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

Summary

A Senate Commerce Committee statement to the Senate on Senate Bill No. 3478, State of New Jersey, dated May 15, 2023, reporting the bill favorably. The bill provides that a health benefits company managing a public employer's health benefits plan under contract may give the employer a credit toward the cost of a contract to manage a medical home model, and may refer covered employees and dependents to providers it contracts with. Any credit must not exceed payments the company received from insurers for claims for provider services. A "medical home" means on-site physicians, nurses, and pharmacy and laboratory services provided at no cost to school district employees and dependents, with salaried medical staff rather than fee-for-service.

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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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