Bill Text: NJ A1811 | 2016-2017 | Regular Session | Introduced
Bill Title: Requires insurers, Medicaid, and NJ FamilyCare to reimburse for childhood immunizations at levels specified by regulation.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Introduced - Dead) 2016-01-27 - Introduced, Referred to Assembly Health and Senior Services Committee [A1811 Detail]
Download: New_Jersey-2016-A1811-Introduced.html
STATE OF NEW JERSEY
217th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2016 SESSION
Sponsored by:
Assemblyman HERB CONAWAY, JR.
District 7 (Burlington)
Assemblyman DANIEL R. BENSON
District 14 (Mercer and Middlesex)
SYNOPSIS
Requires insurers, Medicaid, and NJ FamilyCare to reimburse for childhood immunizations at levels specified by regulation.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning third party coverage for childhood immunizations, amending P.L.1995, c.316 and supplementing Title 30 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 7 of P.L.1995, c.316 (C.26:2-137.1) is amended to read as follows:
7. The [Department] Commissioner of Health and Senior Services shall specify by regulation, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.):
a. [The] the lead screening provided for under P.L.1995, c.316 (C.17:48E-35.10 et al.), including the age of the child when initial screening should be conducted, the time intervals between screening, when follow-up testing is required, the methods that shall be used to conduct the lead screening, and the level of lead in the bloodstream that shall be considered to be "lead poisoning"; [and]
b. [The] the childhood and adolescent immunizations recommended by the Advisory Committee on Immunization Practices of the United States Public Health Service and the Department of Health and Senior Services; and
c. in consultation with the Commissioner of Banking and Insurance:
(1) the minimum level at which an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization shall reimburse a health care provider for childhood immunizations provided for under P.L.1995, c.316 (C.17:48E-35.10 et al.), which shall:
(a) reflect the reasonable costs to a health care provide,r as determined by the Commissioner of Health and Senior Services, of acquiring, maintaining, and administering the childhood immunizations;
(b) be determined by the Commissioner of Health and Senior Services after consultation with appropriate entities, including, but not limited to, the Medical Society of New Jersey, the American Academy of Pediatrics - New Jersey Chapter, and the New Jersey Academy of Family Physicians; and
(c) be periodically updated as determined appropriate by the Commissioner of Health and Senior Services;
(2) a civil penalty to which a health insurer as specified in paragraph (1) of this subsection that fails to comply with the requirements adopted by regulation pursuant to that paragraph shall be liable, which shall not exceed $1,000 for the first violation, $5,000 for the second violation, and $10,000 for the third and each subsequent violation, and shall be collected by the Commissioner of Health and Senior Services or the Commissioner of Banking and Insurance in the name of the State in a summary proceeding in accordance with the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.); and
(3) a form and manner by which a health care provider that administers childhood immunizations provided for under P.L.1995, c.316 (C.17:48E-35.10 et al.) may register a complaint concerning reimbursement for childhood immunizations by a health insurer as specified in paragraph (1) of this subsection that is not in compliance with requirements established by regulation pursuant to paragraph (1) of this subsection.
(cf: P.L.1995, c.316, s.7)
2. (New section) The Commissioner of Human Services shall specify by regulation, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) and in consultation with the Commissioners of Health and Senior Services and Banking and Insurance:
a. the minimum level at which a health maintenance organization authorized to operate in this State, which contracts with the Department of Human Services for the provision of health care services to persons enrolled in the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) and the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et seq.), shall reimburse a health care provider for childhood immunizations provided for under P.L.1995, c.316 (C.17:48E-35.10 et al.), which shall:
(1) reflect the reasonable costs to a health care provider, as determined by the Commissioner of Human Services, of acquiring, maintaining, and administering the childhood immunizations;
(2) be determined by the Commissioner of Human Services after consultation with appropriate entities, including, but not limited to, the Medical Society of New Jersey, the American Academy of Pediatrics - New Jersey Chapter, and the New Jersey Academy of Family Physicians; and
(3) be periodically updated as determined appropriate by the Commissioner of Human Services;
b. a civil penalty to which a health maintenance organization as specified in subsection a. of this section that fails to comply with the requirements adopted by regulation pursuant to that subsection shall be liable, which shall not exceed $1,000 for the first violation, $5,000 for the second violation, and $10,000 for the third and each subsequent violation, and shall be collected by the Commissioner of Human Services in the name of the State in a summary proceeding in accordance with the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.); and
c. a form and manner by which a health care provider that administers childhood immunizations provided for under P.L.1995, c.316 (C.17:48E-35.10 et al.) may register a complaint concerning reimbursement for childhood immunizations by a health maintenance organization as specified in subsection a. of this section that is not in compliance with requirements established by regulation pursuant to subsection a. of this section.
3. This act shall take effect on the 180th day from the date of enactment, but the Commissioners of Health and Senior Services, Banking and Insurance, and Human Services may take such anticipatory administrative action in advance thereof as shall be necessary for the implementation of this act.
STATEMENT
This bill amends P.L.1995, c.316 (C.17:48E-35.10 et al.), the statute that requires health insurers to cover all childhood immunizations as recommended by the Advisory Committee on Immunization Practices of the United States Public Health Service and the Department of Health and Senior Services, to ensure appropriate reimbursement to health care providers that adequately covers their costs incurred in providing these immunizations, which are critical to the health of New Jersey children.
The bill directs the Commissioner of Health and Senior Services, in consultation with the Commissioner of Banking and Insurance, to specify by regulation the minimum level at which a health insurer is to reimburse a health care provider for childhood immunizations provided for under P.L.1995, c.316. The reimbursement is to reflect the reasonable costs to a health care provider, as determined by the Commissioner of Health and Senior Services, of acquiring, maintaining, and administering the childhood immunizations. The reimbursement is to be determined by the Commissioner of Health and Senior Services after consultation with appropriate entities, including, but not limited to, the Medical Society of New Jersey, the American Academy of Pediatrics - New Jersey Chapter, and the New Jersey Academy of Family Physicians. The reimbursement is to be periodically updated as determined appropriate by the Commissioner of Health and Senior Services.
The commissioners are also directed to specify by regulation a civil penalty to which a health insurer that fails to comply with the requirements adopted by regulation pursuant to this bill is to be liable, which will not exceed $1,000 for the first violation, $5,000 for the second violation, and $10,000 for the third and each subsequent violation, and is to be collected by the Commissioner of Health and Senior Services or the Commissioner of Banking and Insurance in the name of the State in a summary proceeding in accordance with the "Penalty Enforcement Law of 1999."
The commissioners are also to specify by regulation a form and manner by which a health care provider that administers childhood immunizations provided for under P.L.1995, c.316 may register a complaint concerning reimbursement for childhood immunizations by a health insurer that is not in compliance with requirements established by regulation pursuant to this bill.
The bill also mandates that HMOs participating in Medicaid and NJ FamilyCare reimburse health care providers who administer childhood immunizations at a level specified by regulation of the Commissioner of Human Services in a manner such as that provided for other health insurers under the bill, and provides the same civil penalties for noncompliance.
The bill takes effect on the 180th day after enactment, but authorizes the Commissioners of Health and Senior Services, Banking and Insurance, and Human Services to take anticipatory administrative action in advance as necessary for its implementation.
