Bill > A943

Introduced Session

This bill provides that a health care provider that is managing a medical home, pursuant to a contract with a public employer, for its employees and their dependents, who are covered by the employer's health benefits program or plan may: (a) provide a credit to the public employer toward the cost of the contract awarded to the health care provider to manage a medical home model for health care services for the public employees and their dependents; and (b) refer covered employees and their dependents, who receive services through the medical home model to other providers with whom the health care provider has a contractual relationship. If provided, the amount of the credit permitted toward the cost of the contract must not exceed the amount of the payments received by the health care provider from the health care benefits program or plan for claims submitted for provider services. Nothing in this bill will preclude the provider from billing the health benefits program or plan on a fee-for-service basis when such payments by the health benefits program or plan are used to apply a credit toward the cost of the contract. As used in this bill, "medical home" means on-site physicians, nurses, and pharmacy and laboratory services, provided at no cost to public employees, and their dependents, when the medical staff receive salaries and services are not provided on a fee-for-service basis and when primary care, care coordination through the use of health information technology and chronic disease registries, and referrals for specialist care are provided. The provisions of this bill will apply retroactively to July 1, 2022.

AI Summary

Committee Categories

Roy Freiman (D)*,  Carol Murphy (D)*, 

Withdrawn Because Approved P.L.2023, c.225. (on 01/09/2024)

Official Document