New Jersey-2016-S2459-Introduced

An Act concerning local unit employee health insurance and supplementing chapter 10 of Title 40A of the New Jersey Statutes.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. As used in P.L. , c. (C. ) (pending before the Legislature as this bill):

"Carrier" means an entity that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services under a health benefits plan, including: an insurance company authorized to issue health benefits plans; a health maintenance organization; a health, hospital, or medical service corporation; a multiple employer welfare arrangement; an entity under contract with the State Health Benefits Program to administer a health benefits plan; or any other entity providing a health benefits plan.

"Health care data" means data from a carrier relating to the provision, financing, and administration of health care, as applicable, including, but not limited to, information regarding: medical, pharmacy, and behavioral health claims; health care utilization; health care safety and quality; health outcomes; health care providers; and costs.

"Insurance consultant" means an individual or a business entity providing, for a commission, brokerage fee, or other consideration, services, including, but not limited to, brokerage, risk management, and related administrative services associated with the procurement, evaluation, and advice, counsel, or opinion with respect to the benefits, advantages, or disadvantages of any insurance product or contract that is or could be issued to a local unit.

"Local unit" means a county or municipality with at least 100 participants in its health benefits plan.

"Other forms of compensation" includes but is not limited to incentive payments, bonuses, rebates, or any other thing of value, whether provided directly or indirectly.

2. a. A contract for the provision of health insurance consulting services shall require that the insurance consultant provide to the local unit, no later than five months prior to the introduction of the annual budget of the local unit, a certification of the amount of commissions or other forms of compensation accepted from a carrier during the prior calendar year for any insurance consultant services provided in connection with any contract awarded to the carrier by the local unit.

b. If an insurance consultant fails to provide a certification as required by subsection a. of this section, the local unit shall be entitled to terminate any contract with the insurance consultant and the insurance consultant shall be liable to a civil penalty of $2 per employee covered under the local unit's health benefits plan for each day the violation continues, which penalty may be collected in a summary proceeding by the local unit pursuant to the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.). The remedies for a violation provided under this subsection shall be in addition to any other remedies that may be provided by contract.

3. a. A contract for the provision of, delivery of, arrangement for, payment for, or reimbursement of any of the costs of health care services under a health benefits plan to the local unit's employees shall require that the carrier report to the local unit on a monthly basis health care data, including, but not limited to, medical claims files, pharmacy claims files, dental claims files, and covered person eligibility files containing records associated with each of the categories of claims files reported.

b. The carrier and local unit shall comply with the applicable provisions of the federal health privacy rules set forth in sections 160 and 164 of Title 45, Code of Federal Regulations, and with other proprietary requirements related to the collection and release of health care data.

c. If a carrier fails to report information as required by subsection a. of this section, the carrier shall be liable to a civil penalty of $2 per employee covered under the local unit's health benefits plan for each day the violation continues, which penalty may be collected in a summary proceeding by the local unit pursuant to the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.). If a carrier fails to report information as required by subsection a. of this section three or more times in any one year, the local unit shall be entitled to terminate any contract with the carrier. The remedies for a violation provided under this subsection shall be in addition to any other remedies that may be provided by contract.

4. The governing body of a local unit shall, no later than four months prior to the introduction of the annual budget of the local unit, review the information provided to the local unit pursuant to sections 2 and 3 of P.L. , c. (C. ) (pending before the Legislature as this bill). The governing body shall certify that this review has been completed in the annual budget of the local unit. The Director of the Division of Local Government Services in the Department of Community Affairs shall not certify approval of an annual budget of a local unit if the annual budget does not contain the certification required by this section.

5. This act shall take effect immediately.

STATEMENT

This bill would require health insurance consultants and carriers to provide certain health insurance information to local units and require these local units to review this information in advance of the preparation of their annual budgets. The local units that would be subject to this bill are counties and municipalities with at least 100 participants covered under their health insurance plans. Health insurance is a major expense for local units. By requiring greater transparency in health insurance usage and costs as well as requiring local unit review of this information, this bill would help local units ensure that taxpayer funds are being spent on their employees' health insurance in a cost-effective manner.

Under the bill, a health insurance consultant that contracts with a local unit would be required to annually disclose to the local unit the amount of compensation received in the prior year from a carrier for any insurance consultant services provided in connection with a contract awarded to the carrier by the unit. The bill would make the compensation disclosure requirement a part of the contract between a local unit and the health insurance consultant. If a health insurance consultant fails to make a required annual disclosure, the local unit would be permitted to terminate any contract with the consultant and collect a civil penalty from the consultant in addition to any other remedies that may be provided by contract.

The bill would also require a carrier that contracts with a local unit to provide health care data to the local unit on a monthly basis. The carrier and local unit would be required to comply with the applicable provisions of federal health privacy rules, and with other proprietary requirements related to the collection and release of health care data. The bill would make these reporting requirements a part of the contract between a local unit and the carrier. If a carrier fails to meet a monthly reporting requirement, the local unit would be permitted to collect a civil penalty from the carrier and, if there are more than three such violations in a year, to terminate any contract with the carrier, in addition to any other remedies that may be provided by contract.