacy regulations can fairly address access to those facilities; and

(12) any other considerations the task force deems appropriate towards improving the State’s policies concerning tiered health insurance networks.

The task force is comprised of 19 members as follows:

(1) the Commissioners of Human Services, Health, and Banking and Insurance, and the Attorney General, or their designees, who shall serve ex officio;

(3) 11 public members, who shall be appointed by the Governor no later than the 60th day after the effective date of this bill, as follows: one person upon the recommendation of the New Jersey Hospital Association; one person upon the recommendation of the Hospital Alliance of New Jersey; one person upon the recommendation of the New Jersey Primary Care Association; one person upon the recommendation of the Medical Society of New Jersey; one person upon the recommendation of the New Jersey Business and Industry Association; one person upon the recommendation of the New Jersey State AFL-CIO; one person upon the recommendation of the New Jersey Association of Health Plans; one person upon the recommendation of The Center for State Health Policy at Rutgers, The State University of New Jersey; and three members of the public who have a demonstrated expertise in issues relating to the work of the task force.

The bill provides that the Commissioner of Banking and Insurance or the commissioner's designee is to serve as chairperson of the task force. The members will serve without compensation, but will be reimbursed for necessary expenses incurred in the performance of their duties and within the limits of funds available to the task force.

The task force may call to its assistance and avail itself of the services of the employees of any State, county or municipal department, board, bureau, commission or agency as it may require and as may be available to it for its purposes. The task force may meet and hold hearings at the places it designates during the sessions or recesses of the Legislature. The bill directs the Department of Banking and Insurance to provide staff support to the task force.

The task force is to report its findings and recommendations to the Governor and the Legislature, along with any legislative bills that it desires to recommend for adoption by the Legislature, no later than 12 months after the date of organization of the task force, at which point the task force will expire.