Bill Text: NJ S3196 | 2018-2019 | Regular Session | Introduced


Bill Title: Requires health benefits coverage for private duty nursing services.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced) 2018-11-26 - Introduced in the Senate, Referred to Senate Commerce Committee [S3196 Detail]

Download: New_Jersey-2018-S3196-Introduced.html

SENATE, No. 3196

STATE OF NEW JERSEY

218th LEGISLATURE

 

INTRODUCED NOVEMBER 26, 2018

 


 

Sponsored by:

Senator  JOSEPH F. VITALE

District 19 (Middlesex)

Senator  LINDA R. GREENSTEIN

District 14 (Mercer and Middlesex)

 

 

 

 

SYNOPSIS

     Requires health benefits coverage for private duty nursing services.

 

CURRENT VERSION OF TEXT

     As introduced.

 


An Act concerning health benefits coverage for private duty nursing services and supplementing various parts of the statutory law.

 

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

 

      1.   a.   A hospital service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in the provision of private duty nursing services.

      b.   Private duty nursing services shall be subject to the same deductibles, coinsurance, and other cost sharing as apply to similar services under the contract.  Nothing in this section is intended to prevent a hospital service corporation from requiring prior authorization for services.

      c.    The provisions of this section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.

      d.   As used in this section, "private duty nursing services" means nursing services for recipients who require more individual and continuous care than is available from a visiting nurse or routinely provided by the nursing staff of the hospital or skilled nursing facility. These services are provided:

     (1)   by a registered nurse or a licensed practical nurse;

     (2)   under the direction of the recipient's physician; and

     (3)   to a recipient in that person's own home, a hospital, or a skilled nursing facility.

 

      2.   a.   A medical service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in the provision of private duty nursing services.

      b.   Private duty nursing services shall be subject to the same deductibles, coinsurance, and other cost sharing as apply to similar services under the contract.  Nothing in this section is intended to prevent a medical service corporation from requiring prior authorization for services.

      c.    The provisions of this section shall apply to those medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.

      d.   As used in this section, "private duty nursing services" means nursing services for recipients who require more individual and continuous care than is available from a visiting nurse or routinely provided by the nursing staff of the hospital or skilled nursing facility. These services are provided:

     (1)   by a registered nurse or a licensed practical nurse;

     (2)   under the direction of the recipient's physician; and

     (3)   to a recipient in that person's own home, a hospital, or a skilled nursing facility.

 

      3.   a.   A health service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in the provision of private duty nursing services.

      b.   Private duty nursing services shall be subject to the same deductibles, coinsurance, and other cost sharing as apply to similar services under the contract.  Nothing in this section is intended to prevent a health service corporation from requiring prior authorization for services.

      c.    The provisions of this section shall apply to those health service corporation contracts in which the health service corporation has reserved the right to change the premium.

      d.   As used in this section, "private duty nursing services" means nursing services for recipients who require more individual and continuous care than is available from a visiting nurse or routinely provided by the nursing staff of the hospital or skilled nursing facility. These services are provided:

     (1)   by a registered nurse or a licensed practical nurse;

     (2)   under the direction of the recipient's physician; and

     (3)   to a recipient in that person's own home, a hospital, or a skilled nursing facility.

 

      4.   a.   An individual health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in the provision of private duty nursing services.

      b.   Private duty nursing services shall be subject to the same deductibles, coinsurance, and other cost sharing as apply to similar services under the policy.  Nothing in this section is intended to prevent an insurer from requiring prior authorization for services.

      c.    The provisions of this section shall apply to those policies in which the insurer has reserved the right to change the premium.

      d.   As used in this section, "private duty nursing services" means nursing services for recipients who require more individual and continuous care than is available from a visiting nurse or routinely provided by the nursing staff of the hospital or skilled nursing facility. These services are provided:

     (1)   by a registered nurse or a licensed practical nurse;

     (2)   under the direction of the recipient's physician; and

     (3)   to a recipient in that person's own home, a hospital, or a skilled nursing facility.

 

      5.   a.   A group health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in the provision of private duty nursing services.

      b.   Private duty nursing services shall be subject to the same deductibles, coinsurance, and other cost sharing as apply to similar services under the policy.  Nothing in this section is intended to prevent an insurer from requiring prior authorization for services.

      c.    The provisions of this section shall apply to those policies in which the insurer has reserved the right to change the premium.

      d.   As used in this section, "private duty nursing services" means nursing services for recipients who require more individual and continuous care than is available from a visiting nurse or routinely provided by the nursing staff of the hospital or skilled nursing facility. These services are provided:

     (1)   by a registered nurse or a licensed practical nurse;

     (2)   under the direction of the recipient's physician; and

     (3)   to a recipient in that person's own home, a hospital, or a skilled nursing facility.

 

      6.   a.   An individual health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in the provision of private duty nursing services.

      b.   Private duty nursing services shall be subject to the same deductibles, coinsurance, and other cost sharing as apply to similar services under the plan.  Nothing in this section is intended to prevent a carrier from requiring prior authorization for services.

      c.    The provisions of this section shall apply to those individual health benefits plans in which the carrier has reserved the right to change the premium.

      d.   As used in this section, "private duty nursing services" means nursing services for recipients who require more individual and continuous care than is available from a visiting nurse or routinely provided by the nursing staff of the hospital or skilled nursing facility. These services are provided:

     (1)   by a registered nurse or a licensed practical nurse;

     (2)   under the direction of the recipient's physician; and

     (3)   to a recipient in that person's own home, a hospital, or a skilled nursing facility.

 

      7.   a.   A small employer health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in the provision of private duty nursing services.

      b.   Private duty nursing services shall be subject to the same deductibles, coinsurance, and other cost sharing as apply to similar services under the plan.  Nothing in this section is intended to prevent a carrier from requiring prior authorization for services.

      c.    The provisions of this section shall apply to those small employer health benefits plans in which the carrier has reserved the right to change the premium.

      d.   As used in this section, "private duty nursing services" means nursing services for recipients who require more individual and continuous care than is available from a visiting nurse or routinely provided by the nursing staff of the hospital or skilled nursing facility. These services are provided:

     (1)   by a registered nurse or a licensed practical nurse;

     (2)   under the direction of the recipient's physician; and

     (3)   to a recipient in that person's own home, a hospital, or a skilled nursing facility.

 

      8.   a.   A health maintenance organization contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in the provision of private duty nursing services.

      b.   Private duty nursing services shall be subject to the same deductibles, coinsurance, and other cost sharing as apply to similar services under the contract.  Nothing in this section is intended to prevent a health maintenance organization from requiring prior authorization for services.

      c.    The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the health maintenance organization has reserved the right to change the schedule of charges.

      d.   As used in this section, "private duty nursing services" means nursing services for recipients who require more individual and continuous care than is available from a visiting nurse or routinely provided by the nursing staff of the hospital or skilled nursing facility. These services are provided:

     (1)   by a registered nurse or a licensed practical nurse;

     (2)   under the direction of the recipient's physician; and

     (3)   to a recipient in that person's own home, a hospital, or a skilled nursing facility.

 

      9.   a.   The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act shall provide coverage for expenses incurred in the provision of private duty nursing services.

      b.   Private duty nursing services shall be subject to the same deductibles, coinsurance, and other cost sharing as apply to similar services under the contract.  Nothing in this section is intended to prevent a contract from requiring prior authorization for services.

      c.    As used in this section, "private duty nursing services" means nursing services for recipients who require more individual and continuous care than is available from a visiting nurse or routinely provided by the nursing staff of the hospital or skilled nursing facility. These services are provided:

     (1)   by a registered nurse or a licensed practical nurse;

     (2)   under the direction of the recipient's physician; and

     (3)   to a recipient in that person's own home, a hospital, or a skilled nursing facility.

 

     10.  a.   The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act shall provide coverage for expenses incurred in the provision of private duty nursing services.

      b.   Private duty nursing services shall be subject to the same deductibles, coinsurance, and other cost sharing as apply to similar services under the contract.  Nothing in this section is intended to prevent a contract from requiring prior authorization for services.

      c.    As used in this section, "private duty nursing services" means nursing services for recipients who require more individual and continuous care than is available from a visiting nurse or routinely provided by the nursing staff of the hospital or skilled nursing facility. These services are provided:

     (1)   by a registered nurse or a licensed practical nurse;

     (2)   under the direction of the recipient's physician; and

     (3)   to a recipient in that person's own home, a hospital, or a skilled nursing facility.

 

     11.  This act shall take effect on January 1 of the year following enactment.

STATEMENT

 

     This bill requires health insurers (health, hospital and medical service corporations, commercial individual and group health insurers, health maintenance organizations, health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs, the State Health Benefits Program, and the School Employees' Health Benefits Program) to provide health benefits coverage for any expenses incurred in the provision of private duty nursing services.

     Under the bill, private duty nursing services are subject to the same deductibles, coinsurance, and other cost sharing as apply to similar services under the contract, policy, or plan.  Nothing in the bill is intended to prevent a contract, policy, or plan from requiring prior authorization for services.

     As used in the bill, "private duty nursing services" means nursing services for recipients who require more individual and continuous care than is available from a visiting nurse or routinely provided by the nursing staff of the hospital or skilled nursing facility. These services are provided:

     (1)   by a registered nurse or a licensed practical nurse;

     (2)   under the direction of the recipient's physician; and

     (3)   to a recipient in that person's own home, a hospital, or a skilled nursing facility.

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