State Legislature Hopes To Put Brakes On OMNIA Tiered Health Insurance Plan

Source: New Jersey Spotlight
A package of four bills that would block or radically modify OMNIA — and other tiered health plans — could come up for a vote in the New Jersey Legislature as early as December 17, just ahead of OMNIA’s planned launch. But the Christie administration recently approved the launch of the tiered health plan, in which patients pay less out of pocket if they visit preferred doctors and hospitals that are designated as “Tier 1.”
The four bills, sponsored by state senators Nia H. Gill (D-Essex and Passaic) and Joseph F. Vitale (D-Middlesex) would revise how plans like OMNIA are designed and approved. For Christie to sign the bills at the 11th hour, however, would require him to effectively reverse OMNIA’s approval, which Department of Banking and Insurance officials issued in September.

“Horizon has misled the government and healthcare consumers, and this will provide an opportunity to reset this process and allow consumers to enroll in other plans in the short term,” says Sen. Joseph F. Vitale. That would “allow policymakers and regulators to repair, or reinvent, or completely scrap the OMNIA model.”

Horizon has estimated that 40,000 currently uninsured residents would be enticed by the prices to enroll in OMNIA through the federal insurance marketplace. But hospitals and doctors left outside of Tier 1 have expressed concern that the plan would lead to them losing patients. Since healthcare providers have an incentive to accept lower payments in tiered plans because they are guaranteed more patients, that, in turn, could lead to the closure of Tier 2 hospitals and the sale of Tier 2 medical practices to Tier 1 hospitals.
Other OMNIA critics have noted that Horizon executives didn’t tell providers how they chose Tier 1 providers, and the company hasn’t disclosed many details, citing the information as confidential. The bill that would add transparency to the process insurers use to design tiered networks would also prevent insurers from limiting the number of providers that could participate. “Horizon touts this as (promoting) population health, but it’s not the true definition,” Vitale said. “They’re redefined it to suit their own goals.”
Senator Gill added that it’s vitally important to include University Hospital, which is located less than a mile from her district, in any preferred tier. The hospital is the only one in the state that is owned by the state government. It’s also one of three hospitals that serve as the highest-level trauma centers, and is a center for training new doctors.
The OMNIA plan offered through the State Health Benefit Program will launch on December 26, while the plans offered through employers and the individual marketplace will start on January 1.

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