Bill Text: NJ S3049 | 2022-2023 | Regular Session | Amended

---

Bill Title: Requires certain information to be included in SHBP and SEHBP claims experience data provided to certain public employers.

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2022-10-13 - Reported from Senate Committee with Amendments, 2nd Reading [S3049 Detail]

Download: New_Jersey-2022-S3049-Amended.html

---

[First Reprint]

SENATE, No. 3049

STATE OF NEW JERSEY

220th LEGISLATURE

 

INTRODUCED SEPTEMBER 22, 2022

 

 

Sponsored by:

Senator  JAMES BEACH

District 6 (Burlington and Camden)

Senator  LINDA R. GREENSTEIN

District 14 (Mercer and Middlesex)

 

 

 

 

SYNOPSIS

     Requires certain information to be included in SHBP and SEHBP claims experience data provided to certain public employers.

 

CURRENT VERSION OF TEXT

     As reported by the Senate State Government, Wagering, Tourism & Historic Preservation Committee on October 13, 2022, with amendments.

  

An Act concerning State Health Benefits Program ¹and School Employees' Health Benefits Program¹ claims experience data provided to certain public employers and amending P.L.2013, c.189.

 

     Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

     1.  Section 1 of P.L.2013, c.189 (C.52:14-17.37a) is amended to read as follows: 

     1.    a.  The State Health Benefits Program ¹and the School Employees' Health Benefits Program¹ shall provide at no cost to the requestor, and not more than once [in a 24-month period] in each calendar year, complete claims experience data to a public employer other than the State that participates in the State Health Benefits Program ¹or the School Employees' Health Benefits Program¹ and makes a written request for its claims experience information, including loss reports and large claims data.  The State Health Benefits Program ¹and the School Employees' Health Benefits Program¹ shall provide the information in an electronic and manual format to the participating public employer who has made a written request for its information, within 60 days of the receipt of the written request made by the public employer.  When requested by a public employer other than the State, the data shall be made available, upon request, to the majority representatives of the employees of that public employer within 15 days of the receipt of the written request made by the majority representative. 

     Notwithstanding the above, the State Health Benefits Program ¹and the School Employees' Health Benefits Program¹ shall issue claims experience data only in a manner that complies with the privacy requirements of the federal Health Insurance Portability and Accountability Act of 1996, Pub. L.104-191, and related regulations. 

     Notwithstanding any provision of this section, no information shall be released in such form as to result in the identification of an individual or in such form as to adversely affect personal privacy rights. 

     b.  At a minimum, the claims experience data shall include: 

     (1)  Medical loss ratio reports;

     (2)  Group structure census report, including age, gender and member identification number or unique patient identifier;

     (3)  Medical claims summary report by classification;

     (4)  Medical high-level detailed claims report by classification, including member identification number or unique patient identifier, large medical claim data for anyone with claims in excess

of $50,000 indicating if an employee or dependent, patient age and gender, diagnosis and prognosis, and all case management notes or information;

     (5)  Medical executive health summary;

     (6)  Top 20 diagnoses by amount paid;

     (7)  Top 20 diagnosis codes ranked by health care facility or institution and by amount paid;

     (8)  Top 20 diagnosis codes ranked by medical professional and by amount paid;

     (9)  Utilization by major disease category;

     (10)  Utilization by place of service with type of service;

     (11) Aggregate specific report;

     (12) Provider report with tax identification numbers;

     (13) Network utilization report;

     (14)  Prescription claims report, including:

     a.     Member identification number or unique patient identifier ;

     b.    National drug code of the drug or medicine dispensed;

     c.     The number of days' supply dispensed;

     d.    Metric decimal quantity dispensed;

     e.     Final ingredient cost on the claim excluding sales tax and dispensing fee;

     f.     Dispensing fees added to the ingredient cost prior to member copayment;

     g.    Amount paid by patient for claims which includes copay and deductible;

     h.    Date prescription was filled at the pharmacy;

     i.     Type of pharmacy where the prescription was filled, whether retail, mail, long term care, Veterans Administration, or specialty pharmacy;

     j.     If the prescription was for a compound product; and

     k.    If the prescription was formulary or non- formulary;

     (15)  Prescription loss ratio reports;

     (16)  Top 50 drugs or medicines that require a doctor's prescription by total number dispensed;

     (17)  Top 50 drugs or medicines that require a doctor's prescription by total dollars paid;

     (18)  Number and type of ongoing maintenance prescriptions separately by mail order and by retail;

     (19)  Prescription claims experience;

     (20)  Prescription utilization summary;

     (21)  Prescription executive summary report;

     (22)  Prescription trend performance summary for each plan design;

     (23)  Prescription key performance indicator report;

     (24)  Prescription utilizer summary by cost;

     (25)  Prescription utilization summary by population; and

     (26)  Prescription quarterly rebate report.

(cf: P.L.2013, c.189, s.1)

     2.  This act shall take effect on the 90th day after the date of enactment.