Bill Text: NJ A4177 | 2020-2021 | Regular Session | Introduced
Bill Title: Revises certificate of need program.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2020-06-01 - Introduced, Referred to Assembly Health Committee [A4177 Detail]
Download: New_Jersey-2020-A4177-Introduced.html
Sponsored by:
Assemblyman RALPH R. CAPUTO
District 28 (Essex)
SYNOPSIS
Revises certificate of need program.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning emergency medical services and amending P.L.1971, c.136 and P.L.1992, c.160.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 7 of P.L.1971, c.136 (C.26:2H-7) is amended to read as follows:
7. No health care facility shall be constructed or expanded, and no new health care service shall be instituted after the effective date of P.L.1971, c.136 (C.26:2H-1 et seq.) except upon application for and receipt of a certificate of need as provided by P.L.1971, c.136 (C.26:2H-1 et seq.). No agency of the State or of any county or municipal government shall approve any grant of funds for, or issue any license to, a health care facility which is constructed or expanded, or which institutes a new health care service, in violation of the provisions of P.L.1971, c.136 (C.26:2H-1 et seq.).
Except as provided in section 19 of P.L.1992, c.160 (C.26:2H-7a) and section 16 of P.L.1998, c.43 (C.26:2H-7c), the provisions of this section shall apply to:
a. The initiation of any health care service as provided in section 2 of P.L.1971, c.136 (C.26:2H-2);
b. The initiation by any person of a health care service which is the subject of a health planning regulation adopted by the Department of Health;
c. The purchase by any person of major moveable equipment whose total cost is over $2 million;
d. The expenditure by a licensed health care facility of over $2 million for construction of a new health care facility; [and]
e. The construction of a facility by any person, whose total project cost exceeds $2 million, if the facility-type is the subject of a health planning regulation adopted by the Department of Health; and
f. The operation as an emergency medical services provider. The issuance of a certificate of need under this subsection shall be required to lawfully operate as an emergency medical services provider in this State. The issuance of a certificate of need under this subsection shall be valid for a period of three calendar years following the date of issuance. Thereafter, an emergency medical services provider shall be required to reapply for a certificate of need with the Department of Health on a triennial basis. An emergency medical services provider licensed by the Department of Health before the effective date of P.L. c. (C. ) (pending before the Legislature as this bill) shall apply for a certificate of need to lawfully operate as an emergency services provider within three calendar years following the effective date of P.L. c. (C. ) (pending before the Legislature as this bill). An emergency medical services provider applicant under this subsection shall, in addition to any other application requirements provided by law, provide the following to the Department of Health:
(1) a list of services to be provided to patients and the expected cost to patients for each of those services; and
(2) a plan to provide patients an itemized receipt listing the cost of each service provided to the patient and detailed information that is easily understandable to the general public on how a patient may formally dispute the costs charged to the patient by the emergency medical services provider.
The commissioner may periodically increase the monetary thresholds established in this section, by regulation, to reflect inflationary increases in the costs of health care equipment or construction.
[For the purposes of] As used in this section[,]:
"Emergency medical services provider" means any association, organization, company, department, agency, service, program, unit, or other entity that provides pre-hospital emergency medical care to patients in this State, including, but not limited to, a basic life support ambulance service, a mobile intensive care unit, an air medical service, or a non-volunteer first aid, rescue, and ambulance squad.
["health] "Health care service" [shall include] includes any service which is the subject of a health planning regulation adopted by the Department of Health [, and] .
["person"] "Person" [shall include] includes a corporation, company, association, society, firm, partnership, and joint stock company, as well as an individual.
A physician who initiates a health care service which is the subject of a health planning regulation or purchases major moveable equipment pursuant to subsection b. or c. of this section, may apply to the commissioner for a waiver of the certificate of need requirement if: the equipment or health care service is such an essential, fundamental, and integral component of the physician's practice specialty, that the physician would be unable to practice his specialty according to the acceptable medical standards of that specialty without the health care service or equipment; the physician bills at least 75[%] percent of [his] the total amount of charges in the practice specialty which uses the health care service or equipment; and the health care service or equipment is not otherwise available and accessible to patients, pursuant to standards established by the commissioner[,] by regulation. The commissioner shall make a determination about whether to grant or deny the waiver[,] within 120 days from the date the request for the waiver is received by the commissioner and shall so notify the physician who requested the waiver. If the request is denied, the commissioner shall include in that notification the reason for the denial. If the request is denied, the initiation of a health care service or the purchase of major moveable equipment shall be subject to the certificate of need requirements pursuant to this section.
A health maintenance organization which furnishes at least basic comprehensive care health services on a prepaid basis to enrollees either through providers employed by the health maintenance organization or through a medical group or groups which contract directly with the health maintenance organization, which initiates a health care service, or constructs a health care facility pursuant to subsection a., b., d., or e. of this section, may apply to the commissioner for a waiver of the certificate of need requirement if: the initiation of the health care service or the construction is in the best interests of State health planning[;] and the health maintenance organization is in compliance with the provisions of P.L.1973, c.337 (C.26:2J-1 et seq.) and complies with the provisions of subsection d. of section 3 of P.L.1973, c.337 (C.26:2J-3) regarding notification to the commissioner. The commissioner shall make a determination about whether to grant or deny the waiver within 45 days from the date the request for the waiver is received by the commissioner and shall so notify the health maintenance organization. If the request for a waiver is denied on the basis that the request would not be in the best interests of State health planning, the commissioner shall state in that notification the reason why the request would not be in the best interests of State health planning. If the request for a waiver is denied, the health maintenance organization's initiation of a health care service or construction project shall be subject to the certificate of need requirements pursuant to this section.
The requirement to obtain a certificate of need for major moveable equipment pursuant to subsection c. of this section shall not apply if a contract to purchase that equipment was entered into prior to July 1, 1991.
(cf: P.L.2012, c.17, s.169)
2. Section 19 of P.L.1992, c.160 (C.26:2H-7a) is amended to read as follows:
19. Notwithstanding the provisions of section 7 of P.L.1971, c.136 (C.26:2H-7) to the contrary, the following are exempt from the certificate of need requirement:
Community-based primary care centers;
Outpatient drug and alcohol services;
Hospital-based medical detoxification for drugs and alcohol;
[Ambulance and invalid] Invalid coach services;
Mental health services which are non-bed related outpatient services;
Residential health care facility services;
Dementia care homes;
Capital improvements and renovations to health care facilities;
Additions of medical/surgical, adult intensive care and adult critical care beds in hospitals;
Inpatient special psychiatric beds used solely for services for patients with co-occurring mental health and substance use disorders;
Replacement of existing major moveable equipment;
Inpatient operating rooms;
Alternate family care programs;
Hospital-based subacute care;
Ambulatory care facilities;
Comprehensive outpatient rehabilitation services;
Special child health clinics;
New technology in accordance with the provisions of section 18 of P.L.1998, c.43 (C.26:2H-7d);
Transfer of ownership interest except in the case of an acute care hospital;
Change of site for approved certificate of need within the same county;
Additions to vehicles or hours of operation of a mobile intensive care unit;
Relocation or replacement of a health care facility within the same county, except for an acute care hospital;
Continuing care retirement communities authorized pursuant to P.L.1986, c.103 (C.52:27D-330 et seq.);
Magnetic resonance imaging;
Adult day health care facilities;
Pediatric day health care facilities;
Chronic or acute renal dialysis facilities; and
Transfer of ownership of a hospital to an authority in accordance with P.L.2006, c.46 (C.30:9-23.15 et al.).
(cf: P.L.2017, c.94, s.1)
3. The Commissioner of Health shall adopt rules and regulations, in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), as are necessary to effectuate the provisions of this act.
4. This act shall take effect immediately.
STATEMENT
This bill revises the certificate of need program and requests an increase in the Medicaid reimbursement rate for emergency medical services.
Under the bill, an emergency medical services provider is to obtain a certificate of need from the Department of Health (DOH) in order to be licensed to operate in this State. The issuance of a certificate of need is to be valid for a period of three calendar years following the date of issuance. Thereafter, an emergency medical services provider will be required to reapply for a certificate of need with the DOH on a triennial basis. An emergency medical services provider licensed by the DOH before the bill's effective date is to apply for a certificate of need to continue operations as a emergency services provider within three calendar years following the bill's effective date.
The bill provides that an emergency medical services provider applicant, in addition to any other application requirements provided by law, is to provide the DOH with: 1) a list of services to be provided to patients and the expected cost to patients for each of those services; and 2) a plan to provide patients an itemized receipt listing the cost of each service provided to the patient and detailed information that is easily understandable to the general public on how a patient may formally dispute the costs charged to the patient by the emergency medical services provider.
Under the bill, "emergency medical services provider" means any association, organization, company, department, agency, service, program, unit, or other entity that provides pre-hospital emergency medical care to patients in this State, including, but not limited to, a basic life support ambulance service, a mobile intensive care unit, an air medical service, or a non-volunteer first aid, rescue, and ambulance squad.
