Bill Text: NJ A3246 | 2010-2011 | Regular Session | Amended
Bill Title: Requires managed care plans, SHBP, and SEHBP to provide for reasonable accommodation in accessing providers for persons with physical disabilities. *
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Introduced - Dead) 2011-12-08 - Reported out of Assembly Comm. with Amendments, 2nd Reading [A3246 Detail]
Download: New_Jersey-2010-A3246-Amended.html
ASSEMBLY, No. 3246
STATE OF NEW JERSEY
214th LEGISLATURE
INTRODUCED SEPTEMBER 20, 2010
Sponsored by:
Assemblywoman JOAN M. QUIGLEY
District 32 (Bergen and Hudson)
Assemblyman CRAIG J. COUGHLIN
District 19 (Middlesex)
Co-Sponsored by:
Assemblyman Fuentes
SYNOPSIS
Requires managed care plans, SHBP and SEHBP to provide for reasonable accommodation in accessing providers for persons with physical disabilities.
CURRENT VERSION OF TEXT
As reported by the Assembly Financial Institutions and Insurance Committee on December 8, 2011, with amendments.
An Act concerning health care coverage for persons with physical disabilities and supplementing P.L.1997, c.192 (C.26:2S-1 et seq.), P.L.1961, c.49 (C.52:14-17.25 et seq.), and P.L.2007, c.103 (C.52:14-17.46.1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. 1a.1 A carrier which offers a managed care plan that is subject to the provisions of P.L.1997, c.192 (C.26:2S-1 et seq.) shall establish procedures to ensure that persons with 1physical1 disabilities have reasonable access to primary and specialty care providers whose professional offices are accessible to persons with 1physical1 disabilities in accordance with the Americans with Disabilities Act of 1990 standards for accessible design published by the United States Department of Justice pursuant to 28 CFR Part 36. 1A carrier shall make a good faith effort to ensure reasonable access to such providers within the geographic access standards for network adequacy promulgated by the Department of Banking and Insurance by regulation.
b.1 The procedures 1established pursuant to subsection a. of this section1 shall provide that in the event a covered person with a 1physical1 disability is unable to reasonably access an in-network primary or specialty care provider whose professional office is accessible to the covered person, the carrier shall arrange for a provider that is accessible, 1and if that provider is out-of-network,1 with the same financial responsibility as the covered person would incur if the provider was in-network. 1The carrier shall reimburse the accessible out-of-network provider for the covered service at the same rate as that which the carrier would pay to an in-network provider for the same service. The out-of-network provider shall accept the payment by the carrier as payment in full for the covered service and shall not balance bill the covered person for any amount in excess of the payment made by the carrier plus any required copayment or coinsurance.1
2. 1a.1 The State Health
Benefits Commission shall ensure that every contract purchased by the
commission on or after the effective date of this act that provides hospital or
medical expense benefits through a managed care plan, provides procedures to
ensure that persons with 1physical1 disabilities have
reasonable access to primary and specialty care providers whose professional
offices are accessible to persons with 1physical1 disabilities in
accordance with the Americans with Disabilities Act of 1990 standards for
accessible design published by the United States Department of Justice pursuant
to 28 CFR Part 36. 1The
commission shall make a good faith effort to ensure reasonable access to such
providers in a manner consistent with the geographic access standards for
network adequacy applicable to carriers offering managed care plans, as
promulgated by the Department of Banking and Insurance by regulation pursuant
to the "Health Care Quality Act," P.L.1997, c.192 (C.26:2S-1 et seq.).
b.1 The procedures 1established pursuant to subsection a. of this section1 shall provide that in the event a covered person with a 1physical1 disability is unable to reasonably access an in-network primary or specialty care provider whose professional office is accessible to the covered person, the managed care plan shall arrange for a provider that is accessible, 1and if that provider is out-of-network,1 with the same financial responsibility as the covered person would incur if the provider was in-network. 1The contract purchased by the commission shall provide that the accessible out-of-network provider shall be reimbursed for the covered service at the same rate as that which would be paid to an in-network provider for the same service. The out-of-network provider shall accept the payment pursuant to the contract as payment in full for the covered service and shall not balance bill the covered person for any amount in excess of the payment made pursuant to the contract plus any required copayment or coinsurance.1
3. 1a.1 The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits through a managed care plan, provides procedures to ensure that persons with 1physical1 disabilities have reasonable access to primary and specialty care providers whose professional offices are accessible to persons with 1physical1 disabilities in accordance with the Americans with Disabilities Act of 1990 standards for accessible design published by the United States Department of Justice pursuant to 28 CFR Part 36. 1The commission shall make a good faith effort to ensure reasonable access to such providers in a manner consistent with the geographic access standards for network adequacy applicable to carriers offering managed care plans, as promulgated by the Department of Banking and Insurance by regulation pursuant to the "Health Care Quality Act," P.L.1997, c.192 (C.26:2S-1 et seq.).
b.1 The procedures 1established pursuant to subsection a. of this section1 shall provide that in the event a covered person with a 1physical1 disability is unable to reasonably access an in-network primary or specialty care provider whose professional office is accessible to the covered person, the managed care plan shall arrange for a provider that is accessible, 1and if that provider is out-of-network,1 with the same financial responsibility as the covered person would incur if the provider was in-network. 1The contract purchased by the commission shall provide that the accessible out-of-network provider shall be reimbursed for the covered service at the same rate as that which would be paid to an in-network provider for the same service. The out-of-network provider shall accept the payment pursuant to the contract as payment in full for the covered service and shall not balance bill the covered person for any amount in excess of the payment made pursuant to the contract plus any required copayment or coinsurance.1
4. This act shall take effect on the 1[90th] 180th1 day following enactment and shall apply to any contract or policy issued or renewed on or after that date.
