New Jersey Senate Bill S1976

New Jersey 2024-2025 Regular Session

• Introduced: 1/9/24
• Refer: 1/9/24

Caption

Requires study and implementation of reference-based pricing for SHBP and SEHBP.

Impact

If enacted, S1976 would require a comprehensive review to evaluate the potential costs and savings associated with implementing reference-based pricing. It mandates that the commissions assess how this pricing model could affect higher-cost medical services such as radiology and specialty care. The reviews will also consider the impact of previous implementations in other jurisdictions, thereby ensuring that decisions are informed by data and trends from places where reference-based pricing has already been enacted. This move is expected to potentially reduce overall healthcare expenditures for state programs.

Summary

Senate Bill 1976 aims to direct the State Health Benefits Commission and the School Employees' Health Benefits Commission to study and implement reference-based pricing for healthcare benefits within the State Health Benefits Program (SHBP) and School Employees' Health Benefits Program (SEHBP). The intention behind this bill is to create a more structured pricing system for medical services, referencing Medicare rates to establish reimbursement levels. This initiative seeks to control healthcare costs while maintaining service quality for state employees and school personnel.

Contention

Notably, the bill has sparked discussion around its implications for healthcare providers and patients' access to services. Supporters argue that it could lead to a more normalized pricing structure that could benefit taxpayers and the state budget. However, there are concerns about the possible adverse effects on provider participation in these programs at the established reimbursement levels. Critics suggest that limiting reimbursement rates may discourage providers from offering services covered under these programs, ultimately affecting the availability of care for participants.