Bill > A2144

Introduced Session

This bill requires the State Health Benefits Commission and the School Employees' Health Benefits Commission to initiate innovative pilot programs for both the delivery of advanced imaging services and elective surgical procedures to the employees and retirees, and their dependents, covered by the State Health Benefits Program and the School Employees' Health Benefits Program. The advanced imaging services would include magnetic resonance imaging, computed tomography, positron emission tomography scans, and services related to advanced imaging services. The elective surgical procedures would include hip replacement, knee replacement, laparoscopic sleeve gastrectomy, hysterectomy, rotator cuff repair, knee arthroscopy, hysteroscopy, and other elective surgical procedures. Each commission would initiate the pilot programs by awarding, in an expedited manner, a contract for an advanced imaging benefits manager and elective surgical procedure manager who would coordinate the delivery of advanced imaging services and elective surgical procedures, respectively. No employee or retiree, or a dependent, would be required to participate in the pilot programs. Participation would be voluntary. Each manager would be authorized to offer incentives to employees and retirees, and their dependents, if they choose to participate in the pilot programs. Such incentives may include a monetary award equal to a portion of the total savings realized by the program that covers the employee or retiree, or dependent, or such other incentives as approved by the commission. The advanced imaging services and elective surgical procedures to be coordinated by the manager would be performed at facilities that are under contract with the manager, but in which the manager has no ownership interest or profit-sharing arrangement. The contract for each manager may include provisions that compensate the manager based, in whole or in part, on a percentage of the total savings achieved by the program. Each manager would be required to provide claims data and other reports in compliance with applicable State and federal laws to document: the cost and nature of both advanced imaging and elective surgical procedure claims incurred through the pilot programs; the nature and results of incentives under the pilot programs; demographic information on the covered population; emerging utilization and demographic trends relating to advanced imaging services and elective surgical procedures; health care outcomes; and such other information as may be appropriate and requested by the commissions to assist in the governance of the programs.

AI Summary

Committee Categories

Lisa Swain (D)*,  Chris Tully (D)*, 

Introduced, Referred to Assembly Health Committee (on 01/14/2020)

Official Document