Bill
Bill > A5288
NJ A5288
NJ A5288Prohibits health insurance carriers from placing time limit on anesthesia services used for medical or surgical procedures.
summary
Introduced
02/10/2025
02/10/2025
In Committee
02/10/2025
02/10/2025
Crossed Over
Passed
Dead
Introduced Session
2024-2025 Regular Session
Bill Summary
This bill prohibits health insurance carriers from placing a time limit on anesthesia services used for medical or surgical procedures. Under the bill, a carrier is not to limit coverage based on the amount of time in which anesthesia services are provided before, during, or after a medical or surgical procedure. The bill also bars a carrier from excluding anesthesia time from anesthesia services. Additionally, under the bill, coverage for anesthesia services will be based on a formula that is the sum of base units and time units multiplied by a conversion factor that is determined in each individual network agreement between an anesthesiologist or nurse anesthetist and a carrier. "Anesthesia services" is defined in the bill to mean the same as the prevailing medical coding standards found within the American Medical Association's Current Procedural Terminology code for anesthesia, including anesthesia modifier codes. "Anesthesia time" is defined as the period of time during which a licensed anesthesiologist or nurse anesthetist is present with the patient and providing anesthesia services before, during, or after a medical or surgical procedure. When calculating the length of anesthesia time, a licensed anesthesiologist or nurse anesthetist may combine blocks of time around an interruption in anesthesia time, provided that the anesthesiologist or nurse anesthetist provides continuous anesthesia services within the time periods around the interruption.
AI Summary
This bill prohibits health insurance carriers in New Jersey from imposing time limits on anesthesia services during medical or surgical procedures. The legislation aims to prevent insurance companies from denying coverage based on the duration of anesthesia, recognizing that surgical complexities, complications, and training needs can extend anesthesia time. The bill defines key terms such as "anesthesia services" (using standard medical coding like Current Procedural Terminology codes) and "anesthesia time" (the period an anesthesiologist or nurse anesthetist is providing care). It mandates that coverage for anesthesia services will be calculated using a formula combining base units and time units, multiplied by a conversion factor negotiated between the anesthesia provider and the insurance carrier. The legislation applies to various types of health insurance carriers and allows providers to combine time blocks around brief interruptions in anesthesia care. The bill's underlying rationale is to protect patient health and safety by ensuring comprehensive anesthesia coverage without arbitrary time restrictions, recognizing that surgical procedures can vary significantly in complexity and duration. The act will take effect 90 days after enactment and will apply to new and renewed insurance policies from that date.
Committee Categories
Business and Industry
Sponsors (1)
Last Action
Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 02/10/2025)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.njleg.state.nj.us/bill-search/2024/A5288 |
| BillText | https://pub.njleg.gov/Bills/2024/A5500/5288_I1.HTM |
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