New Jersey § 26:2j-4

§ 26:2j-4.

a. Notwithstanding any provision of law to the contrary, a certificate of authority

to establish and operate a health maintenance organization in this State shall not

be issued or continued by the Commissioner of Banking and Insurance on or after the

effective date of this act 1 unless the health maintenance organization provides health care services to any enrollee

for expenses incurred for services provided under the newborn home nurse visitation

program established pursuant to section 2 of P.L.2021, c. 187 ( C.26:2H-159 ). The benefits shall: (1) provide coverage for the services provided by the newborn home nurse visitation

program established pursuant to section 2 of P.L.2021, c. 187 ( C.26:2H-159 ); (2) notify a covered person of the services provided by the newborn home nurse visitation

program, upon application by the covered person for coverage of a newborn infant; (3) ensure that the plan does not contain any provision that requires a covered person

to receive the services provided by the newborn home nurse visitation program as a

condition of coverage, or that denies or limits benefits to the covered person if

that person declines the services provided under the program; and (4) have the discretion to determine how best to reimburse for the expenses incurred

for services provided under the newborn home nurse visitation program, including,

but not limited to, utilizing: (a) a value-based payment methodology; (b) an invoice claim process; (c) a capitated payment arrangement; (d) a payment methodology that takes into account the need for an agency or organization

providing services under the program to expand its capacity to provide services and

address health disparities; or (e) any other payment arrangement agreed to by the carrier and an agency or organization

providing services under the program. b. Any copayment, coinsurance, or deductible that may be required pursuant to the

health benefits plan for such services shall be waived. c. Every health maintenance organization that is subject to the provisions of this

section shall submit to the Department of Banking and Insurance, in a form and manner

prescribed by the department, a report on the claims submitted for services provided

under the newborn home nurse visitation program. The information contained in the report shall be shared with the Department of Children

and Families and used by that department to assess the newborn home nurse visitation

program pursuant to subsection a. of section 4 of P.L.2021, c. 187 ( C.26:2H-161 ). d. (1) Except as provided in paragraphs (2) and (3) of this subsection, the contract

shall specify that no deductible, coinsurance, copayment, or any other cost-sharing

requirement may be imposed on the coverage required pursuant to this section. (2) A contract offered by a health maintenance organization that qualifies as a high

deductible health plan shall provide benefits for expenses incurred for services provided

under the newborn home nurse visitation program established pursuant to section 2

of P.L.2021, c. 187 ( C.26:2H-159 ) at the lowest deductible and other cost-sharing requirement permitted for a high

deductible health plan under section 223(c)(2)(A) of the Internal Revenue Code ( 26 U.S.C. s.223 ). (3) A contract offered by a health maintenance organization that meets the requirements

of a catastrophic plan, as defined in 45 C.F.R. s.156.155 , shall provide benefits for expenses incurred for services provided under the newborn

home nurse visitation program established pursuant to section 2 of P.L.2021, c. 187 ( C.26:2H-159 ) at the lowest deductible and other cost-sharing requirement to the extent permitted

for a catastrophic plan under federal law. e. The benefits shall be provided to the same extent as for any other medical condition

under the contract. 1

L.2021, c. 187, eff. July 29, 2021.