Legislation to establish a pilot program that would encourage better health care practices by employees with chronic health conditions was released by an Assembly panel. The bill,  sponsored by Assemblywoman Linda Stender and Assemblyman Herb Conaway, Jr., would create a five-year pilot program to provide benefits coverage to select employees with chronic health conditions using a value-based benefit design under the State Health Benefits Program (SHBP). The following chronic health conditions would be targeted under the value-based benefit design: diabetes, high cholesterol, hypertension and asthma.

“This program uses financial incentives to increase the employee’s interaction with appropriate health care providers, and encourage use of health benefits that will specifically address and help improve their chronic health condition,” said Stender (D-Middlesex/Somerset/Union). “That, in turn, should benefit taxpayers.”

“The underlying goal of this program is to increase the employee’s access to care and information that will help them control their condition and thus better manage the overall costs of their health benefits coverage,” said Conaway (D-Burlington). “That should lead to taxpayer savings that will benefit everyone.”

The State Health Benefits Commission would be charged with selecting eligible employees based on their chronic health conditions to participate in the pilot program. Participation in the pilot program is voluntary. Employees who choose to participate in the program would be offered the following incentives directly related to the diagnosis, care, mitigation or treatment of the condition:

· All tuition costs shall be covered for any education class attended by the employee that provides medical condition self-management, recommended to the employee by the primary treating physician or assigned pharmacist.

· All costs for private visits with the employee’s assigned pharmacist shall be covered

· All costs shall be covered for a medical device or supply deemed medically necessary by the primary treating physician or assigned pharmacist.

· All laboratory testing shall be covered.

· All copayments for any prescription drug shall be waived.

The commission will provide selected employees with coverage through one or more contracts negotiated and arranged with one or more carriers licensed to operate in the state. The selection of eligible employees will be based on a procedure determined by the commission.

Participants will be assigned a pharmacist responsible for coordinating prescription drug benefits and related pharmaceutical care within the scope of the pharmacist’s license to practice pharmacy. The pharmacist will periodically update the employee’s primary treating physician concerning the provision of any prescription drug benefit and related pharmaceutical care.

In order to remain a participant in the pilot program and receive these financial incentives, the employee must comply with all aspects of the value-based benefit design regimen, including, but not limited to: attendance at all medical appointments; adherence to advice or instructions provided by the primary treating physician or assigned pharmacist; and use of all prescription drugs as directed.

No later than the date of expiration on the five-year pilot program, the commission shall issue a report to the Governor and to the Legislature, which report shall include a detailed summary of the commission’s activities, the application of the value-based benefit design coverage within the SHBP, and any recommendations with respect to the extension, modification, or expansion of the program.

The bill was released by the Assembly State Government Committee chaired by Stender. TLS.