Bill Text: NJ S2225 | 2018-2019 | Regular Session | Introduced
Bill Title: Requires DOBI to obtain and consider certain information from Commissioner of Health concerning provider network adequacy requirements for managed care plans.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2018-03-08 - Introduced in the Senate, Referred to Senate Commerce Committee [S2225 Detail]
Download: New_Jersey-2018-S2225-Introduced.html
Sponsored by:
Senator SHIRLEY K. TURNER
District 15 (Hunterdon and Mercer)
SYNOPSIS
Requires DOBI to obtain and consider certain information from Commissioner of Health concerning provider network adequacy requirements for managed care plans.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health insurance carrier network adequacy and amending P.L.1997, c.192.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 19 of P.L.1997, c.192 (C.26:2S-18) is amended to read as follows:
19. The [commissioner] Commissioner of Banking and Insurance shall enforce the provisions of this act.
a. [Within six months of the effective date of this act, in consultation with the] The Commissioner of Banking and Insurance, the commissioner shall adopt rules and regulations, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), necessary to carry out the purposes of this act. The regulations shall establish consumer protection and quality standards governing carriers which offer a managed care plan or use a utilization management system that are consistent with the standards governing health maintenance organizations in the State.
b. The regulations adopted pursuant to subsection a. of this section shall include standards for: a quality management program; provider participation in a network; adequacy of the provider network with respect to the scope and type of health care benefits provided by the carrier, the geographic service area covered by the provider network and access to medical specialists, when appropriate; utilization management as required in this act; a covered person complaint system; a patient appeals system as required in this act; the establishment of consumer rights of covered persons; carrier disclosure as required in this act; and outcomes and data reporting requirements as required in this act.
c. With respect to a carrier's satisfaction of provider network adequacy as required by subsection b. of this section and the regulations adopted pursuant to that subsection, the Commissioner of Banking and Insurance shall, in consultation and coordination with the Commissioner of Health, implement a system for the Commissioner of Health to provide to the Commissioner of Banking and Insurance the following information, to the extent that it may affect provider network adequacy requirements:
(1) any change in the delivery of a health care service by a hospital or a health care facility;
(2) any approval of an application for a certificate of need, and any change in a certificate of need, for a hospital or health care facility; and
(3) an assessment of the
financial soundness of a hospital or health care facility in relation to its
anticipated ability to continue to
provide health care services.
The Commissioner of Banking and Insurance shall take into consideration the information provided pursuant to paragraphs (1), (2), and (3) of this subsection in making any decision to approve or disapprove the provider network adequacy of a managed care plan offered by a carrier.
(cf: P.L.1997, c.192, s.19)
2. This act shall take effect on the 90th day next following enactment.
STATEMENT
The bill amends the "Health Care Quality Act" to provide that, with respect to a carrier's satisfaction of provider network adequacy as required by the act and its implementing regulations, the Commissioner of Banking and Insurance shall, in consultation and coordination with the Commissioner of Health, implement a system for the Commissioner of Health to provide to the commissioner the following information, to the extent that it may affect provider network adequacy requirements:
(1) any change in the delivery of a health care service by a hospital or a health care facility;
(2) any approval of an application for a certificate of need, and any change in a certificate of need, for a hospital or health care facility; and
(3) any assessment of the financial soundness of a hospital or health care facility in relation to its anticipated ability to continue to provide health care services.
The bill requires the Commissioner of Banking and Insurance to take this information into consideration in any decision to approve or disapprove the provider network adequacy of a managed care plan offered by a carrier.
Current law requires carriers to maintain provider networks that meet certain standards that are largely based on geographic accessibility by persons covered under the carrier's health benefits plan, to assure that covered persons are able to access services in-network and take advantage of the in-network benefits levels provided under their plan. This bill expands the factors to be considered in determinations of provider network adequacy by requiring the Commissioner of Banking and Insurance to take into consideration more specific information regarding the delivery of health care services by hospitals and health care facilities.
The bill also makes certain technical changes.
