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  • NJ A1811
  • Requires insurers, Medicaid, and NJ FamilyCare to reimburse for childhood immunizations at levels specified by regulation.
Introduced
(1/27/2016)
In Committee
(1/27/2016)
Crossed OverPassedSignedDead/Failed/Vetoed
2016-2017 Regular Session
This bill amends P.L.1995, c.316 (C.17:48E-35.10 et al.), the statute that requires health insurers to cover all childhood immunizations as recommended by the Advisory Committee on Immunization Practices of the United States Public Health Service and the Department of Health and Senior Services, to ensure appropriate reimbursement to health care providers that adequately covers their costs incurred in providing these immunizations, which are critical to the health of New Jersey children. The bill directs the Commissioner of Health and Senior Services, in consultation with the Commissioner of Banking and Insurance, to specify by regulation the minimum level at which a health insurer is to reimburse a health care provider for childhood immunizations provided for under P.L.1995, c.316. The reimbursement is to reflect the reasonable costs to a health care provider, as determined by the Commissioner of Health and Senior Services, of acquiring, maintaining, and administering the childhood immunizations. The reimbursement is to be determined by the Commissioner of Health and Senior Services after consultation with appropriate entities, including, but not limited to, the Medical Society of New Jersey, the American Academy of Pediatrics - New Jersey Chapter, and the New Jersey Academy of Family Physicians. The reimbursement is to be periodically updated as determined appropriate by the Commissioner of Health and Senior Services. The commissioners are also directed to specify by regulation a civil penalty to which a health insurer that fails to comply with the requirements adopted by regulation pursuant to this bill is to be liable, which will not exceed $1,000 for the first violation, $5,000 for the second violation, and $10,000 for the third and each subsequent violation, and is to be collected by the Commissioner of Health and Senior Services or the Commissioner of Banking and Insurance in the name of the State in a summary proceeding in accordance with the "Penalty Enforcement Law of 1999." The commissioners are also to specify by regulation a form and manner by which a health care provider that administers childhood immunizations provided for under P.L.1995, c.316 may register a complaint concerning reimbursement for childhood immunizations by a health insurer that is not in compliance with requirements established by regulation pursuant to this bill. The bill also mandates that HMOs participating in Medicaid and NJ FamilyCare reimburse health care providers who administer childhood immunizations at a level specified by regulation of the Commissioner of Human Services in a manner such as that provided for other health insurers under the bill, and provides the same civil penalties for noncompliance. The bill takes effect on the 180th day after enactment, but authorizes the Commissioners of Health and Senior Services, Banking and Insurance, and Human Services to take anticipatory administrative action in advance as necessary for its implementation.
Health and Senior Services
Introduced, Referred to Assembly Health and Senior Services Committee  (on 1/27/2016)
 
 
Date Chamber Action Description
1/27/2016 A Introduced, Referred to Assembly Health and Senior Services Committee
Date Motion Yea Nay Other
None specified