Bill Text: NJ S3182 | 2010-2011 | Regular Session | Introduced
Bill Title: Requires insurers to cover treatment for sickle cell anemia; requires DHSS to provide information to public about sickle cell anemia.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2011-12-15 - Introduced, 1st Reading without Reference, 2nd Reading [S3182 Detail]
Download: New_Jersey-2010-S3182-Introduced.html
Sponsored by:
Senator RONALD L. RICE
District 28 (Essex)
Senator SHIRLEY K. TURNER
District 15 (Mercer)
SYNOPSIS
Requires insurers to cover treatment for sickle cell anemia; requires DHSS to provide information to public about sickle cell anemia.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning insurance coverage for, and the provision of information about, sickle cell anemia, and supplementing Titles 17 and 26 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. Every 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 medical expenses incurred by a covered person for the treatment of sickle cell anemia and, if the contract provides benefits for expenses incurred in the purchase of outpatient prescription drugs, then the contract shall provide coverage for prescription drug expenses incurred by a covered person for the treatment of sickle cell anemia.
The benefits shall be provided to the same extent as for any other medical 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. Every 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 medical expenses incurred by a covered person for the treatment of sickle cell anemia and, if the contract provides benefits for expenses incurred in the purchase of outpatient prescription drugs, then the contract shall provide coverage for prescription drug expenses incurred by a covered person for the treatment of sickle cell anemia.
The benefits shall be provided to the same extent as for any other medical 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. Every 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 medical expenses incurred by a covered person for the treatment of sickle cell anemia and, if the contract provides benefits for expenses incurred in the purchase of outpatient prescription drugs, then the contract shall provide coverage for prescription drug expenses incurred by a covered person for the treatment of sickle cell anemia.
The benefits shall be provided to the same extent as for any other medical 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. Every 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 medical expenses incurred by a covered person for the treatment of sickle cell anemia and, if the policy provides benefits for expenses incurred in the purchase of outpatient prescription drugs, then the policy shall provide coverage for prescription drug expenses incurred by a covered person for the treatment of sickle cell anemia.
The benefits shall be provided to the same extent as for any other medical condition under the policy.
This section shall apply to those policies in which the insurer has reserved the right to change the premium.
5. Every 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 medical expenses incurred by a covered person for the treatment of sickle cell anemia and, if the policy provides benefits for expenses incurred in the purchase of outpatient prescription drugs, then the policy shall provide coverage for prescription drug expenses incurred by a covered person for the treatment of sickle cell anemia.
The benefits shall be provided to the same extent as for any other medical condition under the policy.
This section shall apply to those policies in which the insurer has reserved the right to change the premium.
6. Every health maintenance organization contract that provides health care services and 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 Banking and Insurance, on or after the effective date of this act, shall provide health care services to an enrollee for the medical treatment of sickle cell anemia and, if the contract provides health care services for outpatient prescription drugs, then the contract shall provide health care services to an enrollee for prescription drugs for the treatment of sickle cell anemia.
The health care services shall be provided to the same extent as for any other medical condition under the contract.
The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the right to change the schedule of charges for enrollee coverage is reserved.
7. Every 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.), or approved for issuance or renewal in this State, on or after the effective date of this act, shall provide coverage for medical expenses incurred by a covered person for the treatment of sickle cell anemia and, if the plan provides benefits for expenses incurred in the purchase of outpatient prescription drugs, then the plan shall provide coverage for prescription drug expenses incurred by a covered person for the treatment of sickle cell anemia.
The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.
This section shall apply to all individual health benefits plans in which the carrier has reserved the right to change the premium.
8. Every 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.), or approved for issuance or renewal in this State, on or after the effective date of this act, shall provide coverage for medical expenses incurred by a covered person for the treatment of sickle cell anemia and, if the plan provides benefits for expenses incurred in the purchase of outpatient prescription drugs, then the plan shall provide coverage for prescription drug expenses incurred by a covered person for the treatment of sickle cell anemia.
The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.
This section shall apply to all small employer health benefits plans in which the carrier has reserved the right to change the premium.
9. The Legislature finds and declares that:
a. Sickle cell anemia is an inherited blood disorder characterized primarily by chronic anemia and periodic episodes of pain;
b. The clinical course of sickle cell anemia does not follow a single pattern, for the symptoms can range from mild to very severe;
c. Sickle cell anemia affects millions of people throughout the world but in this country affects approximately 72,000 people, according to the National Heart, Lung, and Blood Institute, most of whom are African-Americans and Hispanic-Americans of Caribbean ancestry;
d. Approximately two million Americans, or one in 12 African-Americans, carry the sickle cell trait; and the disease occurs in approximately one in 500 African-Americans and one in every 1,000-1,400 Hispanic-Americans;
e. All newborn infants born in New Jersey and in most other states are screened for sickle cell anemia; however, there is currently no known means of prevention or cure for the disease, although promising new methods of treatment have emerged from clinical studies in recent years, including drug therapy, bone marrow transplants from matched siblings, and umbilical cord blood transplants; and
f. There is a widespread need for information among those populations who are at greatest risk for carrying the sickle cell trait about the genetic risk factors associated with sickle cell anemia and the symptoms and treatment of the disease.
10. a. The Department of Health and Senior Services, in consultation with the Medical Society of New Jersey and the University of Medicine and Dentistry of New Jersey, shall prepare, and make available on its Internet website, information in English and Spanish, which is designed to be easily understandable by the general public, about the genetic risk factors associated with, and the symptoms and treatment of, sickle cell anemia, in addition to any other information that the Commissioner of Health and Senior Services deems necessary for the purposes of this act. The department shall revise this information whenever new information about sickle cell anemia becomes available.
b. The department shall prepare an informational booklet in English and Spanish that contains the information posted on its website pursuant to subsection a. of this section, as funds become available for that purpose. The department shall make a supply of booklets available to all licensed health care facilities engaged in the diagnosis or treatment of sickle cell anemia, as well as to health care professionals, community health centers, members of the public, and social services agencies upon their request.
11. Sections 9 and 10 of this act shall take effect immediately, and sections 1 through 8 shall take effect on the first day of the fourth month next following the date of enactment and shall apply to policies or contracts issued or renewed on or after the effective date.
STATEMENT
This bill is designed to improve access to treatments for sickle cell anemia through enhanced health insurance coverage and the dissemination of information about this inherited blood disorder to health care providers and the general public.
Specifically, the bill requires hospital, medical and health service corporations, commercial individual, small employer and group health insurers, and health maintenance organizations to provide coverage for medical expenses incurred by a covered person for the treatment of sickle cell anemia and for prescription drug expenses incurred by a covered person for the treatment of sickle cell anemia if the contract, policy, or plan provides outpatient prescription drug benefits.
In addition, the bill requires that the Department of Health and Senior Services (DHSS), in consultation with the Medical Society of New Jersey and the University of Medicine and Dentistry of New Jersey, prepare, and make available on its Internet website, information in English and Spanish, which is designed to be easily understandable by the general public, about the genetic risk factors associated with, and the symptoms and treatment of, sickle cell anemia, in addition to any other information that the Commissioner of Health and Senior Services deems necessary for the purposes of the bill. DHSS is to revise this information whenever new information about sickle cell anemia becomes available.
DHSS is also required to prepare an informational booklet in English and Spanish that contains the information posted on its website pursuant to the bill, as funds become available for that purpose, and to make a supply of booklets available to all licensed health care facilities engaged in the diagnosis or treatment of sickle cell anemia, as well as to health care professionals, community health centers, members of the public, and social services agencies upon their request.
The insurance coverage provisions of the bill take effect on the first day of the fourth month following the date of enactment and apply to policies and contracts issued or renewed on or after its effective date.
