SENATE COMMERCE COMMITTEE

STATEMENT TO

SENATE, No. 3478

STATE OF NEW JERSEY

DATED:  MAY 15, 2023

      The Senate Commerce Committee reports favorably Senate Bill No. 3478.

This bill provides that a health benefits company that is managing, pursuant to a contract with a public employer, a health benefits program or plan 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 benefits company 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 benefits company 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 benefits company from insurers for claims submitted for provider services.

     As used in this bill, “medical home” means on-site physicians, nurses, and pharmacy and laboratory services, provided at no cost to employees, and their dependents, of the school district, 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.