All Payer Claims Databases
The Assembly Health Committee took testimony on the concept of creating an all payer claim database, partly for the purpose of determining proper charges and reimbursement for certain services, particularly out of network services. MSNJ has testified on existing legislation, stating that APCDs can be a good tool. MSNJ opposes legislation that would create artificial limits on out of network charges and supports improvements on in network issues first. See media coverage here.
The Assembly passed the final version of A2022/S792, which now heads to the Governor’s desk. MSNJ worked on this bill in great detail. The bill 1) requires insurance companies to cover certain screenings, 2) requires physicians to provide information to certain patients regarding breast density and 3) requires study of breast cancer risk factors. Radiology facilities must distribute to certain patients a notice that reads as follows: “Your mammogram may show that you have dense breast tissue as determined by the Breast Imaging Reporting and Data System established by the American College of Radiology. Dense breast tissue is very common and is not abnormal. However, in some cases, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with a risk factor for breast cancer. Discuss this and other risks for breast cancer that pertain to your personal medical history with your health care provider. A report of your results was sent to your health care provider. You may also find more information about breast density at the website of the American College of Radiology.” The bill states that it does not impose a standard of care obligation upon a patient’s health care provider. The bill requires the Mandated Health Benefits Advisory Commission to prepare a report regarding the implementation and administration of the bill, including analyses of social, medical and financial impact. The bill requires the Department of Health, in conjunction with the Medical Society of New Jersey, to convene a work group to review and report on strategies to improve the dialogue between patients and health care professionals regarding risk factors for breast cancer and breast imaging options.
The Senate and Assembly have both passed A4222/S2779, which allows practitioner with financial interest in health care service providing lithotripsy to refer patients to that health care service if certain conditions are met. MSNJ and New Jersey urologists support this bill, which is a “clean up” to the reforms made to self-referral laws (the Codey Act) in 2009. Lithotripsy was left out of the exemptions in 2009. The bill heads to the Governor.
Gender Changes on Birth Certificates
The Senate and Assembly have both passed A4097/S2876, which allows more people to change their birth certificates. To obtain the amended certificate, a person would be required to submit: 1) a form provided by the State registrar of vital statistics and completed by the person’s licensed health care provider which indicates that the person has undergone clinically appropriate treatment for the purpose of gender transition, based on contemporary medical standards, or that the person has an intersex condition; and 2) a certified copy of a court order indicating the person’s name change, if the person has changed his or her name. Under current law, a person is required to undergo sex reassignment surgery to receive an amended birth certificate.
The Assembly has passed A4324, which requires that certain health care facilities be either equipped with a generator or be equipped with an appropriate electrical transfer switch and wiring to which a portable generator can be connected in order to provide back-up electrical power to the facility. Health care facilities included under the provisions of the bill are the following: nursing homes; assisted living facilities; comprehensive personal care homes; pediatric community transitional homes; federally qualified health centers; dialysis centers; hospice in-patient cares; or residential health care centers connected to another licensed facility. The bill requires that these facilities be equipped with a generator or be generator ready within three years of the effective date of the bill. The bill also requires the New Jersey Economic Development Authority (“authority”) to offer financial assistance in the form of low-interest loans to eligible facilities for the purchase and installation of a generator, or to make the facility generator ready (the loans are to have an interest rate of not greater than two percent). There is no Senate counterpart.
Reconstructive Breast Surgery
The Senate has passed S374, which grants a state sales tax exemption for services prescribed by a doctor in conjunction with reconstructive breast surgery. The procedures, currently subject to the 7 percent tax rate, are utilized to restore the appearance of the breast. The bill addresses a current loophole where insurance providers cover the costs of the procedures but pass on the cost of the sales tax to the patient. The Assembly version of the bill, A4526, is awaiting final adoption, which will likely happen in lame duck.
Physician Loan Redemption
The Assembly Higher Education passed A4507, which establishes a Physician Loan Redemption Program. MSNJ, along with NJ AFP and COTH worked expediently to improve the bill that was passed by the Senate in a skeletal, flawed form. This is a lame duck priority for policy makers and will reach the Governor’s desk this month. With our input, the bill now bill provides for redemption of eligible qualifying loan expenses for physicians who work for no less than four years at an approved site in the clinical practice of primary care or in the clinical practice of specialized care if the specialty is projected to experience a significant shortage. The bill also provides that the redemption of eligible qualifying loan expenses under the program will be exempt from the program participant’s individual New Jersey State income tax. Also, in the case of an approved site that is a private primary care physician practice that has hired a loan redemption program participant, the site will have a State income tax exemption for all practice revenues received from providing services under the Medicaid program.
Any Willing Provider
The Senate Health Committee took testimony on a bill that would prohibit an NJ insurance company from having exclusive contracts with providers. The bill stems from Horizon’s exclusive contract with LabCorp, but is not limited to lab services. The Association of Health Plans opposes the bill, stating that keeping narrow networks is a business decision they should have the flexibility to make to control costs (for consumers). Please find MSNJ’s testimony here.
Student Eye Injuries
Both houses have passed a bill that requires the Commissioner of Education to develop an educational fact sheet that provides information about sports-related eye injuries. Each school district and nonpublic school is to distribute the fact sheet annually to the parents or guardians of the students. The fact sheet is to include, but not be limited to:
— a list of the most common sports-related eye injuries and the recognition of the symptoms of those injuries;
— a recommendation that children seek treatment and advice from a licensed health care professional regarding the appropriate amount of time to delay the return to sports after injury
— a recommendation that all children participating in school sports or recreational sports wear protective eyewear;
— information concerning the purchase of appropriate protective eyewear; and
— any other information the commissioner deems appropriate.
The Assembly passed a bill that directs the Commissioner of Health to develop a plan to phase out the use of latex gloves in licensed health care facilities and food service establishments to address consumer latex allergies. The Senate will likely pass the bill soon.
The Assembly has passed A4415/S2367. This bill, the “Sudden Cardiac Arrest Prevention Act”, provides student-athletes, parents, and coaches with information on sudden cardiac arrest and establishes protocol concerning removal-from-play for athletes exhibiting symptoms of sudden cardiac arrest. The following organizations were in support of the bill: NJ Chapter of American College Emergency Physicians, American Heart Association, NJ School Boards Association and the Athletic Trainers Association of NJ. As previously reported, the Senate passed the bill in June.
Mental Health Screenings
The Assembly has passed A3155, which concerns assessments of persons believed to be in need of involuntary commitment to treatment. The bill requires that an assessment be performed prior to the performance of routine laboratory and diagnostic testing. If, as a result of the assessment, involuntary commitment to treatment seems necessary, then the routine laboratory and diagnostic testing is to be performed. (Laboratory and diagnostic testing is currently completed and submitted to screening services before the assessment, so this bill seeks to avoid such testing expenses if the person does not need commitment, and to reduce hospital emergency room waiting times because staff would not have to wait for test results to be reviewed before the assessment is performed.) There is no Senate counterpart.
Declaration of Death
Both houses have passed A3586/S2756, which removes the statutory authority of the Department of Health (DOH) and the State Board of Medical Examiners (BME) over medical standards governing declarations of death upon the basis of neurological criteria. The bill requires that a declaration of death upon the basis of neurological criteria be made by a licensed physician professionally qualified by specialty or expertise, based upon the exercise of the physician’s best medical judgment and in accordance with currently accepted medical standards. Joint DOH/BME regulations would no longer be needed to set forth currently accepted medical standards (including criteria, tests, and procedures) to govern declarations of death upon the basis of neurological criteria. If they are used, the regulations concerning the declaration of death upon the basis of neurological criteria may not require the use of any specific test or procedure in the declaration of death upon the basis of such criteria.
MSNJ supports this bill.
The Assembly has passed two bills concerning breast milk. A3702 requires the Commissioner of Health to establish a public awareness campaign to advise pregnant women, new parents, and women who are breast feeding their children about the dangers of casual milk sharing. The campaign would, at a minimum, provide information on: risk factors associated with casual milk sharing, including disease transmission and contamination from drugs, germs, or chemicals; the federal Food and Drug Administration’s warning against mothers using donated breast milk obtained directly from individuals or other unknown sources; and human milk banks and the procedures they use to select donors and collect, process, store, dispense, or sell donated breast milk.
A3703 gives the Department of Health the authority to license and inspect human milk banks, including an inspection of records, files, and other data, and requires the commissioner to promulgate rules and regulations for the operation and maintenance of human milk banks. The regulations governing human milk banks would include provisions for: staff qualifications; procedures for selecting and screening potential donors; standards for the collection, processing, storage, and distribution of donated breast milk; the maintenance and confidentiality of milk bank records; and license application, issuance, renewal, expiration, denial, suspension, and revocation.
The Assembly Education Committee has passed A954, which creates a 16-member School Asthma Protocol Task Force. The membership of the task force would include: the Commissioners of Education and Health and 14 public members to be appointed by the Governor as follows: four persons who are parents of children with asthma who are attending a public or nonpublic school; a licensed physician who is a pulmonary specialist; a licensed pediatrician; a certified school nurse; an advanced practice nurse certified in pediatric nursing; a school administrator; a public school teacher; a public school principal or supervisor; a local school board member; a representative of a nonpublic school; and a representative of the American Lung Association. The task force would be responsible for selecting a school asthma protocol and developing guidelines for the most appropriate and effective means of implementing the selected school asthma protocol on a Statewide basis. There is no Senate counterpart.
The Assembly has passed A4537 which would permit State medical marijuana patients and their primary caregivers to possess, and patients to use, medical marijuana legally obtained from another jurisdiction. The bill would also permit qualifying out-of-State medical marijuana patients and their primary caregivers to engage in any conduct related to medical marijuana permitted under New Jersey law. In both situations, the other jurisdiction’s medical marijuana law must be recognized by the Department of Health. The bill would additionally provide that both parents of a patient who is a minor may serve as the minor’s primary caregivers under the State medical marijuana program, and that a parent who is currently serving as a primary caregiver may concurrently serve as primary caregiver to any minor child of the parent who is a qualifying patient. There has not yet been action on the Senate counterpart.