Bill To Increase State Health Plan Transparency Clears Senate Committee

By Nikita Biryukov, New Jersey Monitor

October 15, 2022

A Senate panel unanimously approved a bill Thursday that would require a public worker health plan to release claims data more frequently and to a greater number of requestors.

The bill’s advancement before the Senate’s state government committee follows the approval of public worker premium hikes of more than 20% last month. The increases have drawn the ire of local and county officials, who stand to face the worst of the hikes.

Labor leaders involved in the negotiations over health rates have railed against the state over a lack of transparency, charging the state plan and Horizon Blue Cross Blue Shield, the program’s third-party administrator, failed to provide data to justify the rate increases.

“We talked to brokers, municipalities, DAs, providers, and the common thread between all of their statements was transparency,” Matt Caliente, treasurer of the Professional Firefighters Association of New Jersey, told the committee.

The bill would require the state to make claims data available to non-state public employers within 15 days of their request.

The release must include information about network utilization, the 20 costliest diagnoses under a variety of metrics, and the most prescribed and most expensive pharmaceuticals obtained by plan members, among a host of others.

The bill’s backers say information currently provided by the state is insufficient to determine whether a town or county might be better served to find insurance outside of the state plan — something local governments are considering following last month’s increases.

Luis Alamo, founder and CEO of the Alamo Insurance Group, a risk management firm that advises government clients on insurance decisions, said his company had received just three pages of claims information from the state. By page count, that’s less than one-hundredth of what was provided by private-sector brokers, Alamo said.

“This is simply not enough,” he said. “Three pages versus 300-some-odd pages.”

The measure advanced Thursday would also allow public employers to request the data at no cost once per year instead of once every 24 months, as is the case under current law.

It’s not clear when the Assembly will consider the bill.

The Senate committee tabled a separate bill that would have given local and county governments representation on the State and School Employee Health Benefit Commissions, the bodies that annually set plan premiums.

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