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2009
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Chapter 115, P.L. 2009 This law requires health insurers to provide health benefits coverage for expenses incurred for medically necessary therapies for covered persons with autism and other developmental disabilities.
Chapter 113, P.L. 2009 This law provides that certain health benefits plans that include benefits for maternity services shall provide for reimbursement in installments to obstetrical providers licensed in New Jersey for maternity services rendered during the term of a covered person’s pregnancy. 
Chapter 85, P.L. 2009 This law changes the definition of compensation for certain State employees enrolled in the Public Employees’ Retirement System (PERS) or the Teachers’ Pension and Annuity Fund (TPAF) for the period of July 1, 2009 through June 30, 2011. This law provides that during this period, “contractual salary” for a State employee includes wage increases under a collective negotiations agreement notwithstanding that, by amendment to that collective negotiations agreement, the effective date of the contractual increase has been deferred. 
Chapter 23, P.L. 2009 This new law provides the same benefits to the survivors of an active member of the Police and Firemen's Retirement System (PFRS), the State Police Retirement System (SPRS), the Public Employees' Retirement System (PERS), or the Teachers' Pension and Annuity Fund (TPAF), who dies as a result of service in either the reserve component of the Armed Forces of the United States or the National Guard while on federal active duty as are currently provided to an active member of the respective retirement system, who dies as a result of an accident sustained in the actual performance of duty.
Chapter 19, P.L. 2009 This new law provides for an adjustment in the contributions that local employers must make to the Public Employees' Retirement System (PERS) and the Police and Firemen's Retirement System (PFRS) during State fiscal year 2009.
Chapter 126, P.L. 2008 The law, otherwise known as “Grace’s Law,” requires hospital, medical and health service corporations, commercial insurers, health maintenance organizations and health benefits plans contracted through the New Jersey Individual Health Coverage Program, New Jersey Small Employer Health Benefits Program, the State Health Benefits Program or the NJ FamilyCare Program to provide coverage for medically necessary hearing aids for children under the age of 16.

Links to the New Jersey Legislature and other legislature information.


Chapter 115, P.L. 2009

Date Approved: August 13, 2009.

Effective Date: February 9, 2010 (180 days after enactment).

Description:

This law requires health insurers to provide health benefits coverage for expenses incurred for medically necessary therapies for covered persons with autism and other developmental disabilities.

In addition to the State Health Benefits Program (see Section 9 of the law) and the School Employees’ Health Benefits Program (see Section 10 of the law), the provisions of this law apply to health, hospital and medical service corporations; commercial individual and group health insurers; health maintenance organizations; and health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs.

The insurer is to provide coverage for expenses incurred in screening and diagnosing autism or another developmental disability.  When the covered person’s diagnosis is autism or another developmental disability, the covered treatments are to include medically necessary occupational therapy, physical therapy, and speech therapy, as prescribed through a treatment plan; and coverage of these therapies is not to be denied on the basis that the treatment is not restorative.

When the covered person is under 21 years of age and the covered person's diagnosis is autism, the covered treatments are to include medically necessary behavioral interventions based on the principles of applied behavioral analysis and related structured behavioral programs, as prescribed through a treatment plan, subject to the provisions of this law. The benefits provided for behavioral interventions for a covered person under 21 years of age are to be provided to the same extent as for any other medical condition under the contract or policy, except as provided in this law, and are not to be subject to limits on the number of visits that a covered person may make to a provider of behavioral interventions; and are not to be denied on the basis that the treatment is not restorative.

With respect to benefits provided for behavioral interventions, the maximum benefit for a covered person in any calendar year through 2011 is $36,000.  Commencing on January 1, 2012, the maximum benefit amount will be subject to an adjustment, to be promulgated by the Commissioner of Banking and Insurance and published in the New Jersey Register no later than February 1 of each calendar year, which is equal to the change in the consumer price index for all urban consumers for the nation, as prepared by the United States Department of Labor, for the calendar year preceding the calendar year in which the adjustment to the maximum benefit amount is promulgated.  The adjusted maximum benefit amount will apply to a contract or policy that is delivered, issued, executed, or renewed, or approved for issuance or renewal, in the 12-month period following the date on which the adjustment is promulgated.  An insurer is not precluded from providing a benefit amount for a covered person in any calendar year that exceeds the benefit amounts set forth above.

The treatment plan required pursuant to this law is to include all elements necessary for the insurer to appropriately provide benefits, including, but not limited to a diagnosis; proposed treatment by type, frequency, and duration; the anticipated outcomes stated as goals; the frequency by which the treatment plan will be updated; and the treating physician’s signature.  The insurer may only request an updated treatment plan once every six months from the treating physician to review medical necessity, unless the insurer and the treating physician agree that a more frequent review is necessary due to emerging clinical circumstances.

The provisions of this law are not to be construed as limiting benefits otherwise available to a covered person.  The provisions of this law are also not to be construed to require that benefits be provided to reimburse the cost of services provided under an individualized family service plan or an individualized education program, or affect any requirement to provide those services; except that the required benefits do include coverage for expenses incurred by participants in an individualized family service plan through a family cost share.

The coverage required under this law may be subject to utilization review, including periodic review, by the health insurer of the continued medical necessity of the specified therapies and interventions.

The law takes effect on the 180th day after enactment.

To view the new law, click here:  Chapter 115, P.L. 2009 Adobe PDF (84K)

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Chapter 113, P.L. 2009

Date Approved: August 12, 2009.

Effective Date: First day of the thirteenth month next following enactment (September 1, 2010).

Description:

This law provides that certain health benefits plans that include benefits for maternity services shall provide for reimbursement in installments to obstetrical providers licensed in New Jersey for maternity services rendered during the term of a covered person’s pregnancy.  The law defines “obstetrical provider licensed in New Jersey” to mean: (1) an obstetrician/gynecologist licensed by the State Board of Medical Examiners; or (2) a midwife licensed by the State Board of Medical Examiners as a certified midwife or a certified nurse midwife.

Health benefits plans affected by the law include: contracts, policies or plans issued by health, hospital, and medical service corporations, commercial individual and group health insurers, and health maintenance organizations; and those plans issued or provided pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs, the State Health Benefits Program, and the School Employees’ Health Benefits Program.

To view the new law, click here:  Chapter 113, P.L. 2009 Adobe PDF (29K)

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Chapter 85, P.L. 2009

Date Approved: July 2, 2009.

Effective Date:  July 2, 2009.

Description:

This law changes the definition of compensation for certain State employees enrolled in the Public Employees’ Retirement System (PERS) or the Teachers’ Pension and Annuity Fund (TPAF).

Current law defines compensation as the base or contractual salary for services as an employee. This law would provide that, for the period of July 1, 2009 through June 30, 2011, “contractual salary” for a State employee would include wage increases under a collective negotiations agreement notwithstanding that, by amendment to that collective negotiations agreement, the effective date of the contractual increase has been deferred.

For the purpose of this law, “State employee” means an employee in the Executive Branch of State government.  The term excludes an employee of an autonomous authority, commission, entity, or instrumentality authorized to participate in the PERS.

To view the new law, click here:  Chapter 85, P.L. 2009 Adobe PDF (75K)

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Chapter 23, P.L. 2009

Date Approved: March 17, 2009.

Effective Date:  March 17, 2009, retroactive to June 1, 2008.

Description:

This new law provides the same benefits to the survivors of an active member of the Police and Firemen's Retirement System (PFRS), the State Police Retirement System (SPRS), the Public Employees' Retirement System (PERS), or the Teachers' Pension and Annuity Fund (TPAF), who dies as a result of service in either the reserve component of the Armed Forces of the United States or the National Guard while on federal active duty as are currently provided to an active member of the respective retirement system, who dies as a result of an accident sustained in the actual performance of duty.

The provisions of this new law are retroactive to June 1, 2008.

To view the new law, click here:  Chapter 23, P.L. 2009 Adobe PDF (38K)

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Chapter 19, P.L. 2009

Date Approved: March 17, 2009.

Effective Date:  March 17, 2009.

Description:

This new law provides for an adjustment in the contributions that local employers must make to the Public Employees' Retirement System (PERS) and the Police and Firemen's Retirement System (PFRS) during State fiscal year 2009.

Specifically, this law provides that the State Treasurer will reduce for local employers the normal and accrued liability contributions to 50 percent of the amount certified by the PERS and PFRS for payments due in State fiscal year 2009.

An employer that elects to pay the reduced normal and accrued liability contribution must adopt a resolution stating that the employer needs to pay the reduced contribution and providing an explanation of that need which must include (1) a description of its inability to meet the levy cap without jeopardizing public safety, health, and welfare or without jeopardizing the fiscal stability of the employer, or (2) a description of another condition that offsets the long term fiscal impact of the payment of the reduced contribution.  An employer also must document those actions it has taken to reduce its operating costs, or provide a description of relevant anticipated circumstances that could have an impact on revenues or expenditures.  This resolution must be submitted to and approved by the Local Finance Board after making a finding that these fiscal conditions are valid and affirming the findings contained in the employer resolution.

This law also provides that a local employer may pay 100 percent of the required contribution.  Such an employer will be credited with the full payment and any such amounts will not be included in their unfunded liability.

The actuaries for PERS and PFRS will determine the unfunded liability of those retirement systems, by employer, for the reduced normal and accrued liability contributions provided under this law. This unfunded liability will be paid by the employer in level annual payments over a period of 15 years beginning with the payments due in the State fiscal year ending June 30, 2012 and will be adjusted by the rate of return on the actuarial value of assets.

In the area of local budget law, it law provides that for the respective fiscal year during which a local public employers' pension contributions to the PERS and PFRS is reduced, and for the year thereafter when the employers would again be subject to the full contribution requirement, the affected contribution payments will be exempt from the limits imposed on increases to municipal appropriations set forth in N.J.S.A.40A:4-45.3, the local budget "cap" law, and to the county tax levy set forth in N.J.S.A.40A:4-45.4.  This law also amends current law concerning the calculation of the tax levy growth limitation for the purpose of an increase in the adjusted tax levy for a school district, and the exclusions added to the calculation for the adjusted tax levy for a local unit of government, to account for certain normal and accrued liability pension contribution increases.

Finally, the law requires the Director of the Division of Pensions and Benefits in the Department of the Treasury to report to the Governor and Legislature, within 180 days after its effective date, on the feasibility and consequences of creating individual employer accounts within the State-administered retirement systems.

To view the new law, click here:  Chapter 19, P.L. 2009 Adobe PDF (88K)

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Chapter 126, P.L. 2008

Date Approved: January 2, 2009.

Effective Date:  March 30, 2009.

Description:

The law, otherwise known as “Grace’s Law,” requires hospital, medical and health service corporations, commercial insurers, health maintenance organizations and health benefits plans contracted through the New Jersey Individual Health Coverage Program, New Jersey Small Employer Health Benefits Program, the State Health Benefits Program or the NJ FamilyCare Program to provide coverage for medically necessary hearing aids for children under the age of 16.

The law requires coverage for hearing aid purchases for each ear that are medically necessary and are prescribed or recommended by a licensed physician or audiologist.  The insurer may limit the benefit to $1,000 per hearing aid for each ear every 24 months.  The law allows a beneficiary to choose a hearing aid that is priced higher than the benefit payable under the law and pay the difference without financial or contractual penalty to the hearing aid provider.

To view the new law, click here:  Chapter 126, P.L. 2008 Adobe PDF (40K)

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Links to the New Jersey Legislature and other legislature information.

 
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