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Senate Commerce Committee Statement — Senate Bill No. 3478, State of New Jersey (May 15, 2023)

Summary

The Senate Commerce Committee statement of May 15, 2023 reports favorably Senate Bill No. 3478. The bill provides that a health benefits company managing a health benefits program or plan for a public employer under a contract may provide a credit to the public employer toward the cost of the contract to manage a medical home model, and may refer covered employees and their dependents to other providers with whom the company has a contractual relationship. The credit must not exceed the payments the company received from insurers for claims submitted for provider services. The statement defines medical home as on-site physicians, nurses, and pharmacy and laboratory services provided at no cost.

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“Senate Commerce Committee Statement — Senate Bill No. 3478, State of New Jersey (May 15, 2023).” Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/2023-05-15-scm-s3478-s1-c565fa30ea/, SHA-256 1f4eee27a3bd2a3a9b8817cb9057b13583571f8bfd374b59513905408a2e58f6.

Full text

     SENATE COMMERCE COMMITTEE

                    STATEMENT TO

                  SENATE, No. 3478

 STATE OF NEW JERSEY
                      DATED: MAY 15, 2023

    The Senate Commerce Committee reports favorably Senate Bill
No. 3478.
   This bill provides that a health benefits company that is
managing, pursuant to a contract with a public employer, a health
benefits program or plan for its employees and their dependents,
who are covered by the employer’s health benefits program or plan,
may:
   (a) provide a credit to the public employer toward the cost of the
contract awarded to the health benefits company to manage a
medical home model for health care services for the public
employees and their dependents; and
   (b) refer covered employees and their dependents, who receive
services through the medical home model to other providers with
whom the health benefits company has a contractual relationship.
   If provided, the amount of the credit permitted toward the cost of
the contract must not exceed the amount of the payments received
by the health benefits company from insurers for claims submitted
for provider services.
   As used in this bill, “medical home” means on-site physicians,
nurses, and pharmacy and laboratory services, provided at no cost
to employees, and their dependents, of the school district, when the
medical staff receive salaries and services are not provided on a fee-
for-service basis and when primary care, care coordination through
the use of health information technology and chronic disease
registries, and referrals for specialist care are provided.

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