Bill Text: NJ A1970 | 2010-2011 | Regular Session | Introduced
Bill Title: Requires managed care plans to cover treatment of overweight and obesity in adults on fee-for-service basis.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2010-02-08 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A1970 Detail]
Download: New_Jersey-2010-A1970-Introduced.html
Sponsored by:
Assemblyman HERB CONAWAY, JR.
District 7 (Burlington and Camden)
SYNOPSIS
Requires managed care plans to cover treatment of overweight and obesity in adults on fee-for-service basis.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health care coverage for treatment of overweight and obesity, supplementing P.L.1997, c.192 (C.26:2S-1 et seq.) and revising parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. A carrier which offers a managed care plan that provides benefits or health care services, as applicable, for adult overweight and obesity assessment and treatment services shall provide payment to a participating health care provider on a fee-for-service basis for weight loss and weight maintenance therapy services for a covered person or enrollee, as applicable, if the services conform with: the "Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults" evidence report developed by the Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults convened by the National Heart, Lung, and Blood Institute in cooperation with The National Institute of Diabetes and Digestive and Kidney Diseases and released in September 1998; or any subsequent modification thereof.
2. Notwithstanding the provisions of chapter 26 of Title 17B of the New Jersey Statutes to the contrary, no policy shall be delivered, issued, executed or renewed on or after the effective date of P.L. , c. (pending before the Legislature as this bill) unless the policy meets the requirements of section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill) and the regulations adopted thereto. The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
3. Notwithstanding the provisions of chapter 27 of Title 17B of the New Jersey Statutes to the contrary, no policy shall be delivered, issued, executed or renewed on or after the effective date of P.L. , c. (pending before the Legislature as this bill) unless the policy meets the requirements of section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill) and the regulations adopted thereto. The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
4. Notwithstanding the provisions of P.L.1992, c.162 (C.17B:27A-17 et seq.) to the contrary, no policy or contract shall be delivered, issued, executed or renewed on or after the effective date of P.L. , c. (pending before the Legislature as this bill) unless the policy or contract meets the requirements of section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill) and the regulations adopted thereto. The provisions of this section shall apply to all policies or contracts in which the carrier has reserved the right to change the premium.
5. Notwithstanding the provisions of P.L.1992, c.161 (C.17B:27A-2 et seq.) to the contrary, no policy or contract shall be delivered, issued, executed or renewed on or after the effective date of P.L. , c. (pending before the Legislature as this bill) unless the policy or contract meets the requirements of section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill) and the regulations adopted thereto. The provisions of this section shall apply to all policies or contracts in which the carrier has reserved the right to change the premium.
6. Notwithstanding the provisions of P.L.1938, c.366 (C.17:48-1 et seq.) to the contrary, no contract shall be delivered, issued, executed or renewed on or after the effective date of P.L. , c pending before the Legislature as this bill) unless the contract meets the requirements of section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill) and the regulations adopted thereto. The provisions of this section shall apply to all contracts in which the hospital service corporation has reserved the right to change the premium.
7. Notwithstanding the provisions of P.L.1940, c.74 (C.17:48A-1 et seq.) to the contrary, no contract shall be delivered, issued, executed or renewed on or after the effective date of P.L. , c (pending before the Legislature as this bill) unless the contract meets the requirements of section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill) and the regulations adopted thereto. The provisions of this section shall apply to all contracts in which the medical service corporation has reserved the right to change the premium.
8. Notwithstanding the provisions of P.L.1985, c.236 (C.17:48E-1 et seq.) to the contrary, no contract shall be delivered, issued, executed or renewed on or after the effective date of P.L. , c. (pending before the Legislature as this bill) unless the contract meets the requirements of section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill) and the regulations adopted thereto. The provisions of this section shall apply to all contracts in which the health service corporation has reserved the right to change the premium.
9. Notwithstanding the provisions of P.L.1973, c.337 (C.26:2J-1 et seq.) to the contrary, a certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued on or after the effective date of P.L. , c. (pending before the Legislature as this bill) unless the health maintenance organization meets the requirements of section 1 of P.L., c. (C. ) (pending before the Legislature as this bill) and the regulations adopted thereto. The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the right to change the schedule of charges for enrollee coverage is reserved.
10. The Commissioner of Banking and Insurance, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt regulations to carry out the provisions of section 1 of this act.
11. This act shall take effect on the 180th day after enactment and shall apply to policies or contracts issued or renewed on or after the effective date.
STATEMENT
This bill is intended to exclude certain services provided by managed care plans for the treatment of overweight and obesity in adults from capitated payment arrangements used by those plans to reimburse their network providers.
Specifically, the bill requires that a health insurance carrier which offers a managed care plan that provides benefits or health care services, as applicable, for adult overweight and obesity assessment and treatment services provide payment to a participating health care provider on a fee-for-service basis for weight loss and weight maintenance therapy services for a covered person or enrollee, as applicable, if the services conform with: the "Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults" evidence report developed by the Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults convened by The National Heart, Lung, and Blood Institute (NHLBI) in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases and released in September 1998; or any subsequent modification thereof.
The requirements of this bill would apply to hospital, medical and health service corporations, commercial individual, small employer and group health insurers, and health maintenance organizations.
The bill takes effect on the 180th day after enactment and applies to policies and contracts issued or renewed on or after the effective date.
This bill would enhance the quality of care provided by managed care plans for the identification, evaluation and treatment of overweight and obesity in adults by recognizing that, as the 1998 NHLBI expert panel report noted: "The literature suggests that weight loss and weight maintenance therapies that provide a greater frequency of contacts between the patient and the practitioner and are provided over the long term should be utilized whenever possible. This can lead to more successful weight loss and weight maintenance." To that end, the bill requires affected insurers to cover the applicable services on a fee-for-service basis in order to make it feasible for participating providers to offer these services on a schedule that will be most effective in meeting the therapeutic objectives of this treatment.
This bill seeks to address a public health problem that has reached epidemic proportions across the entire United States. According to the federal Centers for Disease Control and Prevention:
· In 2006,an estimated 73% of adults in this country were either overweight or obese.
· During the past 20 years, there has been a dramatic increase in obesity nationwide; in 2008, only one state, Colorado, had a prevalence of obesity under 20%, and 32 states had a prevalence equal to or greater than 25%.
· Overweight and obese persons are at risk for such ailments as high blood pressure, high blood cholesterol, type 2 diabetes, insulin resistance, hyperinsulinemia, coronary heart disease, angina pectoris, congestive heart failure, stroke, gallstones, cholescystitis and cholelithiasis, gout, osteoarthritis, obstructive sleep apnea and respiratory problems, some types of cancer, complications of pregnancy, poor female reproductive health, bladder control problems and psychological disorders.
