Below is Part II of our New Jersey Statutory update. As you can see from the below, several statutes were passed imposing requirements on health insurance payers, including new requirements for prior authorization request and new coverage requirements for fertility treatment and hearing aids. In addition, New Jersey finally enacted a mental health diversion program, albeit limited to three counties as a trial run.
New Jersey approved Bill A4913 requiring health insurance payers to offer healthcare providers, for health or dental care services, “all reasonably available methods of payment” from the payer or a contracted vendor. The forms of payment include, but are not limited to, check and electronic funds transfers. The insurance plans should not restrict mandating credit card payments, and a payer should not reimburse a covered person using a virtual credit card. Payers or their vendors cannot restrict the form of payment to only one method for an out-of-network provider for out-of-network covered services.
Reciprocity for Out-of-State EMT Certifications
Approved Bill A831 streamlines the EMT certification process for EMTs from other states. The bill allows a person with an EMT certification from another state, territory, or possession of the United States, the District of Columbia, or the Commonwealth of Puerto Rico to obtain a New Jersey certification from the Commissioner of Health. As a condition of recertification, an EMT must undergo a follow-up criminal history record background check at least once every three years.
Coverage of Palliative Care Benefits under Medicaid
Approved Bill A5225 provides coverage for community-based palliative care services as a benefit under the Medicaid program for beneficiaries with serious illnesses and their caregivers. The bill amends N.J.S.A. § 30:4D-6 to expand coverage beyond hospice services, including but not limited to (1) specialized medical care and emotional and spiritual support for beneficiaries with serious advanced illnesses; (2) relief of symptoms, pain, and stress of serious illness; (3) improvement of quality of life for both the beneficiary and the beneficiary’s family; and (4) appropriate care for any age and for any stage of serious illness, along with curative treatment. The authorized providers to deliver these benefits include Medicaid-approved licensed hospice agencies, home health agencies licensed to provide hospice care, and other licensed healthcare providers.
Health Insurance Coverage Requirements for Fertility Treatment Services
New Jersey approved Bill A5235, which requires health insurance coverage of any infertility treatment that is recommended by the American Society for Reproductive Medicine guidelines and as determined by a physician. Some of the covered services include in vitro fertilization with donor eggs or surrogates, genetic testing, artificial insemination, and embryo transfers. Additionally, the bill requires coverage of treatment for a partner of a person who has successfully reversed a voluntary sterilization. The bill also prohibits payers from imposing any restrictions on the coverage of services based on age, relationship status, or sexual orientation. The bill, however, does exclude coverage for infertility services if infertility resulted solely from voluntary unreversed sterilization.
New Jersey Establishes Minimum Reimbursement Rate for Certain Nursing Facilities under NJ FamilyCare
New Jersey approved Bill S2369 to increase the per diem reimbursement rate for traumatic brain injury special care nursing facilities to $400 above the special care nursing facility’s FY 2022 rate. This rate aligns with other special care nursing facilities. The increase is to cover the higher staffing ratios and higher quantity of therapy services required in a traumatic brain injury unit. Additionally, the bill establishes an enhanced reimbursement rate for nursing facilities that “voluntarily delicense beds in order to create single occupancy rooms.” The per diem reimbursement rate is increased from $350 to $415. The bill also requires a nursing facility that voluntarily delicenses beds to establish a single occupancy room for a NJ FamilyCare beneficiary to be reimbursed for the services provided by the beneficiary equal to 150% of the facility’s base per diem rate.
Mental Health Diversion Program to Divert Nonviolent Criminal Defendants into Mental Health Programs
New Jersey approved Bill S524 to establish the Mental Health Diversion Program (MHDP) to divert individuals with serious mental disorders who have committed nonviolent crimes into mental health treatment. The bill aims to reduce incarceration rates, improve quality of life for eligible individuals, increase community awareness, and reduce recidivism and re-hospitalization for the target population. Crimes of the third or fourth degree that do not involve violence or the threat of violence are eligible for consideration. Under the MHDP, a prosecutor will make an initial determination that a defendant is eligible for the program, mental health professionals will evaluate the individual and create a treatment plan, and the case will be overseen by the judge. The program will initially be established in three vicinages in the state, with the intent to expand to all vicinages. At least one program will operate in each of the northern, central, and southern regions of the state.
Cosmetology and Hairstyling Chair or Booth Rentals
Approved Bill A1507 amends N.J.S.A. § 45:5B-3 to establish a new chair or booth rental license for individuals already licensed by the New Jersey State Board of Cosmetology and Hairstyling (the Board). The bill is intended for individuals who enter a contract with a licensed shop owner to rent or lease a chair or booth and provides that a licensed shop owner shall not enter into such an arrangement unless the practicing licensee holds a chair or booth rental license provided in the bill. The bill also authorizes the Board to inspect shops where such an arrangement exists.
Prohibits Certain Provisions in Agreements between Insurance Payers and Dentists
New Jersey approved Bill S765, which prohibits an insurance payer from precluding a participating dentist from billing a covered person for a covered service if the dentist notifies the covered person prior to the service that the dentist may not be paid by the payer, provides the covered person with benefits and material cost differences for suitable alternatives to the covered service, obtains consent, and accepts as payment the amount the dentist would have accepted from the payer under the covered person’s plan.
Health Insurance Coverage for Hearing Aids and Cochlear Implants for Those 21 Years Old and Younger
New Jersey approved Bill S2535 to require health insurance payers in the state to cover hearing aids and cochlear implants for young adults and children aged 21 years old and younger. The bill allows a coverage limit of a hearing aid for up to $2,500 per hearing aid for each hearing-impaired ear every 60 months. Payors must also provide coverage for the cost of treatments related to cochlear implants, such as implantation procedures and replacements.
Ensuring Transparency in Prior Authorization Act
Approved Bill A1255 aims to simplify the prior authorization process for healthcare services and updates the requirements and standards under the Ensuring Transparency in Prior Authorization Act (the Act). Under the Act, a payer is required to provide, in a clear and conspicuous manner, information about the process of prior authorization on their website. The payer must use easily understandable language and describe its processing and payment of claims in detail. Additionally, the Act attempts to streamline requests by requiring payers to respond to all requests upon submission of all necessary information, to respond to urgent pharmacy requests within 24 hours, and to respond to non-urgent requests within 72 hours. It extends prior authorization time frames for treatment of long-term care or chronic conditions, and denial or limitation of a prior authorization request must be made by a physician of the same specialty as the physician who typically manages the medical condition.
The Act takes effect on January 1, 2025.
In-Home Healthcare Professionals to Complete Implicit Bias Training
New Jersey approved Bill A5516 supplements Title 45 of the Revised Statutes and requires a homemaker-home health aide and any other healthcare professional certified or licensed under Title 45 who provides in-home healthcare services to complete implicit bias training. These individuals must receive at least one credit of continuing education in cultural competency and implicit bias at least one year following the effective date of the bill and then every two years thereafter.
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