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  • NJ A1933
  • Requires managed care plans, SHBP, and SEHBP to provide for reasonable accommodation in accessing providers for persons with physical disabilities.
Introduced
(1/27/2016)
In Committee
(6/16/2016)
Crossed Over
(3/14/2016)
PassedSignedDead/Failed/Vetoed
2016-2017 Regular Session
The purpose of this bill is to ensure that persons with physical disabilities, who have health insurance through a managed care plan, have reasonable access to primary care and specialist providers whose professional offices are accessible in accordance with the federal Americans with Disabilities Act of 1990 (ADA) standards for accessible design. The provisions of the bill apply to individual, small employer and larger employer health benefits plans, and plans issued by the State Health Benefits Program and the School Employees' Health Benefits Program. Specifically, the bill requires a carrier which offers a managed care plan to establish procedures to ensure that persons with physical disabilities have reasonable access to primary and specialty care providers whose professional offices are accessible to persons with physical disabilities in accordance with the ADA standards for accessible design published by the United States Department of Justice pursuant to 28 CFR Part 36. A carrier shall make a good faith effort to ensure reasonable access to such providers within the geographic access standards for network adequacy promulgated by the Department of Banking and Insurance by regulation, pursuant to the "Health Care Quality Act." Under the bill, the procedures must provide that if a covered person with a physical disability is unable to reasonably access an in-network primary or specialty care provider whose professional office is accessible to the covered person, the carrier shall arrange for a provider that is accessible, and if that provider is out-of-network, with the same financial responsibility as the covered person would incur if the provider was in-network. The carrier shall reimburse the accessible out-of-network provider for the covered service at the same rate as that which the carrier would pay to an in-network provider for the same service. The out-of-network provider shall accept the payment by the carrier as payment in full for the covered service and shall not balance bill the covered person for any amount in excess of the payment made by the carrier plus any required copayment or coinsurance. The bill similarly applies these requirements to managed care plan contracts purchased by the State Health Benefits Commission and the School Employees' Health Benefits Commission. The bill takes effect on the 180th day after enactment and applies to any health insurance contract or policy issued or renewed on or after that date.
2nd Reading in the Assembly, Budget and Appropriations, Financial Institutions and Insurance, Health, Human Services and Senior Citizens, Passed Assembly
Referred to Senate Budget and Appropriations Committee  (on 6/16/2016)
 
 

Date Chamber Action Description
6/16/2016 S Referred to Senate Budget and Appropriations Committee
6/16/2016 S Reported from Senate Committee, 2nd Reading
6/16/2016 Senate Health, Human Services and Senior Citizens Hearing (13:00 6/16/2016 Committee Room 1, 1st Floor)
4/21/2016 S Received in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee
3/14/2016 A Passed by the Assembly (63-11-1)
2/4/2016 A Reported out of Assembly Committee, 2nd Reading
2/4/2016 Assembly Financial Institutions and Insurance Hearing (10:00 2/4/2016 Committee Room 11, Fourth Floor)
1/27/2016 A Introduced, Referred to Assembly Financial Institutions and Insurance Committee
Date Motion Yea Nay Other
Detail 6/16/2016 Senate Health, Human Services and Senior Citizens Committee: Reported Favorably 7 2 0
Detail 3/14/2016 Assembly Floor: Third Reading - Final Passage 63 11 6
Detail 2/4/2016 Assembly Financial Institutions and Insurance Committee: Reported Favorably 10 0 3