Requires SHBP and SEHBP to implement referenced based pricing program and bundled payment program.
Impact
If passed, A1249 would have substantial implications for how healthcare benefits are managed for public employees and retirees. The referenced-based pricing program would link reimbursement rates for specialized medical procedures to an external benchmark, potentially reducing costs for the state and employees. The bundled payment program would allow for a single negotiated payment for all services during a patient's treatment episode, promoting efficiency and quality of care while controlling spending. These changes would amend existing laws related to healthcare administration for public sector workers, aiming for a more streamlined process.
Summary
A1249 aims to implement two healthcare programs for public employees and retirees in New Jersey: a referenced-based pricing program and a bundled payment program. The bill mandates that the State Health Benefits Commission (SHBP) and the School Employees' Health Benefits Commission (SEHBP) adopt these programs, which are designed to optimize healthcare costs and payment structures for elective medical procedures. This approach stems from a need to contain healthcare expenditure while ensuring quality services for state employees, thereby responding to the rising costs of healthcare benefits within public employee insurance schemes.
Contention
Debate around A1249 is likely to center on concerns regarding the adequacy of care under new payment structures. Critics may argue that referenced pricing could lead to limitations on available services, with providers potentially declining to accept lower payments deemed reasonable under the new system. Additionally, the bundled payment approach, while efficient, raises questions about its impact on complex cases requiring multiple interventions, which may challenge traditional fee-for-service models. Advocates for the bill, however, posit that these initiatives will lead to more sustainable and equitable healthcare access for public workers.
Permits SHBP and SEHBP to award contracts for more claims administrators for each program plan; requires claims data and trend reports to be provided to certain persons.
Provides SHBP and SEHBP to award contracts for more claims administrators for each program plan; requires claims data and trend reports to be provided to certain persons.