Sponsored by:
Assemblywoman SADAF F. JAFFER
District 16 (Hunterdon, Mercer, Middlesex and Somerset)
Assemblyman REGINALD W. ATKINS
District 20 (Union)
SYNOPSIS
Permits credit against contract cost for primary care services managed by health benefits company for public employees and their dependents; permits referrals to providers that have contractual relationship with such health benefits company.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health care services funded by a public employer for its employees and their dependents and supplementing Title 17B of the New Jersey Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Notwithstanding any provision of law or regulation to the contrary, a health benefits company that is managing, pursuant to a contract with a public employer, a health benefits program or plan for public employees and their dependents who are covered by the district’s health benefits program or plan may:
(a) provide a credit to the public employer toward the cost of the contract awarded by the public employer to the health benefits company to manage a medical home model for health care services for the public employees and their dependents; and
(b) refer public employees and their dependents, who receive services through the medical home model to providers with whom the health benefits company has a contractual relationship.
If provided, the amount of the credit permitted toward the cost of the contract shall not exceed the amount of the payments received by the health benefits company from insurers for claims submitted for provider services rendered to public employees and their dependents.
As used in this section “medical home” means on-site physicians, nurses, and pharmacy and laboratory services, provided at no cost to employees and their dependents, when the medical staff receive salaries and services are not provided on a fee-for-service basis and when primary care, care coordination through the use of health information technology and chronic disease registries, and referrals for specialist care are provided.
2. This act shall take effect immediately.
STATEMENT
This bill provides that a health benefits company that is managing, pursuant to a contract with a public employer, a health benefits program or plan for its employees and their dependents, who are covered by the employer’s health benefits program or plan may:
(a) provide a credit to the public employer toward the cost of the contract awarded to the health benefits company to manage a medical home model for health care services for the public employees and their dependents; and
(b) refer covered employees and their dependents, who receive services through the medical home model to other providers with whom the health benefits company has a contractual relationship.
If provided, the amount of the credit permitted toward the cost of the contract must not exceed the amount of the payments received by the health benefits company from insurers for claims submitted for provider services.
As used in this bill, “medical home” means on-site physicians, nurses, and pharmacy and laboratory services, provided at no cost to employees, and their dependents, of the school district, when the medical staff receive salaries and services are not provided on a fee-for-service basis and when primary care, care coordination through the use of health information technology and chronic disease registries, and referrals for specialist care are provided.