Requires health benefits coverage for private duty nursing services.
Impact
If enacted, S1131 would significantly affect state health law by mandating that multiple types of health benefit plans—including individual, group, and small employer plans—cover expenses related to private duty nursing services. This change is expected to expand access to necessary healthcare services, potentially benefiting elderly individuals, those with disabilities, and patients recovering from significant illnesses. Insurance providers will have to adjust their contracts accordingly, ensuring compliance with this new requirement, which will likely enhance the financial security of many families relying on home healthcare.
Summary
Senate Bill S1131 aims to require health insurers in New Jersey to provide coverage for private duty nursing services. This legislation defines private duty nursing services as those that are given to individuals needing greater levels of care than what a visiting nurse or standard hospital staff can provide. These services must be carried out by registered or licensed practical nurses under the supervision of a physician, and they can take place in various settings including the patient's home, hospitals, or skilled nursing facilities. The intent of the bill is to ensure that individuals who require continuous care can access necessary nursing services without prohibitive costs that are otherwise not covered by their health insurance plans.
Contention
Notably, the bill does not restrict health insurers from implementing prior authorization requirements or stipulating similar cost-sharing measures, such as deductibles and coinsurance, that apply to other similar services. This provision could be a point of contention, as stakeholders may argue about the implications for accessibility and the cost burden on patients and their families. Advocates for the bill might argue that it creates necessary protections for vulnerable populations, while opponents may express concerns about possible loopholes that could limit patient access to these critical services.
Requires Medicaid provide health benefits coverage, and places certain requirements on insurers and State Health Benefits Program regarding existing mandate on health benefits coverage, for certain over-the-counter contraceptives.
Requires health insurance carriers to provide coverage for epinephrine auto-injector devices and asthma inhalers; limits cost sharing for health insurance coverage of insulin.
Requires health insurance carriers to provide coverage for epinephrine auto-injector devices and asthma inhalers; limits cost sharing for health insurance coverage of insulin.
Relating to the administration of and efficiency, cost-saving, fraud prevention, and funding measures for certain health and human services and health benefits programs, including the medical assistance and child health plan programs.
Requires Medicaid coverage for continuous glucose monitors and related supplies for individuals diagnosed with diabetes who meet certain coverage eligibility criteria.