SENATE, No. 3317

STATE OF NEW JERSEY

218th LEGISLATURE

INTRODUCED JANUARY 15, 2019

 


 

Sponsored by:

Senator PAUL A. SARLO

District 36 (Bergen and Passaic)

 

 

 

 

SYNOPSIS

Directs State Health Benefits Commission to study reference-based pricing.

 

CURRENT VERSION OF TEXT

As introduced.

 


An Act directing the State Health Benefits Commission to examine the implementation of reference-based pricing in the State Health Benefits Program.

 

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

 

1. a. The State Health Benefits Commission, established pursuant to section 3 of P.L.1961, c.49 (C.52:14-17.27), shall conduct a comprehensive review of reference-based pricing health benefits models and the fiscal impact of implementing reference-based pricing in this State.

b. The commission shall evaluate the following, at minimum:

(1) the anticipated costs and savings to the State, to participating employers, and to persons covered under the State Health Benefits Program associated with implementing reference-based pricing;

(2) the potential effect of reference-based pricing on higher-cost medical services, including radiology, outpatient specialty, and elective inpatient procedures;

(3) the optimal maximum reimbursable amount, including the optimal percentage of Medicare reimbursement to health care facilities and providers, at which reference-based pricing should be established;

(4) the successes and challenges of reference-based pricing employed in other jurisdictions in the country, including, but not limited to, the various models adopted in California, Montana, and North Carolina;

(5) the changes in consumer choice and provider prices and participation before and after implementation of reference-based pricing in other jurisdictions utilizing reference-based pricing, comparing those changes to choices made by comparable employed groups not subject to reference-based pricing during the same time period; and

(6) the requirements and limitations of State and federal law, including the Patient Protection and Affordable Care Act (PPACA) (Pub. L. 111148, 2010), to which the most feasible models would be subject.

c. The commission shall have the power to call to its assistance and avail itself of the services of employees of any State, county, or municipal department, board, bureau, commission or agency as it may require and as may be available for purposes of this section. The commission may consult with and seek the assistance of any other public or private organization or individual with relevant expertise as may be necessary.

d. The commission shall issue a final report on its findings and recommendations, which shall include recommendations for legislation, to the Governor and to the Legislature, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), by July 1, 2019. Following the issuance of its final report, the commission shall convene at the call of the chairperson to consider and respond to any written request submitted to it by a legislator or officer or employee of the Executive Branch of State government on any item set forth in its report.

 

2. This act shall take effect immediately.

 

 

STATEMENT

 

This bill directs the State Health Benefits Commission (SHBC) to study reference-based pricing. Under the bill, the SHBC will conduct a comprehensive review of reference-based pricing health benefits models and the fiscal impact of implementing reference-based pricing in this State.

The commission is required to evaluate the following, at minimum:

(1) the anticipated costs and savings to the State, to participating employers, and to covered persons associated with implementing reference-based pricing;

(2) the potential effect of reference-based pricing on higher-cost medical services;

(3) the optimal maximum reimbursable amount at which reference-based pricing should be established;

(4) the successes and challenges of reference-based pricing employed in other jurisdictions in the country;

(5) the changes in consumer choice and provider prices and participation before and after implementation of reference-based pricing; and

(6) the requirements and limitations of State and federal law, including the Affordable Care Act, to which the most feasible models would be subject.

The commission will issue a final report on its findings and recommendations, which will include recommendations for legislation, to the Governor and the Legislature by July 1, 2019.