Bill Text: NJ S2603 | 2014-2015 | Regular Session | Introduced
Bill Title: Prohibits anti-tiering clauses in managed care health benefits plans.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2014-12-08 - Introduced in the Senate, Referred to Senate Commerce Committee [S2603 Detail]
Download: New_Jersey-2014-S2603-Introduced.html
Sponsored by:
Senator JOSEPH F. VITALE
District 19 (Middlesex)
Senator NIA H. GILL
District 34 (Essex and Passaic)
SYNOPSIS
Prohibits anti-tiering clauses in managed care health benefits plans.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning managed care health benefits plans and amending P.L.1997, c.192.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 9 of P.L.1997, c.192 (C.26:2S-9) is amended to read as follows:
9. The contract between a participating health care provider and a carrier which offers a managed care plan:
a. Shall state that the health care provider shall not be penalized or the contract terminated by the carrier because the health care provider acts as an advocate for the patient in seeking appropriate, medically necessary health care services;
b. Shall not provide financial incentives to the health care provider for withholding covered health care services that are medically necessary as determined in accordance with section 6 of this act, except that nothing in this subsection shall be construed to limit the use of capitated payment arrangements between a carrier and a health care provider; [and]
c. Shall protect the ability of a health care provider to communicate openly with a patient about all appropriate diagnostic testing and treatment options ; and
d. Shall not contain any provision, commonly referred to as an "anti-tiering clause," that prohibits or limits a carrier's right to use a tiered-network plan in which health care providers are tiered and cost sharing for covered persons is determined by the tier placement of the provider. Any such provision in a contract shall be null and void.
(cf: P.L.1997, c.192, s.9)
2. This act shall take effect on the 90th day following enactment and shall apply to contracts issued or renewed on or after the effective date.
STATEMENT
This bill, which amends the "Health Care Quality Act," provides that a contract between a participating health care provider and a carrier which offers a managed care plan shall not contain any provision, commonly referred to as an "anti-tiering clause," that prohibits or limits a carrier's right to use a tiered-network plan in which health care providers are tiered and cost sharing for covered persons is determined by the tier placement of the provider. The bill provides that any such provision in a contract shall be null and void.
