Health Affairs Legislative and Regulatory Update July 2016

Out-of-Network healthcare costs for “surprise” medical bills

June was a busy month in Trenton and out-of-network healthcare costs became a hot topic of discussion.  There was renewed activity on June 20th when A-1952 was released by the Assembly Financial Institutions and Insurance committee.  Unfortunately, the bill was not considered by the full Assembly or by the Senate.

Legislation to address these ever-increasing costs is necessary not only for employers, employees and all consumers, but also for the State to realize savings in the public employee health benefits plans.

Since no legislation on controlling out-of-network costs moved forward, and the State Budget did not identify specific healthcare cost savings, the Governor issued Executive Order No. 209, freezing approximately $100 million in funding for social services programs and transitional aid to cities.  The funds cannot be spent until the two public employee health benefits plan design committees take action to cut healthcare costs.  You can view Executive Order No. 209 and the list of frozen funding here.

Small Employer Health Plan Regulations

The rules for the Small Employer Health Benefits Program (SEH) will expire next month on August 16th, and the rule proposal was posted July 7^th on the SEH website.

There is a 45-day comment period – until August 22^nd – and by posting the proposal on July 7^th, the expiration date is extended for 180 days.

Proposed changes to definitions in N.J.A.C. 11:21-1.2 will delete the term “eligible employee,” and amend the definition of “employee” and “small employer” to better align the SEH rules with the federal Affordable Care Act.  A detailed explanation of all the proposed changes is included in the rule summary, pages 2–27.

The Department of Banking and Insurance (DOBI) has regulatory authority for certain SEH rules, which also expire on August 16^th.  DOBI has asked for stakeholder input by July 12^th to their proposed changes, and will issue a formal rule proposal with a public comment period after review of any submitted comments.  The synopsis of DOBI’s proposal can be viewed here.