SENATE, No. 1704
STATE OF NEW JERSEY
INTRODUCED NOVEMBER 25, 1996
By Senator INVERSO
An Act concerning coverage for inpatient care following a mastectomy and supplementing P.L.1938, c.366 (C.17:48-1 et seq.), P.L.1940, c.74 (C.17:48A-1 et seq.), P.L.1985, c.236 (C. 17:48E-1 et seq.), Chapters 26 and 27 of Title 17B of the New Jersey Statutes, P.L.1992, c.161 (C.17B:27A-2 et seq.), P.L.1992, c.162 (C.17B:27A-17 et seq.) and P.L.1973, c.337 (C.26:2J-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. Every individual or group hospital service corporation contract that provides hospital or 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 a minimum of 72 hours of inpatient care following surgery for a mastectomy. The contract shall not require a health care provider to obtain authorization from the hospital service corporation for prescribing 72 hours of inpatient care as provided for in this section. The benefits shall be provided to the same extent as for any other sickness under the contract.
The provisions of this section shall apply to all contracts in which the hospital service corporation has reserved the right to change the premium.
b. The Commissioner of Banking and Insurance shall adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to implement the provisions of this section.
2. a. Every individual or group medical service corporation contract that provides hospital or 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 a minimum of 72 hours of inpatient care following surgery for a mastectomy. The contract shall not require a health care provider to obtain authorization from the medical service corporation for prescribing 72 hours of inpatient care as provided for in this section.
The benefits shall be provided to the same extent as for any other sickness under the contract.
The provisions of this section shall apply to all contracts in which the medical service corporation has reserved the right to change the premium.
b. The Commissioner of Banking and Insurance shall adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to implement the provisions of this section.
3. a. Every individual or group health service corporation contract that provides hospital or 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 a minimum of 72 hours of inpatient care following surgery for a mastectomy. The contract shall not require a health care provider to obtain authorization from the health service corporation for prescribing 72 hours of inpatient care as provided for in this section.
The benefits shall be provided to the same extent as for any other sickness under the contract.
The provisions of this section shall apply to all contracts in which the health service corporation has reserved the right to change the premium.
b. The Commissioner of Banking and Insurance shall adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to implement the provisions of this section.
4. a. Every individual policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:26-1 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 a minimum of 72 hours of inpatient care following surgery for a mastectomy. The policy shall not require a health care provider to obtain authorization from the insurer for prescribing 72 hours of inpatient care as provided for in this section.
The benefits shall be provided to the same extent as for any other sickness under the policy.
The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
b. The Commissioner of Banking and Insurance shall adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to implement the provisions of this section.
5. a. Every group policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:27-26 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 benefits for a minimum of 72 hours of inpatient care following surgery for a mastectomy. The policy shall not require a health care provider to obtain authorization from the insurer for prescribing 72 hours of inpatient care as provided for in this section.
The benefits shall be provided to the same extent as for any other sickness under the policy.
The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
b. The Commissioner of Banking and Insurance shall adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to implement the provisions of this section.
6. a. Every individual health benefits plan that provides hospital or 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 benefits for a minimum of 72 hours inpatient care following surgery for a mastectomy. The health benefits plan shall not require a health care provider to obtain authorization from the carrier for prescribing 72 hours of inpatient care as provided for in this section.
The benefits shall be provided to the same extent as for any other sickness under the health benefits plan.
The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.
b. The New Jersey Individual Health Coverage Program Board shall adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to implement the provisions of this section.
7. a. Every small employer health benefits plan that provides hospital or 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 benefits for a minimum of 72 hours inpatient care following surgery for a mastectomy. The health benefits plan shall not require a health care provider to obtain authorization from the carrier for prescribing 72 hours of inpatient care as provided for in this section.
The benefits shall be provided to the same extent as for any other sickness under the health benefits plan.
The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.
b. The New Jersey Small Employer Health Benefits Program Board shall adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to implement the provisions of this section.
8. a. Every enrollee agreement that provides hospital or medical expense benefits 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 Health and Senior Services on or after the effective date of this act shall provide health care services for a minimum of 72 hours of inpatient care following surgery for a mastectomy. The enrollee agreement shall not require a health care provider to obtain authorization from the health maintenance organization for prescribing 72 hours of inpatient care as provided for in this section.
The health care services shall be provided to the same extent as for any other sickness under the enrollee agreement.
The provisions of this section shall apply to enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges.
b. The Commissioner of Health and Senior Services shall adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to implement the provisions of this section.
9. This act shall take effect immediately.
STATEMENT
This bill requires hospital, medical and health service corporations, individual and small and large group commercial insurers, and health maintenance organizations to provide a minimum of 72 hours inpatient care following surgery for a mastectomy. The bill also provides that the insurer or health maintenance organization shall not require a health care provider to obtain authorization from the insurer or health maintenance organization for prescribing the 72 hours of inpatient care as provided for in this bill.
The provisions of this bill are based on recommendations of the New Jersey Division of the American Cancer Society.
Requires health insurers to provide a minimum of 72 hours inpatient care following surgery for a mastectomy.