SENATE, No. 2593

STATE OF NEW JERSEY

218th LEGISLATURE

 

INTRODUCED MAY 21, 2018

 


 

Sponsored by:

Senator  TROY SINGLETON

District 7 (Burlington)

 

 

 

 

SYNOPSIS

     Requires certain health care providers, SHBP, and School Employees' Health Benefits Program to submit certain health care claims data to DOBI.

 

CURRENT VERSION OF TEXT

     As introduced.

 


An Act concerning the disclosure of certain health care claims data and supplementing Titles 30 and 52 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.  A provider that receives reimbursement pursuant to a State Medicaid managed care contract shall annually submit health care claims data from all health insurance payers to the Commissioner of Banking and Insurance for the ten services having the highest costs reimbursed pursuant to the State Medicaid program, as identified by the Commissioner of Human Services.

     b.    As used in this section:

     "Provider" means any person, public or private institution, agency, or business concern, approved by the Division of Medical Assistance and Health Services in the Department of Human Services, lawfully providing medical care, services, goods, and supplies authorized under P.L.1968, c.413 (C.30:4D-1 et seq.), and where applicable, holding a current valid license to provide such services or to dispense such goods or supplies.

 

     2.    The State Health Benefits Program, established pursuant to the "New Jersey State Health Benefits Program Act," P.L.1961, c.49 (C.52:14-17.25 et seq.), shall annually submit health care claims data from all health insurance payers to the Commissioner of Banking and Insurance for the ten hospital and medical expense benefits having the highest costs pursuant to contracts purchased by the Program.

 

     3.    The School Employees' Health Benefits Program, established pursuant to the "School Employees' Health Benefits Program Act," sections 31 through 41 of P.L.2007, c.103 (C.52:14-17.46.1 through C.52:14-17.46.11), shall annually submit health care claims data from all health care payers to the Commissioner of Banking and Insurance for the ten hospital and medical expense benefits having the highest costs pursuant to contracts purchased by the Program.

 

     4.    The Commissioner of Banking and Insurance shall establish and maintain a database that includes a record of all health care claims for which data is submitted to the commissioner pursuant to sections 1, 2, and 3 of P.L.    , c.    (C.          ) (pending before the Legislature as this bill).  The commissioner shall make this information available upon request and at no cost to the public for the purposes of research or policymaking, and shall establish procedures to ensure the privacy and confidentiality of patients.  The commissioner, in consultation with the Commissioner of Human Services, the State Health Benefits Program, and the School Employees’ Health Benefits Program, shall adopt, by regulation, a standard reporting form in paper and electronic formats for the purposes of submitting health care claims data pursuant to sections 1, 2, and 3 of P.L.    , c.    (C.          ) (pending before the Legislature as this bill).

 

     5.    The Commissioner of Banking and Insurance shall, in accordance with the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), adopt any rules and regulations as deemed necessary to carry out the provisions of this act.

 

     6.    This act shall take effect on the first day of the fiscal year next following the date of enactment, except that the Commissioner of Banking and Insurance may take such anticipatory administrative action in advance thereof as shall be necessary for the implementation of the act.

 

 

STATEMENT

 

     This bill requires health care providers reimbursed by the State Medicaid Program, and the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP), to annually submit to the Commissioner of Banking and Insurance information regarding health care claims data from all health care payers for the ten services or benefits having the highest costs within each respective programThe commissioner shall maintain this information and make it available upon request and at no cost to the public for the purposes of research or policymaking.  Furthermore, the commissioner shall establish procedures to ensure privacy and confidentiality of patients and adopt a standard reporting form in paper and electronic formats for the purposes of submitting health care claims data pursuant to the bill.

     The United States Supreme Court decision in Goebeille v. Liberty Mutual Insurance Co. prohibits states from collecting certain health care claims data directly from employers and third-party administrators, and hence, limits efforts to identify measures to lower health care costs.  It is the sponsor’s intent to provide certain health care claims data from the State’s Medicaid Program, SHBP, and SEHBP to researchers and policymakers, in a manner permissible under federal law, as a means to assess utilization, cost, and quality in parts of the State’s health care system.