Bill Text: NJ A3285 | 2020-2021 | Regular Session | Introduced
Bill Title: Establishes Medicaid Services Review Task Force to study national treatment guidelines for certain Medicaid services.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2020-02-25 - Introduced, Referred to Assembly Human Services Committee [A3285 Detail]
Download: New_Jersey-2020-A3285-Introduced.html
Sponsored by:
Assemblywoman VALERIE VAINIERI HUTTLE
District 37 (Bergen)
SYNOPSIS
Establishes Medicaid Services Review Task Force to study national treatment guidelines for certain Medicaid services.
CURRENT VERSION OF TEXT
As introduced.
An Act establishing the Medicaid Services Review Task Force.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. There is established in the Department of Human Services the Medicaid Services Review Task Force, which shall be responsible for:
(1) identifying the 20 most expensive services for which the State Medicaid program provides coverage;
(2) reviewing national treatment guidelines for the services identified pursuant to paragraph (1) of this subsection for each physician specialty directly involved in providing the service;
(3) compiling a list of treatment guidelines reviewed pursuant to paragraph (2) of this subsection, to be made available to managed care organizations under contract with the Department of Human Services; and
(4) in consultation with managed care organizations under contract with the Department of Human Services, recommending to the Governor, the Legislature, and the Commissioner of Human Services whether managed care organizations should be permitted to deny claims for services identified pursuant to paragraph (1) of this subsection when a physician submitting a claim for the service does not comply with specialty-specific treatment guidelines for the provision of that service.
b. The task force shall comprise the Commissioner of Human Services or a designee, who shall serve ex officio, and up to 20 public members to be appointed by the commissioner, who shall be physicians licensed in New Jersey who are representative of the specialties that provide the services identified pursuant to paragraph (1) of subsection a. of this section. In appointing the public members, the commissioner shall consider the recommendations of: the American Board of Allergy and Immunology; the American Board of Anesthesiology; the American Board of Colon and Rectal Surgery; the American Board of Dermatology; the American Board of Emergency Medicine; the American Board of Family Medicine; the American Board of Internal Medicine; the American Board of Medical Genetics and Genomics; the American Board of Neurological Surgery; the American Board of Nuclear Medicine; the American Board of Obstetrics and Gynecology; the American Board of Ophthalmology; the American Board of Orthopaedic Surgery; the American Board of Otolaryngology; the American Board of Pathology; the American Board of Pediatrics; the American Board of Physical Medicine and Rehabilitation; the American Board of Plastic Surgery; the American Board of Preventive Medicine; the American Board of Psychiatry and Neurology; the American Board of Radiology; the American Board of Surgery; the American Board of Thoracic Surgery; and the American Board of Urology.
c. The task force shall organize as soon as practicable following the appointment of its members and shall select a chairperson from among the members. The chairperson shall appoint a secretary who need not be a member of the task force.
d. Members of the task force shall serve without compensation, but shall be reimbursed for necessary expenses incurred in the performance of their duties as members of the task force, within the limits of funds appropriated or otherwise made available to the task force for its purposes.
e. The task force shall be entitled to call to its assistance and avail itself of the services of the employees of any State, county, or municipal department, board, bureau, commission, or agency as it may require and as may be available to it for its purposes.
f. The Department of Human Services shall provide staff support to the task force.
g. No later than 180 days after organization, the task force shall complete the tasks of identifying services and reviewing and compiling treatment guidelines pursuant to paragraphs (1), (2), and (3) of subsection a. of this subsection; and no later than one year after the date that those tasks are completed, the task force shall submit its recommendations pursuant to paragraph (4) of subsection a. of this section to the Governor, the Commissioner of Human Services, and, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), to the Legislature. The task force recommendations may include any recommendations for administrative, legislative, executive, or other action as may be appropriate to effectuate the purposes of this section. The task force shall expire upon submission of its recommendations.
h. The Commissioner of Human Services may take appropriate actions consistent with the task force recommendations submitted pursuant to subsection g. of this section, and shall apply for such State plan amendments or waivers as may be necessary to implement those actions and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
2. This act shall take effect immediately and shall expire 60 days after the date the task force submits its recommendations.
STATEMENT
This bill establishes the Medicaid Services Review Task Force, which will be responsible for identifying the 20 most expensive services covered under the State Medicaid program, reviewing national, specialty-specific treatment guidelines for those services, compiling a list of treatment guidelines to be made available to managed care organizations (MCOs) under contract with the Department of Human Services, and issuing recommendations, in consultation with MCOs, as to whether MCOs should be allowed to deny claims for services when the services are not provided in compliance with treatment guidelines.
The task force will comprise the Commissioner of Human Services or a designee, who will serve ex officio, and up to 20 public members, who will be physicians licensed in New Jersey who are representative of the specialties that provide the services identified by the task force. The public members will be appointed by the commissioner, taking into consideration the recommendations of the boards that certify the various medical specialties and subspecialties. The members will serve without compensation.
The task force's recommendations are to be provided to the Governor, the Legislature, and the commissioner within 18 months after the date the task force organizes, and may include recommendations for administrative, legislative, executive, and other action as may be appropriate to effectuate the purposes of the bill. The task force will expire upon submission of its recommendations.
