Newborn Insurance Coverage

A2665, a bill extending the time period in which newborns are covered under their parents’ health benefits coverage to 60 days after birth, was reported favorably out of the Assembly Financial Institutions and Insurance Committee on June 2. Current law limits the coverage of newborns to 30 days from their birth. At the conclusion of 30 days, the child is without coverage unless the parents enroll the child in a private health benefits coverage policy or in a state or federal program, such as FamilyCare. If enacted, the bill would provide an extended period of time for children to be covered under their parents’ health benefits coverage.

Electronic Health Records

A3831, a bill requiring each owner or administrator of an electronic health records system used to transmit electronic prescriptions in New Jersey to ensure that the system meets the federal requirements to accept, process and transmit prescriptions for Schedule II controlled dangerous substances, was reported favorably out of the Assembly Health and Senior Services Committee on June 2. Entities operating or administering a system on the effective date would have one year to meet this requirement as a condition of continuing to transmit electronic prescriptions in this state.

Medicaid Medication Therapy Management Requirement

A1443, a bill requiring the coverage of medication therapy management services in Medicaid and NJ FamilyCare, was reported favorably out of the Assembly Health and Senior Services Committee, with amendments, on June 2. The bill defines medication therapy management as the systematic process performed by a qualified provider that is designed to optimize therapeutic outcomes through improved medication use and reduced risk of adverse drug events, including:

  • a medication therapy review and consultation relating to all medications, vitamins and herbal supplements currently being taken by an individual;
  • a medication action plan communicated to the individual or the individual’s caretaker and the individual’s primary health care provider or other appropriate prescriber of medication to address safety issues, inconsistencies, duplicative therapy, omissions and medication costs; and
  • documentation and follow-up with the individual or the individual’s caretaker to ensure consistent levels of pharmacy services and positive outcomes, including any follow-up discussions with the individual’s primary health care provider or other appropriate prescriber as are needed to maintain or improve positive outcomes.

The bill requires the Medicaid and NJ FamilyCare programs to provide coverage for medication therapy management services for enrollees (1) who take one or more prescription drugs for any chronic medical condition, provided the participation standards mirror those for medication therapy management programs under the Medicare Part D program; (2) whose primary health care provider or other appropriate prescriber identifies the individual as having a prescription drug therapy problem and refers the individual to a qualified provider for medication therapy management; or (3) who meet other criteria established by the Commissioner of Human Services.

If enacted, the bill would require that medication therapy review and consultation be conducted at least once per plan or calendar year and be provided in person, unless an in-person review and consultation would present a physical hardship to the enrollee. Only licensed physicians, licensed advanced practice nurses, and registered pharmacies or pharmacists would be permitted to perform medication therapy review and consultation under the bill.

Nursing facilities, assisted-living facilities, assisted-living programs, comprehensive personal care homes, adult day health services facilities and pediatric medical day care facilities would be exempt from the requirement to provide medication therapy management.