{"data":{"id":"us-nj/n.j.-stat.-17b-27d-7","jurisdiction":"us-nj","citation":"N.J. Stat. § 17B:27D-7","heading":"Contents of review of bill.","body":"7.\tThe review of a bill containing a proposed mandated health benefit by the commission shall include the following:\na.\tThe social impact of mandating the health benefit, which shall include:\n(1)\tthe extent to which the proposed mandated health benefit and the services it would provide are needed by, available to and utilized by the population of New Jersey;\n(2)\tthe extent to which insurance coverage for the proposed mandated health benefit already exists or, if no coverage exists, the extent to which the lack of coverage results in inadequate health care or financial hardship for the affected population of New Jersey;\n(3)\tthe demand for the proposed mandated health benefit from the public and the source and extent of opposition to mandating the health benefit;\n(4)\trelevant findings bearing on the social impact of the lack of the proposed mandated health benefit; and\n(5)\tsuch other information with respect to the social impact as the commission deems appropriate.\nb.\tThe financial impact of mandating the health benefit, which shall include:\n(1)\tthe extent to which the proposed mandated health benefit would increase or decrease the cost for treatment or service;\n(2)\tthe extent to which similar mandated health benefits in other states have affected charges, costs and payments for services;\n(3)\tthe extent to which the proposed mandated health benefit would increase the appropriate use of the treatment or service;\n(4)\tthe impact of the proposed mandated health benefit on total costs to carriers and on administrative costs;\n(5)\tthe impact of the proposed mandated health benefit on total costs to purchasers and benefit costs;\n(6)\tthe impact of the proposed mandated health benefit on the total cost of health care within New Jersey; and\n(7)\tsuch other information with respect to the financial impact as the commission deems appropriate.\nc.\tThe medical efficacy of mandating the health benefit, which shall include:\n(1)\tif the proposed health benefit mandates coverage of a particular treatment or therapy, the recommendation of a clinical study or review article in a major peer-reviewed professional journal;\n(2)\tif the proposed benefit mandates coverage of the services provided by an additional class of practitioners, the results of at least one professionally accepted, controlled trial comparing the medical results achieved by the additional class of practitioners and the practitioners already covered by benefits;\n(3)\tthe results of other research;\n(4)\tthe impact of the proposed benefit on the general availability of health benefits coverage in New Jersey; and\n(5)\tsuch other information with respect to the medical efficacy as the commission deems appropriate.\nd.\tThe effects of balancing the social, economic and medical efficacy considerations, which shall include, but not be limited to:\n(1)\tthe extent to which the need for coverage outweighs the costs of mandating the health benefit; and\n(2)\tthe extent to which the problem of coverage may be solved by mandating the availability of the coverage as an option under a health benefits plan.\ne.\tAn analysis of information collected from various sources, including, but not limited to:\n(1)\ta State data collection system;\n(2)\tthe Departments of Health and Banking and Insurance;\n(3)\thealth planning organizations;\n(4)\tproponents and opponents of the proposed health benefit mandate, who shall be encouraged to provide appropriate documentation supporting their positions.  The commission shall examine such documentation to determine whether:\n(a)\tthe documentation is complete;\n(b)\tthe assumptions upon which the research is based are valid;\n(c)\tthe research cited in the documentation meets professional standards;\n(d)\tall relevant research respecting the proposed benefit has been cited in the documentation;\n(e)\tthe conclusions and interpretations in the documentation are consistent with the data submitted; and\n(5)\tsuch other data sources as the commission deems appropriate.\nIn analyzing information from the various sources, the commission shall give substantial weight to the documentation provided by the proponents and opponents of the mandate to the extent that such documentation is made available to them.\nL.2003, c.193, s.7; amended 2012, c.17, s.64.","path":["TITLE 17B INSURANCE"],"source_url":"https://pub.njleg.state.nj.us/statutes/STATUTES-TEXT.zip","current_through":"P.L.2025, c.405, and J.R.22","vintage":"","retrieved_at":"2026-08-27T17:54:13Z","sha256":"3eb7e8629fb63cd8ee057977cda1e604fa7f2a0677fd836975f93bf59c1c1ba5","source_id":"us-nj","stale":true,"prev":"us-nj/n.j.-stat.-17b-27d-6","next":"us-nj/n.j.-stat.-17b-27d-8"},"notice":"GroundRules: Original legal text. Not legal advice."}