Bill Text: NJ A3562 | 2024-2025 | Regular Session | Introduced
Bill Title: Requires health insurers to cover self-measured blood pressure monitoring for subscribers with preeclampsia; requires health care professionals to provide home blood pressure monitor to pregnant patients diagnosed with preeclampsia.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Introduced) 2024-02-05 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A3562 Detail]
Download: New_Jersey-2024-A3562-Introduced.html
Sponsored by:
Assemblywoman SHANIQUE SPEIGHT
District 29 (Essex and Hudson)
SYNOPSIS
Requires health insurers to cover self-measured blood pressure monitoring for subscribers with preeclampsia; requires health care professionals to provide home blood pressure monitor to pregnant patients diagnosed with preeclampsia.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning preeclampsia and blood pressure monitoring and supplementing various parts of statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. The Legislature finds and declares:
a. Preeclampsia is a rapidly progressive increase in blood pressure that occurs after 20 weeks of pregnancy. Although this high blood pressure usually goes away after birth, it is dangerous for both the mother and baby and can lead to life-threatening complications.
b. The condition can keep the baby from getting proper amounts of blood and oxygen from the mother. Preeclampsia can also cause the mother to have serious problems with her brain, liver, and kidneys. The most severe cases of preeclampsia can lead to seizures.
c. The rate of preeclampsia in the United States has increased in the last two decades and is a leading cause of maternal and infant illness and death. Currently, preeclampsia affects 5 to 8 percent of pregnant women, or approximately 5,000 to 8,000 individuals in New Jersey annually.
d. Monitoring blood pressure is therefore an essential part of prenatal and postpartum care.
e. Self-measured blood pressure monitoring in a patient's home can be particularly critical in the case of masked hypertension, where blood pressure levels are elevated at home despite normal blood pressure in a clinical setting. In addition, sudden rises in blood pressure can threaten pregnant women between prenatal appointments or if they have limited access to healthcare;
f. Access to blood pressure measurement devices or limited knowledge on how to utilize a device should not be barriers to home-based monitoring. Early detection of high blood pressure in pregnancy may improve outcomes and prevent the maternal and neonatal morbidities associated with preeclampsia; and
g. Providing pregnant patients in New Jersey with home blood pressure measurement monitors and the training to use such a monitor is a simple, low cost tool to significantly improve maternal outcomes in the State.
2. a. A hospital service corporation which provides hospital or medical expense benefits under a contract that is 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, shall provide coverage for self-measured blood pressure monitoring for any subscriber who is diagnosed with preeclampsia, which coverage shall include the provision of a validated home blood pressure monitor and the reimbursement of provider time used to educate and train the subscriber on the proper use of the blood pressure monitor, to transmit blood pressure data from the subscriber's blood pressure monitor, and to interpret blood pressure data from the subscriber's blood pressure monitor.
b. This benefit shall be provided to the same extent as for any other medical condition under the 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,
"Preeclampsia" means a high blood pressure disorder that can occur during or after pregnancy and may include, but is by no means limited to, high levels of protein in the patient's urine and other signs of organ damage.
"Self-measured blood pressure monitoring" means the regular measurement of blood pressure by a patient outside the clinical setting, either at home or elsewhere, requiring the use of a home blood pressure measurement device by the patient.
"Validated home blood measurement monitor" means a blood pressure measurement device that has been validated for accuracy and is listed in the United States Blood Pressure Validated Device Listing.
3. a. A medical service corporation which provides hospital or medical expense benefits under a contract that is 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, shall provide coverage for self-measured blood pressure monitoring for any subscriber who is diagnosed with preeclampsia, which coverage shall include the provision of a validated home blood pressure monitor and the reimbursement of provider time used to educate and train the subscriber on the proper use of the blood pressure monitor, to transmit blood pressure data from the subscriber's blood pressure monitor, and to interpret blood pressure data from the subscriber's blood pressure monitor.
b. This benefit shall be provided to the same extent as for any other medical condition under the 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,
"Preeclampsia" means a high blood pressure disorder that can occur during or after pregnancy and may include, but is by no means limited to, high levels of protein in the patient's urine and other signs of organ damage.
"Self-measured blood pressure monitoring" means the regular measurement of blood pressure by a patient outside the clinical setting, either at home or elsewhere, requiring the use of a home blood pressure measurement device by the patient.
"Validated home blood measurement monitor" means a blood pressure measurement device that has been validated for accuracy and is listed in the United States Blood Pressure Validated Device Listing.
4. a. A health service corporation which provides hospital or medical expense benefits under a contract that is 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 shall provide coverage for self-measured blood pressure monitoring for any subscriber who is diagnosed with preeclampsia, which coverage shall include the provision of a validated home blood pressure monitor and the reimbursement of provider time used to educate and train the subscriber on the proper use of the blood pressure monitor, to transmit blood pressure data from the subscriber's blood pressure monitor, and to interpret blood pressure data from the subscriber's blood pressure monitor.
b. This benefit shall be provided to the same extent as for any other medical condition under the 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,
"Preeclampsia" means a high blood pressure disorder that can occur during or after pregnancy and may include, but is by no means limited to, high levels of protein in the patient's urine and other signs of organ damage.
"Self-measured blood pressure monitoring" means the regular measurement of blood pressure by a patient outside the clinical setting, either at home or elsewhere, requiring the use of a home blood pressure measurement device by the patient.
"Validated home blood measurement monitor" means a blood pressure measurement device that has been validated for accuracy and is listed in the United States Blood Pressure Validated Device Listing.
5. a. An individual health insurance policy which provides hospital or medical expense benefits under a policy that is 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, shall provide coverage for self-measured blood pressure monitoring for any subscriber who is diagnosed with preeclampsia, which coverage shall include the provision of a validated home blood pressure monitor and the reimbursement of provider time used to educate and train the subscriber on the proper use of the blood pressure monitor, to transmit blood pressure data from the subscriber's blood pressure monitor, and to interpret blood pressure data from the subscriber's blood pressure monitor.
b. This benefit shall be provided to the same extent as for any other medical condition under the contract.
c. This section shall apply to those policies in which the insurer has reserved the right to change the premium.
d. As used in this section,
"Preeclampsia" means a high blood pressure disorder that can occur during or after pregnancy and may include, but is by no means limited to, high levels of protein in the patient's urine and other signs of organ damage.
"Self-measured blood pressure monitoring" means the regular measurement of blood pressure by a patient outside the clinical setting, either at home or elsewhere, requiring the use of a home blood pressure measurement device by the patient.
"Validated home blood measurement monitor" means a blood pressure measurement device that has been validated for accuracy and is listed in the United States Blood Pressure Validated Device Listing.
6. a. A group health insurance policy which provides hospital or medical expense benefits under a policy that is 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, shall provide coverage for self-measured blood pressure monitoring for any subscriber who is diagnosed with preeclampsia, which coverage shall include the provision of a validated home blood pressure monitor and the reimbursement of provider time used to educate and train the subscriber on the proper use of the blood pressure monitor, to transmit blood pressure data from the subscriber's blood pressure monitor, and to interpret blood pressure data from the subscriber's blood pressure monitor.
b. This benefit shall be provided to the same extent as for any other medical condition under the contract.
c. This section shall apply to those policies in which the insurer has reserved the right to change the premium.
d. As used in this section,
"Preeclampsia" means a high blood pressure disorder that can occur during or after pregnancy and may include, but is by no means limited to, high levels of protein in the patient's urine and other signs of organ damage.
"Self-measured blood pressure monitoring" means the regular measurement of blood pressure by a patient outside the clinical setting, either at home or elsewhere, requiring the use of a home blood pressure measurement device by the patient.
"Validated home blood measurement monitor" means a blood pressure measurement device that has been validated for accuracy and is listed in the United States Blood Pressure Validated Device Listing.
7. a. 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 this act by the Commissioner of Banking and Insurance unless the health maintenance organization provides coverage for self-measured blood pressure monitoring for any subscriber who is diagnosed with preeclampsia, which coverage shall include the provision of a validated home blood pressure monitor and the reimbursement of provider time used to educate and train the subscriber on the proper use of the blood pressure monitor, to transmit blood pressure data from the subscriber's blood pressure monitor, and to interpret blood pressure data from the subscriber's blood pressure monitor.
b. This benefit shall be provided to the same extent as for any other medical condition under the contract.
c. The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the health maintenance organization has reserved the right to change the schedule of charges for enrollee coverage.
d. As used in this section,
"Preeclampsia" means a high blood pressure disorder that can occur during or after pregnancy and may include, but is by no means limited to, high levels of protein in the patient's urine and other signs of organ damage.
"Self-measured blood pressure monitoring" means the regular measurement of blood pressure by a patient outside the clinical setting, either at home or elsewhere, requiring the use of a home blood pressure measurement device by the patient.
"Validated home blood measurement monitor" means a blood pressure measurement device that has been validated for accuracy and is listed in the United States Blood Pressure Validated Device Listing.
8. a. An individual health benefits plan that is delivered, issued, executed, renewed, or approved for issuance or renewal 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 self-measured blood pressure monitoring for any subscriber who is diagnosed with preeclampsia, which coverage shall include the provision of a validated home blood pressure monitor and the reimbursement of provider time used to educate and train the subscriber on the proper use of the blood pressure monitor, to transmit blood pressure data from the subscriber's blood pressure monitor, and to interpret blood pressure data from the subscriber's blood pressure monitor.
b. This benefit shall be provided to the same extent as for any other medical condition 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,
"Preeclampsia" means a high blood pressure disorder that can occur during or after pregnancy and may include, but is by no means limited to, high levels of protein in the patient's urine and other signs of organ damage.
"Self-measured blood pressure monitoring" means the regular measurement of blood pressure by a patient outside the clinical setting, either at home or elsewhere, requiring the use of a home blood pressure measurement device by the patient.
"Validated home blood measurement monitor" means a blood pressure measurement device that has been validated for accuracy and is listed in the United States Blood Pressure Validated Device Listing.
9. 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.), on or after the effective date of this act, shall provide coverage for self-measured blood pressure monitoring for any subscriber who is diagnosed with preeclampsia, which coverage shall include the provision of a validated home blood pressure monitor and the reimbursement of provider time used to educate and train the subscriber on the proper use of the blood pressure monitor, to transmit blood pressure data from the subscriber's blood pressure monitor, and to interpret blood pressure data from the subscriber's blood pressure monitor.
b. This benefit shall be provided to the same extent as for any other condition 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,
"Preeclampsia" means a high blood pressure disorder that can occur during or after pregnancy and may include, but is by no means limited to, high levels of protein in the patient's urine and other signs of organ damage.
"Self-measured blood pressure monitoring" means the regular measurement of blood pressure by a patient outside the clinical setting, either at home or elsewhere, requiring the use of a home blood pressure measurement device by the patient.
"Validated home blood measurement monitor" means a blood pressure measurement device that has been validated for accuracy and is listed in the United States Blood Pressure Validated Device Listing.
10. a. Notwithstanding any other provision of law to the contrary, 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 shall provide coverage for self-measured blood pressure monitoring for any subscriber who is diagnosed with preeclampsia, which coverage shall include the provision of a validated home blood pressure monitor and the reimbursement of provider time used to educate and train the subscriber on the proper use of the blood pressure monitor, to transmit blood pressure data from the subscriber's blood pressure monitor, and to interpret blood pressure data from the subscriber's blood pressure monitor.
b. This benefit shall be provided to the same extent as for any other medical condition under the contract.
c. As used in this section,
"Preeclampsia" means a high blood pressure disorder that can occur during or after pregnancy and may include, but is by no means limited to, high levels of protein in the patient's urine and other signs of organ damage.
"Self-measured blood pressure monitoring" means the regular measurement of blood pressure by a patient outside the clinical setting, either at home or elsewhere, requiring the use of a home blood pressure measurement device by the patient.
"Validated home blood measurement monitor" means a blood pressure measurement device that has been validated for accuracy and is listed in the United States Blood Pressure Validated Device Listing.
11. a. Notwithstanding any other provision of law to the contrary, 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 shall provide coverage for self-measured blood pressure monitoring for any subscriber who is diagnosed with preeclampsia, which coverage shall include the provision of a validated home blood pressure monitor and the reimbursement of provider time used to educate and train the subscriber on the proper use of the blood pressure monitor, to transmit blood pressure data from the subscriber's blood pressure monitor, and to interpret blood pressure data from the subscriber's blood pressure monitor.
b. This benefit shall be provided to the same extent as for any other medical condition under the contract.
c. As used in this section,
"Preeclampsia" means a high blood pressure disorder that can occur during or after pregnancy and may include, but is by no means limited to, high levels of protein in the patient's urine and other signs of organ damage.
"Self-measured blood pressure monitoring" means the regular measurement of blood pressure by a patient outside the clinical setting, either at home or elsewhere, requiring the use of a home blood pressure measurement device by the patient.
"Validated home blood measurement monitor" means a blood pressure measurement device that has been validated for accuracy and is listed in the United States Blood Pressure Validated Device Listing.
12. a. Notwithstanding any State law or regulation to the contrary, the Division of Medical Assistance and Health Services in the Department of Human Services shall, contingent on maintaining or receiving necessary federal approvals, ensure coverage for self-measured blood pressure monitoring under the Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), provided that the eligible person has been diagnosed with preeclampsia. Coverage for self-measured blood pressure monitoring shall include the provision of a validated home blood pressure monitor and the reimbursement of provider time used to educate and train the subscriber on the proper use of the blood pressure monitor, to transmit blood pressure data from the subscriber's blood pressure monitor, and to interpret blood pressure data from the subscriber's blood pressure monitor.
b. This benefit shall be provided to the same extent as for any other medical condition under the contract.
c. As used in this section,
"Preeclampsia" means a high blood pressure disorder that can occur during or after pregnancy and may include, but is by no means limited to, high levels of protein in the patient's urine and other signs of organ damage.
"Self-measured blood pressure monitoring" means the regular measurement of blood pressure by a patient outside the clinical setting, either at home or elsewhere, requiring the use of a home blood pressure measurement device by the patient.
"Validated home blood measurement monitor" means a blood pressure measurement device that has been validated for accuracy and is listed in the United States Blood Pressure Validated Device Listing.
d. 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 State expenditures under the federal Medicaid
program.
13. a. As used in this section:
"Preeclampsia" means a high blood pressure disorder that can occur during or after pregnancy and may include, but is by no means limited to, high levels of protein in the patient's urine and other signs of organ damage.
"Validated home blood measurement monitor" means a blood pressure measurement device that has been validated for accuracy and is listed in the United States Blood Pressure Validated Device Listing.
b. The Commissioner of Health shall require every hospital in the State, every birthing center licensed in the State pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.), every federally qualified health center in the State, and every physician or health care practitioner in the State providing care to a pregnant person, to provide, without cost to the patient,:
(1) a validated home blood pressure monitor to a pregnant patient who is diagnosed with preeclampsia;
(2) a validated home blood pressure monitor to a pregnant patient who expresses fear or anxiety regarding the patient's blood pressure and who requests a blood pressure monitor; and
(3) printed educational material regarding preeclampsia to each pregnant patient at the patient's first pregnancy visit. The educational material shall be developed and distributed to providers by the Department of Health and shall include, at a minimum, the following information: a definition of preeclampsia; the symptoms and warning signs of preeclampsia and at what point a patient experiencing those symptoms or warning signs should contact a medical professional; and a description of how a patient can advocate for themselves in regard to addressing preeclampsia.
c. A hospital, a birthing center, a federally qualified health, or a physician or health care practitioner that provides a patient with a validated home blood pressure monitor pursuant to paragraphs (1) and (2) of subsection b. of this section shall, in accordance with guidelines developed by the commissioner, educate and train the patient on the proper use of the blood pressure monitor; transmit blood pressure data from the patient's blood pressure monitor; interpret blood pressure data from the patient's blood pressure monitor; and report to the Department of Health, one year after the effective date of this act and annually thereafter, de-identifiable data on the number of patients who received blood pressure monitors under this section and the health outcomes of those patients.
d. The Department of Health shall establish a process by which a hospital, a birthing center, a federally qualified health center, or a physician or health care practitioner that provides a patient with a validated home blood pressure monitor pursuant to paragraphs (1) and (2) of subsection b. of this section shall be able to submit a claim to the department for the reimbursement of the cost of the validated home blood pressure monitor and any provider time used to educate and train the patient on the proper use of the blood pressure monitor, to transmit blood pressure data from the patient's blood pressure monitor, and to interpret blood pressure data from the patient's blood pressure monitor, provided that the patient does not have coverage of such benefits from a third party, such as an insurance carrier or medical assistance program.
e. The Commissioner of Health shall report to the Governor and to the Legislature, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), 18 months after the effective date of this act, and annually thereafter, on the health care outcomes of patients provided blood pressure monitors under this section, which report shall include: the number of patients who received blood pressure monitors, disaggregated by those patients who were diagnosed with preeclampsia and those patients who requested blood pressure monitors; and the number of patients who received blood pressure monitors and who: (1) had documented improvement with blood pressure following the receipt of the monitor; (2) required hospitalization due to blood pressure issues following the receipt of the monitor; and (3) experienced maternal mortality attributable to preeclampsia.
14. The Commissioner of Health, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations to effectuate the purposes of section 13 of this act.
15. There is appropriated from the General Fund to the Department of Health $1,000,000 to issue reimbursements for claims submitted to the department pursuant to subsection d. of section 13 of this act. Any amount of unspent balance from this appropriation at the end of the current fiscal year shall be appropriated for the same purpose in the following fiscal year.
16. This act shall take effect on the first day of the fourth month next following the date of enactment. Sections 2 through 12 of this act shall apply to all contracts and policies that are delivered, issued, executed, or renewed or approved for issuance or renewal in this State on or after the effective date.
STATEMENT
This bill directs the Commissioner of Health to require every hospital in the State, every birthing center licensed in the State, every federally qualified health center in the State, and every physician or health care practitioner in the State providing care to a pregnant person, to provide, without cost to the patient,:
(1) a validated home blood pressure monitor to a pregnant patient who is diagnosed with preeclampsia;
(2) a validated home blood pressure monitor to a pregnant patient who expresses fear or anxiety regarding the patient's blood pressure and who requests a blood pressure monitor; and
(3) printed educational material regarding preeclampsia to each pregnant patient at the patient's first pregnancy visit. The educational material shall be developed and distributed to providers by the Department of Health and shall include, at a minimum, the following information: a definition of preeclampsia; the symptoms and warning signs of preeclampsia and at what point a patient experiencing those symptoms or warning signs should contact a medical professional; and a description of how a patient can advocate for themselves in regard to addressing preeclampsia.
The sponsor's goal is to provide pregnant patients in New Jersey, particularly those diagnosed with preeclampsia, with home blood pressure monitors and the training to use such a monitor to improve maternal outcomes in the State. Preeclampsia is a high blood pressure disorder that can occur during or after pregnancy. The condition can keep the baby from getting proper amounts of blood and oxygen from the mother. Preeclampsia can also cause the mother to have serious problems with her brain, liver, and kidneys. Monitoring blood pressure is therefore an essential part of prenatal and postpartum care.
Self-measured blood pressure monitoring in a patient's home can be particularly critical in the case of masked hypertension, where blood pressure levels are elevated at home despite normal blood pressure in a clinical setting. In addition, sudden rises in blood pressure can threaten pregnant women between prenatal appointments or if they have limited access to healthcare. This bill seeks to eliminate barriers to home-based monitoring, such as access to blood pressure measurement devices or limited knowledge on how to utilize a device. In doing so, this bill provides for the early detection of life-threatening high blood pressure in pregnancy, thereby preventing the maternal and neonatal morbidities associated with preeclampsia.
In addition, the bill directs that a hospital, a birthing center, a federally qualified health center, or a physician or health care practitioner that provides a patient a validated home blood pressure monitor pursuant to the bill is required, in accordance with guidelines developed by the commissioner, to educate and train the patient on the proper use of the blood pressure monitor; to transmit blood pressure data from the patient's blood pressure monitor; to interpret blood pressure data from the patient's blood pressure monitor; and to report to the Department of Health, one year after the effective date of this act and annually thereafter, de-identifiable data on the number of patients who received blood pressure monitors under this section and the health outcomes of those patients.
The bill also directs the Department of Health to establish a process by which a hospital, a birthing center, a federally qualified health center, or a physician or health care practitioner that provides a patient with a validated home blood pressure monitor under the bill is able to submit a claim to the department for the reimbursement of the cost of the validated home blood pressure monitor and any provider time used to educate and train the patient on the proper use of the blood pressure monitor, to transmit blood pressure data from the patient's blood pressure monitor, and to interpret blood pressure data from the patient's blood pressure monitor, provided that the patient does not have coverage of such benefits from a third party, such as an insurance carrier or medical assistance program. The bill appropriations $1 million to the department to issue these reimbursements and requires that any unspent balance at the end of the current fiscal year be appropriated for the same purpose in the next fiscal year.
Finally, under the bill, the Commissioner of Health is mandated to report to the Governor and to the Legislature, 18 months after the effective date of the bill, and annually thereafter, on the health care outcomes of patients provided blood pressure monitors under the bill, which report is to include: the number of patients who received blood pressure monitors, disaggregated by those patients who were diagnosed with preeclampsia and those patients who requested blood pressure monitors; and the number of patients who received blood pressure monitors who: had documented improvement with blood pressure following the receipt of the monitor, required hospitalization due to blood pressure issues following the receipt of the monitor, and experienced maternal mortality related to preeclampsia.
The bill also requires health insurers to provide coverage for self-measured blood pressure monitoring for any subscriber who is diagnosed with preeclampsia, which coverage is to include the provision of a validated home blood pressure monitor and the reimbursement of provider time used to educate and train the subscriber on the proper use of the blood pressure monitor, to transmit blood pressure data from the subscriber's blood pressure monitor, and to interpret blood pressure data from the subscriber's blood pressure monitor. Specifically, this provision of the bill affects health, hospital, and medical service corporations; individual and group health insurance policies; health maintenance organizations; individual health benefits plans; small employer health benefits plans; the State Health Benefits Program; the School Employees' Health Benefits Program; and the State Medicaid Program.
