Bill Text: NJ A1214 | 2012-2013 | Regular Session | Introduced


Bill Title: Establishes pilot program to utilize value-based benefit design in SHBP to increase health benefits coverage for certain employees concerning chronic health conditions.

Spectrum: Bipartisan Bill

Status: (Enrolled - Dead) 2014-01-21 - Pocket Veto - Bills not Acted on by Governor-end of Session [A1214 Detail]

Download: New_Jersey-2012-A1214-Introduced.html

ASSEMBLY, No. 1214

STATE OF NEW JERSEY

215th LEGISLATURE

 

PRE-FILED FOR INTRODUCTION IN THE 2012 SESSION

 


 

Sponsored by:

Assemblywoman  LINDA STENDER

District 22 (Middlesex, Somerset and Union)

Assemblyman  HERB CONAWAY, JR.

District 7 (Burlington)

Assemblyman  JAY WEBBER

District 26 (Essex, Morris and Passaic)

Assemblyman  DANIEL R. BENSON

District 14 (Mercer and Middlesex)

 

 

 

 

SYNOPSIS

     Establishes pilot program to utilize value-based benefit design in SHBP to increase health benefits coverage for certain employees concerning chronic health conditions.

 

CURRENT VERSION OF TEXT

     Introduced Pending Technical Review by Legislative Counsel

  


An Act concerning coverage provided under the State Health Benefits Program and supplementing P.L.1961, c.49 (C.52:14-17.25 et seq.).

 

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

 

     1.    a. (1)  The State Health Benefits Commission shall establish a pilot program to provide coverage to select employees with chronic health conditions using a value-based benefit design, as described herein, pursuant to one or more contracts negotiated and arranged by the commission with one or more carriers licensed to operate in this State.

     (2)   The value-based benefit design shall target the following chronic health conditions: diabetes; high cholesterol; hypertension; and asthma.

     (3)   The value-based benefit design shall utilize explicit financial incentives to increase the employee's interaction with appropriate health care providers, and encourage use of those health benefits that specifically relate to the employee's chronic health condition; the underlying goal being to increase the employee's access to care and information to help improve the employee's condition and, thus, better manage the overall costs of that employee's health benefits coverage under the State Health Benefits Program.

     b.    (1)  (a)  Only an employee diagnosed with one or more of the chronic health conditions set forth in paragraph (2) of subsection a. of this section shall be eligible to participate in the pilot program.

     (b)   Participation by any eligible employee in the pilot program shall be voluntary.  The selection of an employee to participate shall be based upon a procedure determined by the commission, as part of any contract negotiated with a carrier establishing the program.

     (2)   The value-based benefit design shall assign an eligible employee who is selected to participate in the pilot program to a pharmacist, who shall be responsible for coordinating prescription drug benefits and related pharmaceutical care within the scope of the pharmacist's license to practice pharmacy.  The pharmacist shall periodically update the employee's primary treating physician concerning the provision of any prescription drug benefit and related pharmaceutical care.

     (3)   For those eligible employees who are selected to participate in the pilot program, the value-based benefit design shall provide the following financial incentives directly related to the diagnosis, care, mitigation, or treatment of the condition for which the employee is participating in the program:

     (a)   all tuition costs shall be covered for any education class attended by the employee which provides medical condition self-management, recommended to the employee by the primary treating physician or assigned pharmacist;

     (b)   all costs for private visits with the employee's assigned pharmacist shall be covered;

     (c)   all costs shall be covered for a medical device or supply deemed medically necessary by the primary treating physician or assigned pharmacist;

     (d)   all laboratory testing shall be covered; and

     (e)   all copayments for any prescription drug shall be waived.

     (4)   In order to remain a participant in the pilot program and receive the financial incentives set forth in paragraph (3) of this subsection related to the diagnosis, care, mitigation, or treatment of the condition for which the employee is participating in the program, the employee shall comply with all aspects of the value-based benefit design regimen, including, but not limited to: attendance at all medical appointments; adherence to advice or instructions provided by the primary treating physician or assigned pharmacist; and use of all prescription drugs as directed.  An employee's removal from the program shall be based upon appropriate proofs and a procedure determined by the commission, as part of any contract negotiated with a carrier establishing the program.

     c.     The commission shall select one department, division, office, agency, bureau or other unit of this State, or a part thereof, with at least 500 but not more than 1000 employees who are eligible to participate in the pilot program; provided, however, the commission shall not enter into a contract under the pilot program to adjust the existing coverage of any employee for whom there is a majority representative for collective negotiations purposes, unless permitted pursuant to an applicable binding collective negotiations agreement or through further negotiation with the majority representative during the application of the binding collective negotiations agreement, or upon the expiration of that agreement.

     d.    The commission shall seek to obtain any funding as may be available from the United States government pursuant to federal law to assist in the development and implementation of the value-based benefit design coverage under the pilot program.

     e.     The pilot program shall expire on the last day of the fifth year next following commencement of any value-based benefit design coverage under the program.  The commission shall issue a report to the Governor and, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), to the Legislature regarding the pilot program no later than that date, which report shall include a detailed summary of the commission's activities, the application of the value-based benefit design coverage within the State Health Benefits Program, and any recommendations with respect to the extension, modification, or expansion of the program.

     2.    This act shall take effect immediately.

 

 

STATEMENT

 

     This bill establishes a five-year pilot program to provide benefits coverage to select employees with chronic health conditions using a value-based benefit design under the State Health Benefits Program (SHBP).  The value-based benefit design shall target the following chronic health conditions: diabetes; high cholesterol; hypertension; and asthma.

     Such coverage design shall utilize explicit financial incentives to increase the employee's interaction with appropriate health care providers, and encourage use of those health benefits that specifically relate to the employee's chronic health condition.  The underlying goal of the value-based benefit design is to increase the employee's access to care and information to help improve the employee's condition and, thus, better manage the overall costs of that employee's health benefits coverage under the State Health Benefits Program.

     The State Health Benefits Commission is charged with selecting one department, division, office, agency, bureau or other unit of this State, or a part thereof, with at least 500 but not more than 1000 employees who are eligible, based on their chronic health conditions, to participate in the pilot program.  The commission shall provide the selected employees with the value-based benefit design coverage as set forth in the bill through one or more contracts negotiated and arranged with one or more carriers licensed to operate in this State.

     Participation by any eligible employee in the pilot program shall be voluntary.  The selection of an employee to participate shall be based upon a procedure determined by the commission, as part of any contract negotiated with a carrier establishing the program.

     The value-based benefit design shall assign a participating employee to a pharmacist, who shall be responsible for coordinating prescription drug benefits and related pharmaceutical care within the scope of the pharmacist's license to practice pharmacy.  The pharmacist shall periodically update the employee's primary treating physician concerning the provision of any prescription drug benefit and related pharmaceutical care.

     For the participating employees, the value-based benefit design shall provide the following financial incentives directly related to the diagnosis, care, mitigation, or treatment of the condition for which the employee is participating in the program:

     (1)   all tuition costs shall be covered for any education class attended by the employee which provides medical condition self-management, recommended to the employee by the primary treating physician or assigned pharmacist;

     (2)   all costs for private visits with the employee's assigned pharmacist shall be covered;

     (3)   all costs shall be covered for a medical device or supply deemed medically necessary by the primary treating physician or assigned pharmacist;

     (4)   all laboratory testing shall be covered; and

     (5)   all copayments for any prescription drug shall be waived.

     In order to remain a participant in the pilot program and receive these financial incentives, the employee shall comply with all aspects of the value-based benefit design regimen, including, but not limited to: attendance at all medical appointments; adherence to advice or instructions provided by the primary treating physician or assigned pharmacist; and use of all prescription drugs as directed.

     No later than the date of expiration on the five-year pilot program, the commission shall issue a report to the Governor and to the Legislature, which report shall include a detailed summary of the commission's activities, the application of the value-based benefit design coverage within the SHBP, and any recommendations with respect to the extension, modification, or expansion of the program.

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