Bill > S4218

Introduced Session

This bill, the "New Jersey Public Option Health Care Act," creates the New Jersey Public Option Health Care Program in the Department of Health. The bill requires the Commissioner of Health, in consultation with the Commissioner of Banking and Insurance, to establish and implement the program, which will provide a comprehensive health insurance coverage option to every State resident who enrolls in the program. The health insurance coverage offered by the program shall compete in the market with insurance offered by private health insurers. The commissioner will determine when individuals may begin enrolling in the program. There shall be an implementation period, which shall begin on the date that individuals may begin enrolling in the program and shall end as determined by the commissioner. The bill creates the New Jersey Public Option Health Care Board to consider any matter to effectuate the provisions and purposes of the bill, and to advise the commissioner in that regard. The board shall be composed of the Commissioner of Health, the Commissioner of Banking and Insurance, and the Treasurer, or their designees, as ex officio members. In addition, the board will have 11 members to be appointed by the Governor: (1) three of whom shall be representatives of health care consumer advocacy organizations which have a Statewide or regional constituency, who have been involved in activities related to health care consumer advocacy, including issues of interest to low- and moderate-income individuals; (2) one of whom shall be a representative of professional organizations representing physicians; (3) one of whom shall be a representative of professional organizations representing licensed or registered health care professionals other than physicians; (4) two of whom shall be representatives of hospitals, and of those two, one of whom shall be a representative of public hospitals; (5) one of whom shall be a representative of community health centers; (6) one of whom shall be a representative of health care organizations; (7) one of whom shall be a representative of organized labor; and (8) one of whom shall have demonstrated expertise in health care finance; and The board will also include six members appointed by the Governor; two of whom to be appointed on the recommendation of the Speaker of the General Assembly; two of whom to be appointed on the recommendation of the President of the Senate; one of whom to be appointed on the recommendation of the Minority Leader of the General Assembly; and one of whom to be appointed on the recommendation of the Minority Leader of the Senate. Members will serve without compensation but will be reimbursed for their necessary and actual expenses incurred while engaged in the business of the board. Under the bill, every resident of the State will be eligible and entitled to enroll as a member under the program. The Commissioner of Health is to establish premiums for which members are responsible and other charges for enrolling in or being a member under the program. The premium shall be determined in a manner to make the program viable, but at the lowest possible cost to members. The bill provides that the program will provide comprehensive health coverage to every member. The commissioner will also determine premiums, deductibles, co-payments or co-insurance under the program. The commissioner is also required to establish and maintain procedures and standards for health care providers to be qualified to participate in the program, including but not limited to procedures and standards relating to the revocation, suspension, limitation, or annulment of qualification to participate on a determination that the health care provider is an incompetent provider of specific health care services or has exhibited a course of conduct which is either inconsistent with program standards and regulations or which exhibits an unwillingness to meet such standards and regulations, or is a potential threat to the public health or safety. Such procedures and standards shall not limit health care provider participation in the program for economic purposes and shall be consistent with good professional practice. Any health care provider who is qualified to participate under Medicaid, NJ FamilyCare or Medicare shall be deemed to be qualified to participate in the program, and any health care provider's revocation, suspension, limitation, or annulment of qualification to participate in any of those programs shall apply to the health care provider's qualification to participate in the program; provided that a health care provider qualified in this manner shall follow the procedures to become qualified under the program by the end of the implementation period. The program will engage in good faith negotiations with health care providers' representatives including, but not limited to, in relation to rates of payment and payment methodologies. Every participating provider is required to furnish to the program such information to, and permit examination of its records by, the program, as may be reasonably required for purposes of reviewing accessibility and utilization of health care services, quality assurance, and cost containment, the making of payments, and statistical or other studies of the operation of the program or for protection and promotion of public, environmental and occupational health. The bill specifies that the program will maintain the confidentiality of all data and other information collected under the program when such data would be normally considered confidential data between a patient and health care provider. Aggregate data of the program which is derived from confidential data but does not violate patient confidentiality will be public information. The bill provides that the commissioner shall seek all federal waivers and other federal approvals and arrangements and submit State plan amendments necessary to operate the program consistent with the bill and to maximize access to health care for residents of the State. The commissioner shall apply to the Secretary of Health and Human Services or other appropriate federal official for all waivers of requirements, and make other arrangements, under Medicare, any federally-matched public health program, the Affordable Care Act, and any other federal programs that provide federal funds for payment for health care services, that are necessary to enable all New Jersey Public Option Health Care Program members to receive all benefits under the program through the program and to enable the State to implement the provisions of the bill and to receive and deposit all federal payments under those programs, where appropriate, including funds that may be provided in lieu of premium tax credits, cost-sharing subsidies, and small business tax credits, in the State treasury to the credit of the New Jersey Public Option Health Care Trust Fund and to use those funds for the New Jersey Public Option Health Care Program and other provisions under the bill. The Commissioner will also directly, and through contracts with not-for-profit organizations, provide: (1) consumer assistance to individuals with respect to enrolling, obtaining health care services, disenrolling, and other matters relating to the program; and (2) health care provider assistance to health care providers providing and seeking or considering whether to provide, health care services under the program, with respect to participating in a health care organization and dealing with a health care organization. The bill establishes in the Department of the Treasury a nonlapsing revolving fund to be known as the "New Jersey Public Option Health Care Trust Fund." This fund shall be the repository for monies collected under the bill and other monies received as grants or otherwise appropriated for the purposes of the program. The monies in the fund shall be used only for the purpose of supporting the activities of the program and as otherwise provided for in the bill.

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Raj Mukherji (D)*, 

Introduced in the Senate, Referred to Senate Commerce Committee (on 03/03/2025)

Official Document