Bill Text: NJ A5658 | 2022-2023 | Regular Session | Introduced
Bill Title: Allows for credit against contract cost for primary care services managed by health care provider for public employees and their dependents; allows referrals to other providers that have contractual relationship with such health care provider.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2023-12-21 - Substituted by S3969 (1R) [A5658 Detail]
Download: New_Jersey-2022-A5658-Introduced.html
Sponsored by:
Assemblyman ROY FREIMAN
District 16 (Hunterdon, Mercer, Middlesex and Somerset)
SYNOPSIS
Allows for credit against contract cost for primary care services managed by health care provider for public employees and their dependents; allows referrals to other providers that have contractual relationship with such health care provider.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health care services funded by a public employer for its employees and their dependents and supplementing Title 17B of the New Jersey Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Notwithstanding any provision of law or regulation to the contrary, a health care provider that is managing a medical home, pursuant to a contract with a public employer, for public employees and their dependents who are covered by the employer's health benefits program or plan may:
(a) provide a credit to the public employer toward the cost of the contract awarded by the public employer to the health care provider to manage a medical home model for health care services for the public employees and their dependents; and
(b) refer public employees and their dependents, who receive services through the medical home model to other providers with whom the health care provider has a contractual relationship.
If provided, the amount of the credit permitted toward the cost of the contract shall not exceed the amount of the payments received by the health care provider from the health benefits program or plan for claims submitted for provider services rendered to public employees and their dependents.
Nothing in this section shall preclude the provider from billing the health benefits program or plan on a fee-for-service basis when such payments by the health benefits program or plan are used to apply a credit toward the cost of the contract.
As used in this section "medical home" means on-site physicians, nurses, and pharmacy and laboratory services, provided at no cost to public employees and their dependents, when the medical staff receive salaries and services are not provided on a fee-for-service basis and when primary care, care coordination through the use of health information technology and chronic disease registries, and referrals for specialist care are provided.
2. This act shall take effect immediately and shall be retroactive to July 1, 2022.
STATEMENT
This bill provides that a health care provider that is managing a medical home, pursuant to a contract with a public employer, for its employees and their dependents, who are covered by the employer's health benefits program or plan may:
(a) provide a credit to the public employer toward the cost of the contract awarded to the health care provider to manage a medical home model for health care services for the public employees and their dependents; and
(b) refer covered employees and their dependents, who receive services through the medical home model to other providers with whom the health care provider has a contractual relationship.
If provided, the amount of the credit permitted toward the cost of the contract must not exceed the amount of the payments received by the health care provider from the health care benefits program or plan for claims submitted for provider services.
Nothing in this bill will preclude the provider from billing the health benefits program or plan on a fee-for-service basis when such payments by the health benefits program or plan are used to apply a credit toward the cost of the contract.
As used in this bill, "medical home" means on-site physicians, nurses, and pharmacy and laboratory services, provided at no cost to public employees, and their dependents, when the medical staff receive salaries and services are not provided on a fee-for-service basis and when primary care, care coordination through the use of health information technology and chronic disease registries, and referrals for specialist care are provided.
The provisions of this bill will apply retroactively to July 1, 2022.
