[First Reprint]

SENATE, No. 48

 

STATE OF NEW JERSEY

 

INTRODUCED JANUARY 18, 1996

 

 

By Senators LaROSSA and LITTELL

 

 

An Act requiring health insurers to receive and transmit medical and health care claim information electronically.

 

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

 

    1. Within 90 days of the promulgation of demonstration standards and a timetable for implementation by the Commissioner of Insurance pursuant to section 7 of this act, a hospital service corporation shall demonstrate to the satisfaction of the commissioner that it will adopt and implement the demonstration standards, according to the corresponding timetable, to receive, transmit and store medical and health care claim information electronically, as a condition of its continued authorization to transact business in this State.

    The commissioner may, in his discretion, grant extensions or waivers of the implementation requirement when it has been demonstrated to his satisfaction that compliance with the timetable for implementation will result in an undue hardship to a hospital service corporation or its covered individuals.

 

    2. Within 90 days of the promulgation of demonstration standards and a timetable for implementation by the Commissioner of Insurance pursuant to section 7 of this act, a medical service corporation shall demonstrate to the satisfaction of the commissioner that it will adopt and implement the demonstration standards, according to the corresponding timetable, to receive, transmit and store medical and health care claim information electronically, as a condition of its continued authorization to transact business in this State.

    The commissioner may, in his discretion, grant extensions or waivers of the implementation requirement when it has been demonstrated to his satisfaction that compliance with the timetable for implementation will result in an undue hardship to a medical service corporation or its covered individuals.

 

    3. Within 90 days of the promulgation of demonstration standards and a timetable for implementation by the Commissioner of Insurance pursuant to section 7 of this act, a health service corporation shall demonstrate to the satisfaction of the commissioner that it will adopt and implement the demonstration standards, according to the corresponding timetable, to receive, transmit and store medical and health care claim information electronically, as a condition of its continued authorization to transact business in this State.

    The commissioner may, in his discretion, grant extensions or waivers of the implementation requirement when it has been demonstrated to his satisfaction that compliance with the timetable for implementation will result in an undue hardship to a health service corporation or its covered individuals.

 

    4. Within 90 days of the promulgation of demonstration standards and a timetable for implementation by the Commissioner of Insurance pursuant to section 7 of this act, a health insurer issuing individual health insurance policies shall demonstrate to the satisfaction of the commissioner that it will adopt and implement the demonstration standards, according to the corresponding timetable, to receive, transmit and store medical and health care claim information electronically, as a condition of its continued authorization to transact business in this State.

    The commissioner may, in his discretion, grant extensions or waivers of the implementation requirement when it has been demonstrated to his satisfaction that compliance with the timetable for implementation will result in an undue hardship to a health insurer or its covered individuals.

 

    5. Within 90 days of the promulgation of demonstration standards and a timetable for implementation by the Commissioner of Insurance pursuant to section 7 of this act, a health insurer issuing group health insurance policies shall demonstrate to the satisfaction of the commissioner that it will adopt and implement the demonstration standards, according to the corresponding timetable, to receive, transmit and store medical and health care claim information electronically, as a condition of its continued authorization to transact business in this State.

    The commissioner may, in his discretion, grant extensions or waivers of the implementation requirement when it has been demonstrated to his satisfaction that compliance with the timetable for implementation will result in an undue hardship to a health insurer or its covered individuals.

 

    6. Within 90 days of the promulgation of demonstration standards and a timetable for implementation by the Commissioner of Insurance pursuant to section 7 of this act, a health maintenance organization shall demonstrate to the satisfaction of the commissioner that it will adopt and implement the demonstration standards, according to the corresponding timetable, to receive, transmit and store medical and health care claim information electronically as a condition of its continued authorization to operate in this State.

    The commissioner may, in his discretion, grant extensions or waivers of the implementation requirement when it has been demonstrated to his satisfaction that compliance with the timetable for implementation will result in an undue hardship to a health maintenance organization or its enrollees.

 

    7. a. The Commissioner of Insurance, in consultation with the Healthcare Information Electronic Data Interchange Policy Council established pursuant to P.L. , c. (C. )(now before the Legislature as Senate, No. 50 of 1996), shall establish demonstration standards, along with a timetable for implementation, for the electronic receipt, transmission and storage of medical and health care claim information by hospital service, medical service and health service corporations, health insurers 1[and],1 health maintenance organizations, 1dental service corporations and dental plan organizations,1 respectively. The commissioner may, in his discretion, grant extensions or waivers of the implementation requirement when it has been demonstrated to his satisfaction that compliance with the timetable for implementation will result in an undue hardship to a hospital service, medical service, or health service corporation, health insurer 1, dental service corporation, dental plan organization,1or health maintenance organization, or its covered individuals or enrollees.

    b. In establishing these standards, the commissioner shall:

    (1) Encourage the use of the electronic data interchange (EDI) network developed by the council pursuant to P.L. , c. (C. )(now before the Legislature as Senate, No. 50 of 1996);

    (2) Encourage hospital service, medical service and health service corporations, health insurers 1[and],1 health maintenance organizations, 1dental service corporations and dental plan organizations,1to issue magnetic stripe "smart cards," or similar type patient identification cards or systems to covered individuals; and

    (3) Encourage and facilitate the development of privately owned and operated open networks which are interconnected and available to all participants in the health care services delivery process.

    c. The timetable for implementation promulgated by the commissioner shall provide for extensions and waivers of the implementation requirement pursuant to subsection a. of this section.

    d. The commissioner shall report annually to the policy council, the Legislature and the Governor on progress made in the implementation of these demonstration standards in this State.

 

    18. Within 90 days of the promulgation of demonstration standards and a timetable for implementation by the Commissioner of Insurance pursuant to section 7 of this act, a dental plan organization shall demonstrate to the satisfaction of the commissioner that it will adopt and implement the demonstration standards, according to the corresponding timetable, to receive, transmit and store medical and health care claim information electronically as a condition of its continued authorization to operate in this State.

    The commissioner may, in his discretion, grant extensions or waivers of the implementation requirement when it has been demonstrated to his satisfaction that compliance with the timetable for implementation will result in an undue hardship to a dental plan organization or its enrollees.1

 

    19. Within 90 days of the promulgation of demonstration standards and a timetable for implementation by the Commissioner of Insurance pursuant to section 7 of this act, a dental service corporation shall demonstrate to the satisfaction of the commissioner that it will adopt and implement the demonstration standards, according to the corresponding timetable, to receive, transmit and store medical and health care claim information electronically as a condition of its continued authorization to operate in this State.

    The commissioner may, in his discretion, grant extensions or waivers of the implementation requirement when it has been demonstrated to his satisfaction that compliance with the timetable for implementation will result in an undue hardship to a dental service corporation or its subscribers.1

 

    1[8.] 10.1 The commissioner shall promulgate regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to effectuate the provisions of this act.

 

    1[9.] 11.1 This act shall take effect immediately.

 

 

                             

 

Requires health insurers to process medical and claims information electronically.