Bill Text: NJ S1623 | 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: Slight Partisan Bill (Democrat 2-1)
Status: (Introduced - Dead) 2014-01-13 - Substituted by A1214 (1R) [S1623 Detail]
Download: New_Jersey-2012-S1623-Introduced.html
Sponsored by:
Senator JIM WHELAN
District 2 (Atlantic)
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
As introduced.
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 and the State Health Benefits Plan Design Committee 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 committee, 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. In collaboration with the employee's primary treating physician, the pharmacist shall be responsible for coordinating medication therapy management services, which shall be within the scope of the pharmacist's license to practice pharmacy in the State of New Jersey, pursuant to P.L.2003, c.280 (C.45:14-40 et seq.).
(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 committee, as part of any contract negotiated with a carrier establishing the program.
c. The committee 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 third year next following commencement and full enrollment of any value-based benefit design coverage under the program. The commission and committee 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 their 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 requires the State Health Benefits Commission and the State Health Benefits Plan Design Committee to establish a three-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 will target the following chronic health conditions: diabetes, high cholesterol, hypertension, and asthma.
The coverage design will 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 SHBP.
The committee 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 1,000 employees who are eligible, based on their chronic health conditions, to participate in the pilot program. The commission will 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 will be voluntary.
The value-based benefit design pilot program will assign a participating employee to a pharmacist, who, in collaboration with the employee's primary treating physician, will be responsible for coordinating medication therapy management services within the scope of the pharmacist's license to practice pharmacy in the State of New Jersey.
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 will be provided:
(1) all tuition costs 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;
(3) all costs for a medical device or supply deemed medically necessary by the primary treating physician or assigned pharmacist;
(4) all costs for laboratory testing; and
(5) waiver of all copayments for any prescription drug.
In order to remain a participant in the pilot program and receive these financial incentives, the employee must comply with all aspects of the value-based benefit design regimen, including 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 of the three-year pilot program, the commission and committee will issue a report to the Governor and to the Legislature, with a detailed summary of their 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.
