Bill Text: NJ A3409 | 2012-2013 | Regular Session | Amended

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Bill Title: Prohibits Medicaid managed care organizations from reducing certain provider reimbursement rates without approval from DHS.*

Spectrum: Partisan Bill (Democrat 7-0)

Status: (Introduced - Dead) 2014-01-06 - Substituted by S2241 (2R) [A3409 Detail]

Download: New_Jersey-2012-A3409-Amended.html

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[First Reprint]

ASSEMBLY, No. 3409

STATE OF NEW JERSEY

215th LEGISLATURE

INTRODUCED OCTOBER 18, 2012

 

 

Sponsored by:

Assemblyman  GARY S. SCHAER

District 36 (Bergen and Passaic)

Assemblyman  GORDON M. JOHNSON

District 37 (Bergen)

Assemblywoman  CELESTE M. RILEY

District 3 (Cumberland, Gloucester and Salem)

Assemblyman  TIMOTHY J. EUSTACE

District 38 (Bergen and Passaic)

Assemblywoman  CONNIE WAGNER

District 38 (Bergen and Passaic)

Assemblywoman  VALERIE VAINIERI HUTTLE

District 37 (Bergen)

 

 

 

 

SYNOPSIS

     Prohibits Medicaid managed care organizations from reducing certain provider reimbursement rates without approval from DHS.

 

CURRENT VERSION OF TEXT

     As reported by the Assembly Financial Institutions and Insurance Committee on June 6, 2013, with amendments.

 

An Act concerning Medicaid managed care organizations and supplementing Title 30 of the Revised Statutes.

 

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

 

     1.    a. A health maintenance organization that contracts with the Division of Medical Assistance and Health Services in the Department of Human Services to provide benefits under a managed care plan to persons who are eligible for medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.) or P.L.2005, c.156 (C.30:4J-8 et al.) shall not reduce reimbursement rates to ¹any category of¹ participating health care providers in ¹[that] the¹ plan ¹that are subject to the regulatory authority of the Department of Human Services, or the Department of Health pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.), or for services provided through a Health Care Service Firm pursuant to P.L.2002, c.126 (C.34:8-45.1 et seq.),¹ without obtaining prior written approval to do so from the Commissioner of Human Services.  The approval by the commissioner shall be subject to the requirements of subsection b. of this section.

     b.    The health maintenance organization shall be required to:

     (1)   apply on a form and in a manner set forth by the commissioner to obtain approval pursuant to subsection a. of this section;

     (2)   demonstrate to the satisfaction of the commissioner that the health maintenance organization has taken all appropriate actions to reduce the cost of providing benefits to eligible recipients covered by that plan, including:  cost-effective utilization review measures as determined by the commissioner; elimination of unnecessary administrative expenses; enhanced fraud detection and recovery efforts; and any other actions that the commissioner may require as a prior condition of obtaining approval;

     (3)   demonstrate to the satisfaction of the commissioner that the proposed reduction in provider reimbursement rates will not adversely impact the quality and accessibility of health care services provided to eligible recipients covered by the plan; and

     (4)   comply with any prospective requirements established by the commissioner at the time, and as a condition, of granting such approval.

     c.     The Division of Medical Assistance and Health Services shall conduct a public hearing on the proposed reduction in reimbursement rates at least 30 days after receipt of the application by the health maintenance organization pursuant to subsection b. of this section, but before making a decision on whether to approve the proposed reduction.

 

     2.    This act shall take effect immediately, and shall apply to any contract that a health maintenance organization has entered into with the Division of Medical Assistance and Health Services in the Department of Human Services to provide benefits under a managed care plan to persons who are eligible for medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.) or P.L.2005, c.156 (C.30:4J-8 et al.), which is in effect on the effective date of this act or executed thereafter.