Sponsored by:
Assemblywoman SHANIQUE SPEIGHT
District 29 (Essex)
Assemblywoman VALERIE VAINIERI HUTTLE
District 37 (Bergen)
SYNOPSIS
Requires health insurance coverage of at-home rehabilitation services.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning at-home rehabilitation and supplementing various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. No group or individual hospital service corporation contract providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State, 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, unless the contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in conducting at-home rehabilitation services.
b. The benefits shall be provided to the same extent as for any other medical condition under the contract.
c. The provisions of this section shall apply to all contracts in which the hospital service corporation has reserved the right to change the premium.
d. As used in this section, “at-home rehabilitation” means the treatment of an individual suffering from a functional physical or mental impairment due to injury or disease through use of medical equipment or other means and within the individual’s home.
2. a. No group or individual medical service corporation contract providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State, 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, unless the contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in conducting at-home rehabilitation services.
b. These benefits shall be provided to the same extent as for any other medical condition under the contract.
c. The provisions of this section shall apply to all contracts in which the medical services corporation has reserved the right to change the premium.
d. As used in this section, “at-home rehabilitation” means the treatment of an individual suffering from a functional physical or mental impairment due to injury or disease through use of medical equipment or other means and within the individual’s home.
3. a. No group or individual health service corporation contract providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State, 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, unless the contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in conducting at-home rehabilitation services.
b. These benefits shall be provided to the same extent as for any other medical condition under the contract.
c. The provisions of this section shall apply to all contracts in which the health services corporation has reserved the right to change the premium.
d. As used in this section, “at-home rehabilitation” means the treatment of an individual suffering from a functional physical or mental impairment due to injury or disease through use of medical equipment or other means and within the individual’s home.
4. a. No individual health insurance policy providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State, 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, unless the policy provides benefits to any named insured or other person covered thereunder for expenses incurred in conducting at-home rehabilitation services.
b. These benefits shall be provided to the same extent as for any other medical condition under the policy.
c. The provision of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
d. As used in this section, “at-home rehabilitation” means the treatment of an individual suffering from a functional physical or mental impairment due to injury or disease through use of medical equipment or other means and within the individual’s home.
5. a. No group health insurance policy providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State, 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, unless the policy provides benefits to any named insured or other person covered thereunder for expenses incurred in conducting at-home rehabilitation services.
b. These benefits shall be provided to the same extent as for any other medical condition under the policy.
c. The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
d. As used in this section, “at-home rehabilitation” means the treatment of an individual suffering from a functional physical or mental impairment due to injury or disease through use of medical equipment or other means and within the individual’s home.
6. a. Notwithstanding any provision of law to the contrary, a certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued by the Commissioner of Banking and Insurance on or after the effective date of this act unless the health maintenance organization provides health care services to any enrollee for the use of at-home rehabilitation services.
b. These health care services shall be provided to the same extent as for any other medical condition under the enrollee agreement.
c. The provisions of this section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges.
d. As used in this section, “at-home rehabilitation” means the treatment of an individual suffering from a functional physical or mental impairment due to injury or disease through use of medical equipment or other means and within the individual’s home.
7. a. Every individual health benefits plan that 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 benefits to any person covered thereunder for expenses incurred in conducting at-home rehabilitation services.
b. The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.
c. The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.
d. As used in this section, “at-home rehabilitation” means the treatment of an individual suffering from a functional physical or mental impairment due to injury or disease through use of medical equipment or other means and within the individual’s home.
8. a. Every small employer health benefits plan that 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 benefits to any person covered thereunder for expenses incurred in conducting at-home rehabilitation services.
b. The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.
c. The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.
d. As used in this section, “at-home rehabilitation” means the treatment of an individual suffering from a functional physical or mental impairment due to injury or disease through use of medical equipment or other means and within the individual’s home.
9. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide coverage for expenses incurred in conducting at-home rehabilitation services.
b. The benefits shall be provided to the same extent as for any other medical condition under the contract.
c. As used in this section, “at-home rehabilitation” means the treatment of an individual suffering from a functional physical or mental impairment due to injury or disease through use of medical equipment or other means and within the individual’s home.
10. This act shall take effect immediately.
STATEMENT
This bill requires health insurance carriers, including insurance companies, health service corporations, hospital service corporations, medical service corporations, health maintenance organizations authorized to issue health benefits plans in New Jersey, and any entity contracted to administer health benefits in connection with the State Health Benefits Program or School Employees’ Health Benefits Program, to cover at-home rehabilitation services.
For an individual recovering from surgery or suffering from a debilitating disease or disability, the burden of traveling to and from a rehabilitation facility may be too large to overcome. With the rise of the coronavirus 2019 pandemic, many individuals have also been unable to visit a rehabilitation facility for treatment or have delayed treatment for fear of contracting the virus. Thus, requiring carriers to cover at-home rehabilitation services would alleviate these issues by providing access to treatment from within the patient’s home, without fear of aggravating a disability or contracting a deadly virus. As defined in the bill, “at-home rehabilitation” means the treatment of an individual suffering from a functional physical or mental impairment due to injury or disease through use of medical equipment or other means and within the individual’s home.