Bill Text: NJ A2144 | 2020-2021 | Regular Session | Introduced
Bill Title: Requires pilot programs on both advanced imaging services and elective surgical procedures in SHBP and SEHBP.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2020-01-14 - Introduced, Referred to Assembly Health Committee [A2144 Detail]
Download: New_Jersey-2020-A2144-Introduced.html
STATE OF NEW JERSEY
219th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2020 SESSION
Sponsored by:
Assemblyman P. CHRISTOPHER TULLY
District 38 (Bergen and Passaic)
Assemblywoman LISA SWAIN
District 38 (Bergen and Passaic)
SYNOPSIS
Requires pilot programs on both advanced imaging services and elective surgical procedures in SHBP and SEHBP.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning advanced imaging services and elective surgical procedures in the State Health Benefits Program and the School Employees' Health Benefits Program and supplementing P.L.1961, c.49 (C.52:14-17.25 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. The State Health Benefits Commission and the School Employees' Health Benefits Commission each shall establish two pilot programs by awarding, in an expedited manner, a professional services contract for both an advanced imaging services manager and an elective surgical procedure manager for the State Health Benefits Program and the School Employees' Health Benefits Program. The advanced imaging services manager shall coordinate the delivery of advanced imaging services, including, but not limited to: magnetic resonance imaging; computed tomography; positron emission tomography scans; and services related to advanced imaging. The elective surgical procedure manager shall coordinate the delivery of elective surgical procedures, including, but not limited to: hip replacement, knee replacement, laparoscopic sleeve gastrectomy, hysterectomy, rotator cuff repair, knee arthroscopy, hysteroscopy, and other elective surgical procedures.
b. No employee or retiree, or a dependent, covered by the State Health Benefits Program or the School Employees' Health Benefits Program shall be required to participate in the pilot programs. Participation by an employee or retiree, or dependent, shall be on a voluntary basis. Each manager shall be authorized to communicate with employees and retirees, and their dependents, by such means as telephone, electronic mail, text message, electronic application, website, and such other means as the employee or retiree, or a dependent, permits. Such communications shall be in a manner that complies with applicable State and federal laws.
c. Each manager shall be authorized to offer incentives to employees and retirees, and their dependents, if they choose to participate in the pilot programs. Such incentives may include a monetary award equal to a portion of the total savings realized by the program that covers the employee or retiree, or dependent, or such other incentives as approved by the commission.
d. The manager shall not deny care to any employee or retiree, or a dependent, based on a clinical review of the appropriateness or suitability of a requested advanced imaging service or elective surgical procedure for such employee or retiree, or a dependent.
e. The advanced imaging services or elective surgical procedures to be coordinated by the manager shall be performed at facilities that are under contract with the manager, but in which the manager has no ownership interest or profit-sharing arrangement. Each such facility shall be certified by an independent nationally-recognized entity identified by the commission.
f. (1) Notwithstanding the provisions of any other law to the contrary, for the purpose of expediting the award of the contract for the advanced imaging benefits manager and elective surgical procedure manager, the following provisions shall apply as modifications to law or regulation that may interfere with the expedited award:
(a) the timeframes for challenging the specifications shall be modified as determined by the State Treasurer;
(b) in lieu of advertising in accordance with sections 2, 3, and 4 of P.L.1954, c. 48 (C.52:34-7, C.52:34-8, and C.52:34-9, respectively), the State Treasurer shall advertise the request for proposals and any addenda thereto on the website of the Department of the Treasury in an appropriate location;
(c) the period of time that the State Comptroller has to review the request for proposals for compliance with applicable public contracting laws, rules and regulations, pursuant to section 10 of P.L.2007, c.52 (C.52:15C-10), shall be 10 business days or less if practicable, as determined by the State Comptroller;
(d) the timeframes for submissions under section 4 of P.L.2012, c.25 (C.52:32-58) and section 1 of P.L.1977, c.33 (C.52:25-24.2) shall be extended to prior to the issuance of a notice of intent to award; and
(e) the term "bids" in subparagraph (f) of subsection a. of section 7 of P.L.1954, c.48 (C.52:34-12) shall not include pricing which will be revealed to all responsive bidders during the negotiation process.
(2) Each contract shall be awarded on the basis of best value and with the price elements negotiated by the parties to the contract.
Each commission shall enter into its own contracts with a manager that may, but need not be, the same manager for each pilot program or for each commission.
The manager shall not be a carrier, or subsidiary, affiliate, or related party of that carrier, or sub-contracted third party to that carrier, that has contracted with either commission to provide health care services under either program.
The contract for each manager may include provisions that compensate the manager based, in whole or in part, on a percentage of the total savings achieved by the program.
The term of each initial contract shall be no less than three years.
After the award of an initial contract, subsequent contracts for an advanced imaging services manager and elective surgical procedure manager shall be awarded in accordance with laws governing the award of a public contract by a State agency.
g. (1) Each manager shall provide claims data and other reports in compliance with applicable State and federal laws to document: the cost and nature of both advanced imaging claims and elective surgical procedure claims incurred through the pilot programs; the nature and results of incentives under the pilot programs; demographic information on the covered population; emerging utilization and demographic trends relating to advanced imaging services and elective surgical procedures; health care outcomes; and such other information as may be appropriate and requested by the commissions to assist in the governance of the programs. Each manager shall report on the reaction of employees and retirees, and their dependents, covered by the programs of various communication methods and incentives offered.
(2) Each manager shall respond, in a timely manner, to any data, programmatic, or informational requests from the Governor, State Treasurer, Division of Pensions and Benefits, State Health Benefits Commission, School Employees' Health Benefits Commission, State Health Benefits Plan Design Committee, School Employees' Health Benefits Plan Design Committee, President of the Senate, Speaker of the General Assembly, and auditors and claim reviewers of each such program.
2. This act shall take effect immediately.
STATEMENT
This bill requires the State Health Benefits Commission and the School Employees' Health Benefits Commission to initiate innovative pilot programs for both the delivery of advanced imaging services and elective surgical procedures to the employees and retirees, and their dependents, covered by the State Health Benefits Program and the School Employees' Health Benefits Program. The advanced imaging services would include magnetic resonance imaging, computed tomography, positron emission tomography scans, and services related to advanced imaging services. The elective surgical procedures would include hip replacement, knee replacement, laparoscopic sleeve gastrectomy, hysterectomy, rotator cuff repair, knee arthroscopy, hysteroscopy, and other elective surgical procedures.
Each commission would initiate the pilot programs by awarding, in an expedited manner, a contract for an advanced imaging benefits manager and elective surgical procedure manager who would coordinate the delivery of advanced imaging services and elective surgical procedures, respectively.
No employee or retiree, or a dependent, would be required to participate in the pilot programs. Participation would be voluntary.
Each manager would be authorized to offer incentives to employees and retirees, and their dependents, if they choose to participate in the pilot programs. Such incentives may include a
monetary award equal to a portion of the total savings realized by the program that covers the employee or retiree, or dependent, or such other incentives as approved by the commission.
The advanced imaging services and elective surgical procedures to be coordinated by the manager would be performed at facilities that are under contract with the manager, but in which the manager has no ownership interest or profit-sharing arrangement.
The contract for each manager may include provisions that compensate the manager based, in whole or in part, on a percentage of the total savings achieved by the program.
Each manager would be required to provide claims data and other reports in compliance with applicable State and federal laws to document: the cost and nature of both advanced imaging and elective surgical procedure claims incurred through the pilot programs; the nature and results of incentives under the pilot programs; demographic information on the covered population; emerging utilization and demographic trends relating to advanced imaging services and elective surgical procedures; health care outcomes; and such other information as may be appropriate and requested by the commissions to assist in the governance of the programs.
