Bill Text: NJ S496 | 2010-2011 | Regular Session | Introduced
Bill Title: Requires health insurers, Medicaid and NJ FamilyCare to provide coverage for comprehensive program of pediatric feeding and swallowing services.
Sponsorship: Slight Partisan Bill (Republican 2-1)
Status: (Introduced - Dead) 2010-01-12 - Introduced in the Senate, Referred to Senate Commerce Committee [S496 Detail]
Download: New_Jersey-2010-S496-Introduced.html
STATE OF NEW JERSEY
214th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2010 SESSION
Sponsored by:
Senator JOHN A. GIRGENTI
District 35 (Bergen and Passaic)
Senator ANTHONY R. BUCCO
District 25 (Morris)
Co-Sponsored by:
Senator Cardinale
SYNOPSIS
Requires health insurers, Medicaid and NJ FamilyCare to provide coverage for comprehensive program of pediatric feeding and swallowing services.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel
An Act concerning coverage for comprehensive pediatric feeding and swallowing services and supplementing Titles 17, 26 and 30 of the Revised Statutes and Title 17B of the New Jersey Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. A hospital service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.), 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 medically necessary expenses incurred in the provision of a fully dedicated, comprehensive, interdisciplinary, medically-based outpatient program of feeding and swallowing services for a covered child who is unable to ingest balanced and age-appropriate nutrition by mouth for adequate growth. The comprehensive program shall include team assessment with recommendation for provision of services, as appropriate, that include medical management, physical and occupational therapy, oral-motor treatment, feeding therapy and behavioral management, including caregiver training.
The benefits shall be provided to the same extent as for any other condition under the contract.
This section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
2. A medical service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.), 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 medically necessary expenses incurred in the provision of a fully dedicated, comprehensive, interdisciplinary, medically-based outpatient program of feeding and swallowing services for a covered child who is unable to ingest balanced and age-appropriate nutrition by mouth for adequate growth. The comprehensive program shall include team assessment with recommendation for provision of services, as appropriate, that include medical management, physical and occupational therapy, oral-motor treatment, feeding therapy and behavioral management, including caregiver training.
The benefits shall be provided to the same extent as for any other condition under the contract.
This section shall apply to those medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
3. A health service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.), 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 medically necessary expenses incurred in the provision of a fully dedicated, comprehensive, interdisciplinary, medically-based outpatient program of feeding and swallowing services for a covered child who is unable to ingest balanced and age-appropriate nutrition by mouth for adequate growth. The comprehensive program shall include team assessment with recommendation for provision of services, as appropriate, that include medical management, physical and occupational therapy, oral-motor treatment, feeding therapy and behavioral management, including caregiver training.
The benefits shall be provided to the same extent as for any other condition under the contract.
This section shall apply to those health service corporation contracts in which the health service corporation has reserved the right to change the premium.
4. An individual health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to chapter 26 of Title 17B of the New Jersey Statutes, 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 medically necessary expenses incurred in the provision of a fully dedicated, comprehensive, interdisciplinary, medically-based outpatient program of feeding and swallowing services for a covered child who is unable to ingest balanced and age-appropriate nutrition by mouth for adequate growth. The comprehensive program shall include team assessment with recommendation for provision of services, as appropriate, that include medical management, physical and occupational therapy, oral-motor treatment, feeding therapy and behavioral management, including caregiver training.
The benefits shall be provided to the same extent as for any other condition under the policy.
This section shall apply to those policies in which the insurer has reserved the right to change the premium.
5. A group health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to chapter 27 of Title 17B of the New Jersey Statutes, 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 medically necessary expenses incurred in the provision of a fully dedicated, comprehensive, interdisciplinary, medically-based outpatient program of feeding and swallowing services for a covered child who is unable to ingest balanced and age-appropriate nutrition by mouth for adequate growth. The comprehensive program shall include team assessment with recommendation for provision of services, as appropriate, that include medical management, physical and occupational therapy, oral-motor treatment, feeding therapy and behavioral management, including caregiver training.
The benefits shall be provided to the same extent as for any other condition under the policy.
This section shall apply to those policies in which the insurer has reserved the right to change the premium.
6. An individual health benefits plan that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), on or after the effective date of this act, shall provide coverage for medically necessary expenses incurred in the provision of a fully dedicated, comprehensive, interdisciplinary, medically-based outpatient program of feeding and swallowing services for a covered child who is unable to ingest balanced and age-appropriate nutrition by mouth for adequate growth. The comprehensive program shall include team assessment with recommendation for provision of services, as appropriate, that include medical management, physical and occupational therapy, oral-motor treatment, feeding therapy and behavioral management, including caregiver training.
The benefits shall be provided to the same extent as for any other condition under the health benefits plan.
This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
7. A small employer health benefits plan that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), on or after the effective date of this act, shall provide coverage for medically necessary expenses incurred in the provision of a fully dedicated, comprehensive, interdisciplinary, medically-based outpatient program of feeding and swallowing services for a covered child who is unable to ingest balanced and age-appropriate nutrition by mouth for adequate growth. The comprehensive program shall include team assessment with recommendation for provision of services, as appropriate, that include medical management, physical and occupational therapy, oral-motor treatment, feeding therapy and behavioral management, including caregiver training.
The benefits shall be provided to the same extent as for any other condition under the health benefits plan.
This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
8. A health maintenance organization contract for health care services that is delivered, issued, executed or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Health and Senior Services, on or after the effective date of this act, shall provide health care services for medically necessary expenses incurred in the provision of a fully dedicated, comprehensive, interdisciplinary, medically-based outpatient program of feeding and swallowing services for a covered child who is unable to ingest balanced and age-appropriate nutrition by mouth for adequate growth. The comprehensive program shall include team assessment with recommendation for provision of services, as appropriate, that include medical management, physical and occupational therapy, oral-motor treatment, feeding therapy and behavioral management, including caregiver training.
The health care services shall be provided to the same extent as for any other condition under the contract.
This section shall apply to those contracts for health care services under which the right to change the schedule of charges for enrollee coverage is reserved.
9. The Commissioner of Human Services shall ensure that every contract for health care services under the Medicaid program, P.L.1968, c.413 (C.30:4D-1 et seq.), Children's Health Care Coverage Program, P.L.1997, c.272 (C.30:4I-1 et seq.), or the FamilyCare Health Coverage Program, P.L.2000, c.71 (C.30:4J-1 et seq.), entered into on or after the effective date of this act, provides benefits for medically necessary expenses incurred in the provision of a fully dedicated, comprehensive, interdisciplinary, medically-based outpatient program of feeding and swallowing services for a covered child who is unable to ingest balanced and age-appropriate nutrition by mouth for adequate growth. The comprehensive program shall include team assessment with recommendation for provision of services, as appropriate, that include medical management, physical and occupational therapy, oral-motor treatment, feeding therapy and behavioral management, including caregiver training.
10. This act shall take effect immediately.
STATEMENT
This bill requires hospital, medical and health service corporations, individual, small employer and larger group insurers, health maintenance organizations and the State Medicaid and NJ FamilyCare programs to provide coverage for medically necessary expenses incurred in the provision of a fully dedicated, comprehensive, interdisciplinary, medically-based outpatient program of feeding and swallowing services for a covered child who is unable to ingest balanced and age-appropriate nutrition by mouth for adequate growth. The comprehensive program shall include team assessment with recommendation for provision of services, as appropriate, that include medical management, physical and occupational therapy, oral-motor treatment, feeding therapy and behavioral management, including caregiver training.
Children in need of a comprehensive treatment program of feeding and swallowing services typically have a complicated developmental or medical history, sometimes have an interrupted feeding history, and often have a long history of difficult interactions surrounding feeding.
In New Jersey, St. Joseph's Children's Hospital in Paterson has established the St. Joseph's Center for Pediatric Feeding and Swallowing. Since the center opened in September 2000, the center has provided services to over 1,700 patients. The provisions of this bill, to require third party coverage for a comprehensive program, will ensure that children in need of treatment for feeding and swallowing dysfunction will receive the full array of services necessary to achieve the best possible outcome for each child.
