Bill

Bill > A823


NJ A823

Requires health insurance carriers to provide coverage for persons 18 or younger with diagnosed complex medical needs.


summary

Introduced
01/14/2020
In Committee
01/14/2020
Crossed Over
Passed
Dead
01/11/2022

Introduced Session

2020-2021 Regular Session

Bill Summary

This bill requires health insurance carriers, including insurance companies, health service corporations, hospital service corporations, medical service corporations, or health maintenance organizations authorized to issue health benefits plans in New Jersey or any entity contracted to administer health benefits in connection with the State Health Benefits Program or School Employees' Health Benefits Program to provide coverage for persons 18 years of age or younger with diagnosed complex medical needs. The bill requires that the benefits be provided for expenses incurred in conducting medical services, procedures, or testing, nursing care, and the purchase of medical equipment or prescription drugs to persons 18 years of age or younger with diagnosed complex medical needs, provided the attending licensed health care provider determines it medically necessary. In addition, the bill requires that health insurance carriers and contracts for health benefits or prescription drug benefits purchased by the State Health Benefits Program and the School Employees' Health Benefits Program approve any benefit for a person 18 years of age or younger with diagnosed complex medical needs within three days of receipt of a letter from the attending licensed health care provider and shall not condition the payment of any benefit for a medical service, procedure, test, nursing care, or purchase of medical equipment or prescription drug upon any pre-approval or precertification of any kind if that medical service, procedure, test, nursing care, or purchase of medical equipment or prescription drug is otherwise covered under the health benefits plan and it has been prescribed by a licensed health care provider.

AI Summary

This bill requires health insurance carriers, including insurance companies, health service corporations, and health maintenance organizations, to provide coverage for persons 18 years of age or younger with diagnosed "complex medical needs." The bill defines "complex medical needs" as a diagnosis, treatment, or procedure with a high degree of outcome variation requiring specialized skills, or a condition that is emergent, persistent, substantially disabling, or life-threatening, requiring the use of anesthesia or interventions across various care domains. The bill also mandates that carriers approve any benefit for a person 18 or younger with complex medical needs within three days of receiving a letter from the attending healthcare provider and prohibits carriers from conditioning payment on pre-approval or precertification if the service or equipment is otherwise covered.

Committee Categories

Business and Industry

Sponsors (4)

Last Action

Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 01/14/2020)

bill text


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