SENATE COMMITTEE SUBSTITUTE FOR
SENATE, No. 1097
STATE OF NEW JERSEY
221st LEGISLATURE
ADOPTED OCTOBER 7, 2024
Sponsored by:
Senator BRITNEE N. TIMBERLAKE
District 34 (Essex)
Senator ANGELA V. MCKNIGHT
District 31 (Hudson)
SYNOPSIS
Requires health insurance carriers and Medicaid to provide coverage for planned home childbirth.
CURRENT VERSION OF TEXT
Substitute as adopted by the Senate Health, Human Services and Senior Citizens Committee.
An Act concerning health insurance coverage of planned home childbirth and supplementing various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A hospital service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for costs associated with planned home childbirth, including, but not limited to, services provided by a health care provider, services provided by a doula, and equipment and medical supplies.
b. The coverage shall be provided to the same extent as for any other health care services under the hospital service corporation contract.
c. This section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
d. As used in this section, “health care provider” means an individual or entity which, acting within the scope of its licensure or certification, provides health care services. “Health care provider” includes a family practice physician, obstetrician, advanced practice nurse, registered professional nurse, licensed practical nurse, certified professional midwife, certified nurse midwife, or certified midwife.
2. a. A medical service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for costs associated with planned home childbirth, including, but not limited to, services provided by a health care provider, services provided by a doula, and equipment and medical supplies.
b. The coverage shall be provided to the same extent as for any other health care services under the medical service corporation contract.
c. This section shall apply to those medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
d. As used in this section, “health care provider” means an individual or entity which, acting within the scope of its licensure or certification, provides health care services. “Health care provider” includes a family practice physician, obstetrician, advanced practice nurse, registered professional nurse, licensed practical nurse, certified professional midwife, certified nurse midwife, or certified midwife.
3. a. A health service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for costs associated with planned home childbirth, including, but not limited to, services provided by a health care provider, services provided by a doula, and equipment and medical supplies.
b. The coverage shall be provided to the same extent as for any other health care services under the health service corporation contract.
c. This section shall apply to those health service corporation contracts in which the health service corporation has reserved the right to change the premium.
d. As used in this section, “health care provider” means an individual or entity which, acting within the scope of its licensure or certification, provides health care services. “Health care provider” includes a family practice physician, obstetrician, advanced practice nurse, registered professional nurse, licensed practical nurse, certified professional midwife, certified nurse midwife, or certified midwife.
4. a. An individual health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:26-1 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for costs associated with planned home childbirth, including, but not limited to, services provided by a health care provider, services provided by a doula, and equipment and medical supplies.
b. The coverage shall be provided to the same extent as for any other health care services under the policy.
c. This section shall apply to those individual health insurance policies in which the insurer has reserved the right to change the premium.
d. As used in this section, “health care provider” means an individual or entity which, acting within the scope of its licensure or certification, provides health care services. “Health care provider” includes a family practice physician, obstetrician, advanced practice nurse, registered professional nurse, licensed practical nurse, certified professional midwife, certified nurse midwife, or certified midwife.
5. a. A group health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:27-26 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for costs associated with planned home childbirth, including, but not limited to, services provided by a health care provider, services provided by a doula, and equipment and medical supplies.
b. The coverage shall be provided to the same extent as for any other health care services under the policy.
c. This section shall apply to those group health insurance policies in which the insurer has reserved the right to change the premium.
d. As used in this section, “health care provider” means an individual or entity which, acting within the scope of its licensure or certification, provides health care services. “Health care provider” includes a family practice physician, obstetrician, advanced practice nurse, registered professional nurse, licensed practical nurse, certified professional midwife, certified nurse midwife, or certified midwife.
6. a. A health maintenance organization contract for health care services that is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for costs associated with planned home childbirth, including, but not limited to, services provided by a health care provider, services provided by a doula, and equipment and medical supplies.
b. The coverage shall be provided to the same extent as for any other health care services under the contract.
c. This section shall apply to those policies in which the health maintenance organization has reserved the right to change the schedule of charges for enrollee coverage.
d. As used in this section, “health care provider” means an individual or entity which, acting within the scope of its licensure or certification, provides health care services. “Health care provider” includes a family practice physician, obstetrician, advanced practice nurse, registered professional nurse, licensed practical nurse, certified professional midwife, certified nurse midwife, or certified midwife.
7. a. An individual health benefits plan that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for costs associated with planned home childbirth, including, but not limited to, services provided by a health care provider, services provided by a doula, and equipment and medical supplies.
b. The coverage shall be provided to the same extent as for any other health care services under the health benefits plan.
c. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
d. As used in this section, “health care provider” means an individual or entity which, acting within the scope of its licensure or certification, provides health care services. “Health care provider” includes a family practice physician, obstetrician, advanced practice nurse, registered professional nurse, licensed practical nurse, certified professional midwife, certified nurse midwife, or certified midwife.
8. a. A small employer health benefits plan that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for costs associated with planned home childbirth, including, but not limited to, services provided by a health care provider, services provided by a doula, and equipment and medical supplies.
b. The coverage shall be provided to the same extent as for any other health care services under the health benefits plan.
c. This section shall apply to those policies in which the carrier has reserved the right to change the premium.
d. As used in this section, “health care provider” means an individual or entity which, acting within the scope of its licensure or certification, provides health care services. “Health care provider” includes a family practice physician, obstetrician, advanced practice nurse, registered professional nurse, licensed practical nurse, certified professional midwife, certified nurse midwife, or certified midwife.
9. a. The State Health Benefits Commission, on or after the effective date of this act, shall provide coverage for costs associated with planned home childbirth, including, but not limited to, services provided by a health care provider, services provided by a doula, and equipment and medical supplies.
b. The coverage shall be provided to the same extent as for any other health care services under the contract.
c. As used in this section, “health care provider” means an individual or entity which, acting within the scope of its licensure or certification, provides health care services. “Health care provider” includes a family practice physician, obstetrician, advanced practice nurse, registered professional nurse, licensed practical nurse, certified professional midwife, certified nurse midwife, or certified midwife.
10. a. The School Employees’ Health Benefits Commission on or after the effective date of this act, shall provide coverage for costs associated with planned home childbirth, including, but not limited to, services provided by a health care provider, services provided by a doula, and equipment and medical supplies.
b. The coverage shall be provided to the same extent as for any other health care services under the contract.
c. As used in this section, “health care provider” means an individual or entity which, acting within the scope of its licensure or certification, provides health care services. “Health care provider” includes a family practice physician, obstetrician, advanced practice nurse, registered professional nurse, licensed practical nurse, certified professional midwife, certified nurse midwife, or certified midwife.
11. a. Notwithstanding the provisions of any State law or regulation to the contrary, the Division of Medical Assistance and Health Services in the Department of Human Services, or a managed care organization contracted with the division to provide benefits under NJ FamilyCare, shall cover the costs incurred for a planned home childbirth, including, but not limited to, services provided by a health care provider, services provided by a doula, and equipment and medical supplies, when the services are provided to a beneficiary of NJ FamilyCare by an in-network health care provider.
b. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this section and to secure federal financial participation for NJ FamilyCare expenditures under the Medicaid program and Children’s Health Insurance Program.
c. The department may take any administrative action necessary to effectuate the provisions of this section, including modifying or amending any applicable contract or promulgating, amending, or repealing any guidance, guidelines, or rules, which rules or amendments thereto shall be effective immediately upon filing with the Office of Administrative Law for a period not to exceed 12 months, and may, thereafter, be amended, adopted or readopted in accordance with the provisions of the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.).
d. As used in this section:
“Health care provider” means an individual or entity which, acting within the scope of its licensure or certification, provides health care services. “Health care provider” includes a family practice physician, obstetrician, advanced practice nurse, registered professional nurse, licensed practical nurse, certified professional midwife, certified nurse midwife, or certified midwife.
“NJ FamilyCare” means the program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), which includes the Medicaid program and the Children’s Health Insurance Program.
12. Sections 1 through 10 of this act shall take effect on the 120th day following enactment, and shall apply to all contracts delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act. Section 11 of this act shall take effect two years following enactment.