Sponsored by:
Assemblywoman SHANIQUE SPEIGHT
District 29 (Essex)
SYNOPSIS
Requires non-invasive prenatal testing for pregnant persons and health insurance coverage for non-invasive prenatal testing.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning prenatal testing for pregnant persons and health benefits coverage for prenatal testing, and supplementing Titles 17, 26, 30, and 52 of the Revised Statutes and Title 17B of the New Jersey Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. A hospital service corporation which provides hospital or medical expense benefits under a contract that is delivered, issued, executed, or renewed in this State or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide benefits under the contract for expenses incurred in conducting a non-invasive prenatal test for a pregnant person. The methods of testing for which benefits shall be provided shall include the most reliable, medically recognized screening test available. The method and frequency of testing to be utilized shall be in accordance with the most recent published guidelines of the American College of Obstetricians and Gynecologists.
The benefits shall be provided to the same extent as for any other medical condition under the contract.
As used in this section, “non-invasive prenatal test” means a blood test performed beginning at ten weeks of pregnancy that is used to screen for Down syndrome and other chromosomal abnormalities.
This section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
2. A medical service corporation which provides hospital or medical expense benefits under a contract that is delivered, issued, executed, or renewed in this State or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide benefits under the contract for expenses incurred in conducting a non-invasive prenatal test for a pregnant person. The methods of testing for which benefits shall be provided shall include the most reliable, medically recognized screening test available. The method and frequency of testing to be utilized shall be in accordance with the most recent published guidelines of the American College of Obstetricians and Gynecologists.
The benefits shall be provided to the same extent as for any other medical condition under the contract.
As used in this section, “non-invasive prenatal test” means a blood test performed beginning at ten weeks of pregnancy that is used to screen for Down syndrome and other chromosomal abnormalities.
This section shall apply to those medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
3. A health service corporation which provides hospital or medical expense benefits under a contract that is delivered, issued, executed, or renewed in this State or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide benefits under the contract for expenses incurred in conducting a non-invasive prenatal test for a pregnant person. The methods of testing for which benefits shall be provided shall include the most reliable, medically recognized screening test available. The method and frequency of testing to be utilized shall be in accordance with the most recent published guidelines of the American College of Obstetricians and Gynecologists.
The benefits shall be provided to the same extent as for any other medical condition under the contract.
As used in this section, “non-invasive prenatal test” means a blood test performed beginning at ten weeks of pregnancy that is used to screen for Down syndrome and other chromosomal abnormalities.
This section shall apply to those health service corporation contracts in which the health service corporation has reserved the right to change the premium.
4. An individual health insurer which provides hospital or medical expense benefits under a policy that is delivered, issued, executed, or renewed in this State or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide benefits under the contract for expenses incurred in conducting a non-invasive prenatal test for a pregnant person. The methods of testing for which benefits shall be provided shall include the most reliable, medically recognized screening test available. The method and frequency of testing to be utilized shall be in accordance with the most recent published guidelines of the American College of Obstetricians and Gynecologists.
The benefits shall be provided to the same extent as for any other medical condition under the contract.
As used in this section, “non-invasive prenatal test” means a blood test performed beginning at ten weeks of pregnancy that is used to screen for Down syndrome and other chromosomal abnormalities.
This section shall apply to
those policies in which the insurer has reserved the right to change the premium.
5. A group health insurer which provides hospital or medical expense benefits under a policy that is delivered, issued, executed, or renewed in this State or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide benefits under the contract for expenses incurred in conducting a non-invasive prenatal test for a pregnant person. The methods of testing for which benefits shall be provided shall include the most reliable, medically recognized screening test available. The method and frequency of testing to be utilized shall be in accordance with the most recent published guidelines of the American College of Obstetricians and Gynecologists.
The benefits shall be provided to the same extent as for any other medical condition under the contract.
As used in this section, “non-invasive prenatal test” means a blood test performed beginning at ten weeks of pregnancy that is used to screen for Down syndrome and other chromosomal abnormalities.
This section shall apply to those policies in which the insurer has reserved the right to change the premium.
6. A certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued on or after the effective date of this act by the Commissioner of Banking and Insurance unless the health maintenance organization provides health care services in conducting a non-invasive prenatal test for a pregnant person. The methods of testing for which benefits shall be provided shall include the most reliable, medically recognized screening test available. The method and frequency of testing to be utilized shall be in accordance with the most recent published guidelines of the American College of Obstetricians and Gynecologists.
The health care services shall be provided to the same extent as for any other medical condition under the contract.
As used in this section, “non-invasive prenatal test” means a blood test performed beginning at ten weeks of pregnancy that is used to screen for Down syndrome and other chromosomal abnormalities.
The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the health maintenance organization has reserved the right to change the schedule of charges for enrollee coverage.
7. Notwithstanding any other provision of law to the contrary, an individual health benefits plan that is delivered, issued, executed, renewed, or approved for issuance or renewal in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide benefits under the contract for expenses incurred in conducting a non-invasive prenatal test for a pregnant person. The methods of testing for which benefits shall be provided shall include the most reliable, medically recognized screening test available. The method and frequency of testing to be utilized shall be in accordance with the most recent published guidelines of the American College of Obstetricians and Gynecologists.
The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.
As used in this section, “non-invasive prenatal test” means a blood test performed beginning at ten weeks of pregnancy that is used to screen for Down syndrome and other chromosomal abnormalities.
This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
8. A small employer health benefits plan that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), on or after the effective date of this act, shall provide benefits under the contract for expenses incurred in conducting a non-invasive prenatal test for a pregnant person. The methods of testing for which benefits shall be provided shall include the most reliable, medically recognized screening test available. The method and frequency of testing to be utilized shall be in accordance with the most recent published guidelines of the American College of Obstetricians and Gynecologists.
The benefits shall be provided to the same extent as for any other condition under the health benefits plan.
As used in this section, “non-invasive prenatal test” means a blood test performed beginning at ten weeks of pregnancy that is used to screen for Down syndrome and other chromosomal abnormalities.
This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
9. Notwithstanding any other provision of law to the contrary, the State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide benefits under the contract for expenses incurred in conducting a non-invasive prenatal test for a pregnant person. The methods of testing for which benefits shall be provided shall include the most reliable, medically recognized screening test available. The method and frequency of testing to be utilized shall be in accordance with the most recent published guidelines of the American College of Obstetricians and Gynecologists.
The benefits shall be provided to the same extent as for any other medical condition under the contract.
As used in this section, “non-invasive prenatal test” means a blood test performed beginning at ten weeks of pregnancy that is used to screen for Down syndrome and other chromosomal abnormalities.
10. The School Employees’ Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide benefits under the contract for expenses incurred for in conducting a non-invasive prenatal test for a pregnant person. The methods of testing for which benefits shall be provided shall include the most reliable, medically recognized screening test available. The method and frequency of testing to be utilized shall be in accordance with the most recent published guidelines of the American College of Obstetricians and Gynecologists.
The benefits shall be provided to the same extent as for any other medical condition under the contract.
As used in this section, “non-invasive prenatal test” means a blood test performed beginning at ten weeks of pregnancy that is used to screen for Down syndrome and other chromosomal abnormalities.
11. a. Notwithstanding any State law or regulation to the contrary, the Department of Human Services shall, contingent on maintaining or receiving necessary federal approvals, ensure that expenses incurred for services in conducting a non-invasive prenatal test for a pregnant person shall be provided with no cost-sharing to eligible persons under the Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.). The methods of testing for which benefits shall be provided shall include the most reliable, medically recognized screening test available. The method and frequency of testing to be utilized shall be in accordance with the most recent published guidelines of the American College of Obstetricians and Gynecologists.
The benefits shall be provided to the same extent as for any other medical condition under the contract.
As used in this section, “non-invasive prenatal test” means a blood test performed beginning at ten weeks of pregnancy that is used to screen for Down syndrome and other chromosomal abnormalities.
b. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this section and to secure federal financial participation for State expenditures under the federal Medicaid program
12. a. As used in this section, “non-invasive prenatal test” means a blood test performed beginning at ten weeks of pregnancy that is used to screen for Down syndrome and other chromosomal abnormalities.
b. The Commissioner of Health shall require every hospital in the State, every birthing center licensed in the State pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.), every federally qualified health center, and every physician or health care practitioner in the State providing care to a pregnant person, to administer to every pregnant person a non-invasive prenatal test. The testing shall be based on industry best practices and guidance, as determined by the American College of Obstetricians and Gynecologists or another nationally-recognized body as may be designated by the commissioner.
c. A hospital in the State, a birthing center, or a federally qualified health center providing care to, and a physician or health care practitioner who is the primary caregiver for a pregnant person, shall, in accordance with guidelines developed by the commissioner:
(1) provide the person with information on Downs syndrome and other chromosomal abnormalities and the risk factors associated with such abnormalities through the educational program developed pursuant subsection e. of this section;
(2) inform the person of the benefits of undergoing non-invasive prenatal testing, and that the person is required to be tested unless the person issues a written refusal to be tested, which refusal shall be provided on a form and in a manner prescribed by the commissioner consistent with the provisions of subsection d. of this section; and
(3) perform a non-invasive prenatal test unless the person provides written refusal as provided in paragraph (2) of this subsection. The person shall, on the same form and in a manner prescribed by the commissioner consistent with subsection d. of this section, acknowledge receipt of the information provided by the hospital, birthing center, federally qualified health center, physician, or health care practitioner, as applicable, regarding the benefits of undergoing non-invasive prenatal testing.
d. The commissioner shall develop a standardized form to be used for the purposes of providing the acknowledgement required pursuant to paragraph (3) of subsection c. of this section, which may also be used to provide written refusal to undergo non-invasive prenatal testing pursuant to paragraph (2) of subsection c. of this section, if applicable.
e. The commissioner shall develop, in consultation with the New Jersey Perinatal Associates and any other community-based organization as may be designated by the commissioner, a non-invasive prenatal testing educational program for pregnant persons. The educational program shall include information on Downs syndrome and other chromosomal abnormalities and the risk factors associated with such abnormalities.
f. Upon receipt of the results of the non-invasive prenatal test conducted pursuant to subsection b. of this section, the hospital, licensed birthing center, federally qualified health center, or physician or health care practitioner, as applicable, shall discuss the results with the person and, if the person receives a positive test result, make a referral to a genetic counselor for further consultation.
13. The Commissioner of Health, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations to effectuate the purposes of section 12 of P.L., c. (C. ) (pending before the Legislature as this bill).
14. This act shall take effect on the first day of the fourth month next following the date of enactment. Sections 1 through 11 of this act shall apply to all contracts and policies that are delivered, issued, executed, or renewed or approved for issuance or renewal in this State on or after the effective date.
STATEMENT
This bill directs the Commissioner of Health to require every hospital in the State, every birthing center licensed in the State pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.), every federally qualified health center, and every physician or health care practitioner in the State providing care to a pregnant person, to administer to every pregnant person a non-invasive prenatal test.. As defined in the bill, “non-invasive prenatal test” means a blood test performed beginning at ten weeks of pregnancy that is used to screen for Down syndrome and other chromosomal abnormalities.
Under the bill’s provisions, the testing is to be based on industry best practices and guidance, as determined by the American College of Obstetricians and Gynecologists or another nationally-recognized body designated by the commissioner.
A hospital, licensed birthing center, or federally qualified health center providing care to, or a physician or other health care practitioner who is the primary caregiver for, a pregnant person or a person, would, in accordance with guidelines developed by the commissioner: (1) provide the person with information on Downs syndrome and other chromosomal abnormalities and the risk factors associated with such abnormalities based on an educational program developed by the commissioner; (2) inform the person of the benefits of undergoing non-invasive prenatal testing, and that the person is required to be tested, unless the person provides a written refusal to be tested; (3) and perform a non-invasive prenatal test unless the person provides written refusal to be tested. The person would be required to acknowledge receipt of the information provided by the hospital, birthing center, federally qualified health center, physician, or health care practitioner, as applicable, regarding the benefits of undergoing non-invasive prenatal testing.
The bill requires the commissioner to develop a standardized form to be used to acknowledge receipt of the information, which form may also be used to provide written refusal to undergo non-invasive prenatal testing. The commissioner will also be required to develop, in consultation with the New Jersey Perinatal Associates and any other community-based organization as may be designated by the commissioner, a non-invasive prenatal testing educational program for pregnant persons. The educational program would include information on Downs syndrome and other chromosomal abnormalities and the risk factors associated with such abnormalities.
Upon receipt of the results of a non-invasive prenatal test conducted pursuant to the provisions of the bill, the hospital, licensed birthing center, federally qualified health center, or physician or health care practitioner, as applicable, is to discuss the results with the person and, if the person receives a positive test result, make a referral to a genetic counselor for further consultation.
The bill also requires health insurers to cover the costs for conducting non-invasive prenatal tests for a pregnant person.
Specifically, certain health insurers (health, hospital, and medical service corporations, commercial individual and group health insurers, health maintenance organizations, the State Health Benefits Program, the School Employees’ Health Benefits Program, and the State Medicaid Program) are to provide health benefits coverage for expenses incurred expenses incurred in conducting a non-invasive prenatal test for a pregnant person.