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  • NJ A4334
  • Requires alternative payment models to register with DOH; permits health care practitioners to refer patients to health care service in which the practitioner has beneficial interest when related to alternative payment model.
Introduced
(11/21/2016)
In Committee
(12/5/2016)
Crossed Over
(3/23/2017)
Passed
(5/25/2017)
Signed
(7/13/2017)
Dead/Failed/Vetoed
2016-2017 Regular Session
This bill requires alternative payment models to register with the Department of Health (DOH), and permits a health care practitioner to refer patients to a health care service in which the practitioner has beneficial interest when the referral is related to the alternative payment model. Current law prohibits a health care practitioner from referring, or directing an employee to refer, a patient to a health care service in which the practitioner or an immediate family member has a significant beneficial interest, with limited exceptions. This bill would create an additional exception for referrals made within the context of an alternative payment model that is registered with and approved by the DOH. To qualify for an exception, the participants in the alternative payment model must make a bona fide determination that the significant beneficial interest is reasonably related to the alternative payment model standards filed with the DOH, and must document the determination and retain the documentation for a period of 10 years. Under the bill, participants desiring to establish an alternative payment model must submit to the DOH, in a form and manner established by the DOH, an application package to operate an alternative payment model. The application must include: · a description of the alternative payment model, including the participants in the model and how the model satisfies the definition of an alternative payment model. "Alternative payment model" is defined as a model of payment for health care services operated by Medicare, Medicaid, or a health insurance carrier that: (1) has been filed with the DOH; (2) provides for payment for covered professional services earned by participating health care practitioners and health care services based on approved quality measures; and (3) requires an alternative payment entity to bear financial risk for monetary losses under the alternative payment model; is a medical home; or is an accountable care organization authorized by the federal Centers for Medicare & Medicaid Services. · a description of the organizational structure of the entity responsible for carrying out the alternative payment model, including information on the organizational role of the participants in the alternative payment model, and information regarding the compliance with laws and regulations concerning organized delivery systems; · the date on which the alternative payment model is proposed to begin operation; and · an explanation of how the alternative payment model satisfies the alternative payment model standards. "Alternative payment model standards" are defined as institutional and specialty-specific goals under an alternative payment model related to patient safety, use of approved quality measures, and any other applicable quality of care goals, and operational performance, which may incorporate specific patient management tasks, care redesign initiatives, and patient safety and quality of care objectives; and · other information reasonably requested by the DOH. The DOH would review the application, and must notify participants in no more than 60 days if the proposed alternative payment model does not meet the requirement of this act. The DOH would provide the participants with a reasonable opportunity to remedy any deficiencies in the alternative payment model proposal, and may terminate an alternative payment model that continues to fail to meet the requirements of this bill. An alternative payment model already approved by the federal government would be automatically deemed approved by DOH, and would be subject to no additional review. The DOH would review each registered alternative payment model at least once every six years to determine whether the participants in the alternative payment model have complied with this bill and other relevant State and federal laws and regulations, and whether the alternative payment model has resulted in a degradation of quality of health care provided to patients attributable to the alternative payment model. The DOH would have authority to revoke the registration of an alternative payment model if the department's review finds that the alternative payment model fails to comply with State or federal law, or if it results in a degradation of quality of patient care. An alternative payment model's registration would not expire or otherwise be terminated solely as a result of the DOH's failure to conduct a review.
2nd Reading in the Assembly, 2nd Reading in the Senate, Bills and Joint Resolutions Signed by the Governor, Health and Senior Services, Passed Assembly, Passed both Houses
Approved P.L.2017, c.111.  (on 7/13/2017)
 
 
Date Chamber Action Description
7/13/2017 S Approved P.L.2017, c.111.
5/25/2017 S Passed Senate (Passed Both Houses) (38-0)
5/25/2017 S Substituted for S2724 (2R)
5/1/2017 S Received in the Senate without Reference, 2nd Reading
3/23/2017 A Passed by the Assembly (74-0-0)
2/15/2017 A Assembly Floor Amendment Passed (Johnson)
12/5/2016 A Reported out of Assembly Committee, 2nd Reading
12/5/2016 Assembly Health and Senior Services Hearing (10:00 12/5/2016 Committee Room 11, 4th Floor)
11/21/2016 A Introduced, Referred to Assembly Health and Senior Services Committee
Date Motion Yea Nay Other
Detail 5/25/2017 Senate Floor: Third Reading - Final Passage 38 0 2
Detail 5/25/2017 Senate Floor: Substitute For S2724 (Voice Vote) 0 0 0
Detail 3/23/2017 Assembly Floor: Third Reading - Final Passage 74 0 6
Detail 12/5/2016 Assembly Health and Senior Services Committee: Reported Favorably 13 0 0