Sponsored by:
Senator ANDREW ZWICKER
District 16 (Hunterdon, Mercer, Middlesex and Somerset)
SYNOPSIS
Authorizes home care for individuals who are disabled or elderly and requires health insurance coverage therefor.
CURRENT VERSION OF TEXT
As reported by the Senate Health, Human Services and Senior Citizens Committee on June 23, 2022, with amendments.
An Act concerning home health care and supplementing various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. As used in this section:
1"Clinical setting" means a health care professional's office or professional practice setting or a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).1
"Disabled" means total and permanent inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment, including blindness.
"Elderly" means a person age 65 years or older.
1["Health care facility" means a physician's office or any other health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).]1
"Health care professional" means a person licensed to practice a health care profession pursuant to Title 45 of the Revised Statutes.
b. A health care professional shall be permitted to provide care or treatment to an individual who is disabled or elderly in the home of the individual if the individual is unable to present for an in-person visit in a 1[health care facility] clinical setting1 , as documented by a health care professional in the medical record of the individual based upon the good faith clinical judgment of the health care professional, and if the health care professional is able to provide adequate medical care or treatment in the home of the individual in a manner that is consistent with the clinical standards for treatment in the applicable specialty.
2. a. No group or individual hospital service corporation contract providing hospital or medical expense benefits shall be 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, unless the contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in conducting home care.
b. The benefits shall be provided to the same extent as for any other medical condition under the contract. 1The provisions of this section shall not be interpreted as imposing any new network adequacy requirements related specifically to the provision of home care.1
c. The provisions of this
section shall apply to all contracts in
which the hospital service corporation has reserved the right to change the premium.
d. 1Nothing herein shall be interpreted to preclude a hospital service corporation from offering benefits for the provision of care or treatment by a health care professional in a subscriber's home, which coverage may be provided regardless of whether the subscriber is elderly or has a disability and regardless of the reasons for which care or treatment is provided in the subscriber's home.
e.1 As used in this section:
1"Clinical setting" means a health care professional's office or professional practice setting or a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).1
"Disabled" means total and permanent inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment, including blindness.
"Elderly" means a person age 65 years or older.
1["Health care facility" means a physician's office or any other health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).]1
"Health care professional" means a person licensed to practice a health care profession pursuant to Title 45 of the Revised Statutes.
"Home care" means preventative, primary, specialty, or urgent care or treatment provided by a health care professional to an individual who is disabled or elderly in the home of the individual if the individual is unable to present for an in-person visit in a 1[health care facility] clinical setting1 , as reasonably documented by a health care professional in the medical record of the individual based upon the good faith clinical judgment of the health care professional, and if the health care professional is able to provide adequate medical care or treatment in the home of the individual in a manner that is consistent with the clinical standards for treatment in the applicable specialty. "Home care" excludes custodial care.
3. a. No group or individual medical service corporation contract providing hospital or medical expense benefits shall be 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, unless the contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in conducting home care.
b. These benefits shall be provided to the same extent as for any other medical condition under the contract. 1The provisions of this section shall not be interpreted as imposing any new network adequacy requirements related specifically to the provision of home care.1
c. The provisions of this section shall apply to all contracts in which the medical 1[services] service1 corporation has reserved the right to change the premium.
d. 1Nothing herein shall be interpreted to preclude a medical service corporation from offering benefits for the provision of care or treatment by a health care professional in a subscriber's home, which coverage may be provided regardless of whether the subscriber or is elderly or has a disability and regardless of the reasons for which care or treatment is provided in the subscriber's home.
e.1 As used in this section:
1"Clinical setting" means a health care professional's office or professional practice setting or a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).1
"Disabled" means total and permanent inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment, including blindness.
"Elderly" means a person age 65 years or older.
1["Health care facility" means a physician's office or any other health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).]1
"Health care professional" means a person licensed to practice a health care profession pursuant to Title 45 of the Revised Statutes.
"Home care" means preventative, primary, specialty, or urgent care or treatment provided by a health care professional to an individual who is disabled or elderly in the home of the individual if the individual is unable to present for an in-person visit in a 1[health care facility] clinical setting1 , as reasonably documented by a health care professional in the medical record of the individual based upon the good faith clinical judgment of the health care professional, and if the health care professional is able to provide adequate medical care or treatment in the home of the individual in a manner that is consistent with the clinical standards for treatment in the applicable specialty. "Home care" excludes custodial care.
4. a. No group or individual health service corporation contract providing hospital or medical expense benefits shall be 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, unless the contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in conducting home care.
b. These benefits shall be provided to the same extent as for any other medical condition under the contract. 1The provisions of this section shall not be interpreted as imposing any new network adequacy requirements related specifically to the provision of home care.1
c. The provisions of this section shall apply to all contracts in which the health 1[services] service1 corporation has reserved the right to change the premium.
d. 1Nothing herein shall be interpreted to preclude a health service corporation from offering benefits for the provision of care or treatment by a health care professional in a subscriber's home, which coverage may be provided regardless of whether the subscriber is elderly or has a disability and regardless of the reasons for which care or treatment is provided in the subscriber's home.
e.1 As used in this section:
1"Clinical setting" means a health care professional's office or professional practice setting or a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).1
"Disabled" means total and permanent inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment, including blindness.
"Elderly" means a person age 65 years or older.
1["Health care facility" means a physician's office or any other health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).]1
"Health care professional" means a person licensed to practice a health care profession pursuant to Title 45 of the Revised Statutes.
"Home care" means preventative, primary, specialty, or urgent care or treatment provided by a health care professional to an individual who is disabled or elderly in the home of the individual if the individual is unable to present for an in-person visit in a 1[health care facility] clinical setting1 , as reasonably documented by a health care professional in the medical record of the individual based upon the good faith clinical judgment of the health care professional, and if the health care professional is able to provide adequate medical care or treatment in the home of the individual in a manner that is consistent with the clinical standards for treatment in the applicable specialty. "Home care" excludes custodial care.
5. a. No individual health insurance policy providing hospital or medical expense benefits shall be 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, unless the policy provides benefits to any named insured or other person covered thereunder for expenses incurred in conducting home care.
b. These benefits shall be provided to the same extent as for any other medical condition under the policy. 1The provisions of this section shall not be interpreted as imposing any new network adequacy requirements related specifically to the provision of home care.1
c. The provision of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
d. 1Nothing herein shall be interpreted to preclude an insurer from offering benefits for the provision of care or treatment by a health care professional in an insured's home, which coverage may be provided regardless of whether the insured is elderly or has a disability and regardless of the reasons for which care or treatment is provided in the insured's home.
e.1 As used in this section:
1["Health care facility" means a physician's office or any other health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).] "Clinical setting" means a health care professional's office or professional practice setting or a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).1
"Disabled" means total and permanent inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment, including blindness.
"Elderly" means a person age 65 years or older.
"Health care professional" means a person licensed to practice a health care profession pursuant to Title 45 of the Revised Statutes.
"Home care" means preventative, primary, specialty, or urgent care or treatment provided by a health care professional to an individual who is disabled or elderly in the home of the individual if the individual is unable to present for an in-person visit in a 1[health care facility] clinical setting1 , as reasonably documented by a health care professional in the medical record of the individual based upon the good faith clinical judgment of the health care professional, and if the health care professional is able to provide adequate medical care or treatment in the home of the individual in a manner that is consistent with the clinical standards for treatment in the applicable specialty. "Home care" excludes custodial care.
6. a. No group health insurance policy providing hospital or medical expense benefits shall be 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, unless the policy provides benefits to any named insured or other person covered thereunder for expenses incurred in conducting home care.
b. These benefits shall be provided to the same extent as for any other medical condition under the policy. 1The provisions of this section shall not be interpreted as imposing any new network adequacy requirements related specifically to the provision of home care.1
c. The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
d. 1Nothing herein shall be interpreted to preclude an insurer from offering benefits for the provision of care or treatment by a health care professional in an insured's home, which coverage may be provided regardless of whether the insured is elderly or has a disability and regardless of the reasons for which care or treatment is provided in the insured's home.
e.1 As used in this section:
1"Clinical setting" means a health care professional's office or professional practice setting or a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).1
"Disabled" means total and permanent inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment, including blindness.
"Elderly" means a person age 65 years or older.
1["Health care facility" means a physician's office or any other health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).]1
"Health care professional" means a person licensed to practice a health care profession pursuant to Title 45 of the Revised Statutes.
"Home care" means preventative, primary, specialty, or urgent care or treatment provided by a health care professional to an individual who is disabled or elderly in the home of the individual if the individual is unable to present for an in-person visit in a 1[health care facility] clinical setting1 , as reasonably documented by a health care professional in the medical record of the individual based upon the good faith clinical judgment of the health care professional, and if the health care professional is able to provide adequate medical care or treatment in the home of the individual in a manner that is consistent with the clinical standards for treatment in the applicable specialty. "Home care" excludes custodial care.
7. a. Notwithstanding any provision of law to the contrary, a certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued by the Commissioner of Banking and Insurance on or after the effective date of this act unless the health maintenance organization provides health care services to any enrollee for the use of home care.
b. These health care services shall be provided to the same extent as for any other medical condition under the enrollee agreement. 1The provisions of this section shall not be interpreted as imposing any new network adequacy requirements related specifically to the provision of home care.1
c. The provisions of this section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges.
d. 1Nothing herein shall be interpreted to preclude a health maintenance organization from offering benefits for the provision of care or treatment by a health care professional in an enrollee's home, which coverage may be provided regardless of whether the enrollee is elderly or has a disability and regardless of the reasons for which care or treatment is provided in the enrollee's home.
e.1 As used in this section:
1"Clinical setting" means a health care professional's office or professional practice setting or a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).1
"Disabled" means total and permanent inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment, including blindness.
"Elderly" means a person age 65 years or older.
1["Health care facility" means a physician's office or any other health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).]1
"Health care professional" means a person licensed to practice a health care profession pursuant to Title 45 of the Revised Statutes.
"Home care" means preventative, primary, specialty, or urgent care or treatment provided by a health care professional to an individual who is disabled or elderly in the home of the individual if the individual is unable to present for an in-person visit in a 1[health care facility] clinical setting1 , as reasonably documented by a health care professional in the medical record of the individual based upon the good faith clinical judgment of the health care professional, and if the health care professional is able to provide adequate medical care or treatment in the home of the individual in a manner that is consistent with the clinical standards for treatment in the applicable specialty. "Home care" excludes custodial care.
8. a. Every individual health benefits plan that is delivered, issued, executed, or renewed 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, on or after the effective date of this act, shall provide benefits to any person covered thereunder for expenses incurred in conducting home care.
b. The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan. 1The provisions of this section shall not be interpreted as imposing any new network adequacy requirements related specifically to the provision of home care.1
c. The provisions of this section shall apply to all health 1[benefit] benefits1 plans in which the carrier has reserved the right to change the premium.
d. 1Nothing herein shall be interpreted to preclude a carrier from offering benefits for the provision of care or treatment by a health care professional in a covered person's home, which coverage may be provided regardless of whether the covered person is elderly or has a disability and regardless of the reasons for which care or treatment is provided in the covered person's home.
e.1 As used in this section:
1"Clinical setting" means a health care professional's office or professional practice setting or a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).1
"Disabled" means total and permanent inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment, including blindness.
"Elderly" means a person age 65 years or older.
1["Health care facility" means a physician's office or any other health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).]1
"Health care professional" means a person licensed to practice a health care profession pursuant to Title 45 of the Revised Statutes.
"Home care" means preventative, primary, specialty, or urgent care or treatment provided by a health care professional to an individual who is disabled or elderly in the home of the individual if the individual is unable to present for an in-person visit in a 1[health care facility] clinical setting1 , as reasonably documented by a health care professional in the medical record of the individual based upon the good faith clinical judgment of the health care professional, and if the health care professional is able to provide adequate medical care or treatment in the home of the individual in a manner that is consistent with the clinical standards for treatment in the applicable specialty. "Home care" excludes custodial care.
9. a. Every small employer health benefits plan that is delivered, issued, executed, or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) or approved for issuance or renewal in this State, on or after the effective date of this act, shall provide benefits to any person covered thereunder for expenses incurred in conducting home care.
b. The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan. 1The provisions of this section shall not be interpreted as imposing any new network adequacy requirements related specifically to the provision of home care.1
c. The provisions of this section shall apply to all health 1[benefit] benefits1 plans in which the carrier has reserved the right to change the premium.
d. 1Nothing herein shall be interpreted to preclude a carrier from offering benefits for the provision of care or treatment by a health care professional in a covered person's home, which coverage may be provided regardless of whether the covered person is elderly or has a disability and regardless of the reasons for which care or treatment is provided in the covered person's home.
e.1 As used in this section:
1"Clinical setting" means a health care professional's office or professional practice setting or a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).1
"Disabled" means total and permanent inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment, including blindness.
"Elderly" means a person age 65 years or older.
1["Health care facility" means a physician's office or any other health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).]1
"Health care professional" means a person licensed to practice a health care profession pursuant to Title 45 of the Revised Statutes.
"Home care" means preventative, primary, specialty, or urgent care or treatment provided by a health care professional to an individual who is disabled or elderly in the home of the individual if the individual is unable to present for an in-person visit in a 1[health care facility] clinical setting1 , as reasonably documented by a health care professional in the medical record of the individual based upon the good faith clinical judgment of the health care professional, and if the health care professional is able to provide adequate medical care or treatment in the home of the individual in a manner that is consistent with the clinical standards for treatment in the applicable specialty. "Home care" excludes custodial care.
10. a. 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 and medical expense benefits shall provide coverage for expenses incurred in conducting home care.
b. The benefits shall be provided to the same extent as for any other medical condition under the contract. 1The provisions of this section shall not be interpreted as imposing any new network adequacy requirements related specifically to the provision of home care.1
c. 1Nothing herein shall be interpreted to preclude the commission from offering benefits for the provision of care or treatment by a health care professional in a covered person's home, which coverage may be provided regardless of whether the covered person is elderly or has a disability and regardless of the reasons for which care or treatment is provided in the covered person's home.
d.1 As used in this section:
1"Clinical setting" means a health care professional's office or professional practice setting or a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).1
"Disabled" means total and permanent inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment, including blindness.
"Elderly" means a person age 65 years or older.
1["Health care facility" means a physician's office or any other health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).]1
"Health care professional" means a person licensed to practice a health care profession pursuant to Title 45 of the Revised Statutes.
"Home care" means preventative, primary, specialty, or urgent care or treatment provided by a health care professional to an individual who is disabled or elderly in the home of the individual if the individual is unable to present for an in-person visit in a 1[health care facility] clinical setting1 , as reasonably documented by a health care professional in the medical record of the individual based upon the good faith clinical judgment of the health care professional, and if the health care professional is able to provide adequate medical care or treatment in the home of the individual in a manner that is consistent with the clinical standards for treatment in the applicable specialty. "Home care" excludes custodial care.
11. This act shall take effect immediately.