New Jersey-2024-S3334-Introduced

An Act concerning Medicaid coverage of maternal health services and supplementing Title 30 of the Revised Statutes.

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

1. As used in this act:

"Department" means the Department of Human Services.

"Health care provider" means a physician, a certified nurse midwife, a professional midwife, or a midwife who is licensed pursuant to Title 45 of the Revised Statutes.

"Medicaid" means the New Jersey Medical Assistance and Health Services Program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.)

"Remote maternal health services" means the use of digital technology to collect medical and other forms of health data from a pregnant Medicaid beneficiary and electronically transmit this information, in a secure manner, to a health care provider at a distant site for interpretation and use as part of a diagnosis or a treatment plan.

"Remote non-stress test" means the use of a fetal monitoring device, which is FDA cleared for at-home use to transmit fetal heart rate, maternal heart rate, and uterine activity to a remote health care provider.

"Remote patient monitoring" means the use of digital technologies to collect medical and other forms of health data from patients in one location and electronically transmit that information securely to health care providers at a different location for analysis, interpretation, and to make recommendations to, and manage the treatment of, such patients. "Remote patient monitoring" shall include the monitoring of clinical patient data such as weight, blood pressure, pulse oximetry, respiratory flow rate, musculoskeletal system status, blood glucose levels, and other patient-generated physiological data.

"Tele-ultrasound" means the use of an ultrasound device that is capable of sharing live streaming of ultrasound images that are interpreted in real time by a health care provider that is in a different location than the patient. Two-way audiovisual communication with the remote healthcare provider may happen through the ultrasound system or another device that is compliant with the provisions of the federal "Health Insurance Portability and Accountability Act of 1996."

2. a. Contingent upon the receipt of federal reimbursement for eligible State Medicaid expenditures, the Commissioner of Human Services shall establish a voluntary, three-year pilot program to provide remote maternal health services to pregnant Medicaid beneficiaries who are referred to the program by the beneficiary's health care provider.

b. The Commissioner of Human Services shall, based upon clinical evidence and the recommendations of experts in the practice of obstetrics and maternal-fetal medicine, determine the menu of remote maternal health services that will be available through the pilot program, which services shall, at a minimum, include:

(1) remote patient monitoring;

(2) remote non-stress tests; and

(3) tele-ultrasound.

c. Any patient health data collected and transmitted, pursuant to the remote maternal health services pilot program, shall be collected and transmitted by a device that is compliant with the requirements of the federal "Health Insurance Portability and Accountability Act of 1996" (42 U.S.C. s.1320d et seq.) and that has received approval for use in this capacity by the United States Food and Drug Administration.

3. a. A pregnant individual who is enrolled in the Medicaid program is eligible to participate, on a voluntary basis, in the remote maternal health services pilot program, established pursuant to section 2 of this act, provided the Medicaid beneficiary's health care provider determines that:

(1) remote maternal health services meet the standard of care; or

(2) the beneficiary has an increased likelihood of a high-risk pregnancy due to:

(a) pre-existing medical conditions, which shall include, but shall not be limited to: HIV or AIDS, diabetes, high blood pressure, kidney disease, obesity, or polycystic ovary syndrome;

(b) age at the time of pregnancy, including beneficiaries between the ages of ten and 19, and those aged 35 years and older;

(d) diagnosed pregnancy-related conditions, which shall include, but shall not be limited to: multiple gestation, gestational diabetes, preeclampsia, eclampsia, previous preterm births, or the existence of birth defects or genetic conditions in the fetus.

b. The remote maternal health services pilot program shall be offered to a pregnant Medicaid beneficiary who does not meet the eligibility requirements established under paragraph a. of this section, but who resides in a community that lacks a sufficient number of health care providers who offer obstetric care and participate in the Medicaid program.

c. Participation in the remote maternal health services pilot program shall be offered to a pregnant Medicaid beneficiary who does not meet the eligibility requirements under paragraphs a. and b. of this section, but whose health care provider determines is unable to access consistent obstetric care due to socioeconomic factors, such as: the beneficiary's employment schedule, a lack of reliable transportation, or a lack of reliable child care.

d. A pregnant Medicaid beneficiary shall only participate in the remote maternal health services pilot program upon referral by the beneficiary's health care provider.

e. Under no circumstances shall the State or a health care provider require that a pregnant Medicaid beneficiary participate in the remote maternal health services pilot program.

4. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.

5. The Commissioner of Human Services shall adopt rules and regulations pursuant to the "Administrative Procedure Act" P.L.1968, c.410 (C.52:14B-1 et seq.) to implement the provisions of this act.

6. This act shall take effect immediately, but shall remain inoperative until the Commissioner of Human Services receives any federal approvals following the submission of applications for State plan amendments or waivers pursuant to section 4 of this act.

STATEMENT

This bill establishes a voluntary, three-year pilot program to provide certain pregnant Medicaid beneficiaries with remote maternal health services, upon referral by the beneficiaries' health care provider. It is the intent of the bill's sponsor to expand access to obstetric care for pregnant patients who live in the State's rural communities or in medically underserved communities.

The bill provides that the Commissioner of Human Services, based upon clinical evidence and the recommendations of experts in the fields of obstetrics and maternal-fetal medicine, will determine the remote services to be provided through the pilot program. At minimum, the program will provide remote patient monitoring, remote non-stress tests, and tele-ultrasound services for pregnant Medicaid beneficiaries. The bill defines "remote maternal health services" as the use of digital technology to collect medical and health data from a pregnant patient and securely transmit this information to a health care provider at a distant site for interpretation and use as part of a diagnosis or a treatment plan. "Remote patient monitoring" is defined as the use of digital technology to collect and transmit patient health data to a healthcare provider at a distant site for review and treatment management.

The bill stipulates that the devices and digital technologies used to provide remote maternal health services must comply with the requirements of the federal "Health Insurance Portability and Accountability Act of 1996," and be used in an FDA-approved capacity.

The bill provides that State licensed physicians, certified nurse midwives, professional midwives, or midwives may refer a pregnant Medicaid beneficiary to the pilot program if the health care provider determines that remote maternal health services are in the beneficiary's best interests; or that the beneficiary has an increased likelihood of a high-risk pregnancy due to: pre-existing medical conditions; age; lifestyle factors; or a diagnosed pregnancy-related condition, such as preeclampsia.

The bill also provides that remote maternal health services will be available to a pregnant Medicaid beneficiary whose pregnancy is not high-risk, but who resides in a community that lacks a sufficient number of health care providers who offer obstetric care and participate in the Medicaid program. Eligibility for the pilot program will also be extended to a pregnant Medicaid beneficiary who is unable to access consistent obstetric care due to socioeconomic factors, such as the beneficiary's work schedule, a lack of reliable transportation, or a lack of reliable child care.

Pursuant to the bill, the establishment of the remote maternal health services pilot program is contingent upon federal approval of the State's Medicaid waiver application or State plan amendment, in order to ensure federal financial participation for State Medicaid expenditures under the federal Medicaid program.