• Views: in the last
  • 58Week
  • 35Month
  • 670Total


  • NJ A1802
  • Requires audits of managed care plan provider networks.
Introduced
(1/27/2016)
In Committee
(1/27/2016)
Crossed OverPassedSignedDead/Failed/Vetoed
2016-2017 Regular Session
This bill supplements the consumer safeguards with respect to health benefits plans provided by health insurance carriers that were established pursuant to the "Health Care Quality Act," P.L.1997, c.92 (C.26:2S-1 et seq.). The bill provides that a carrier that offers a managed care plan must provide for an annual audit of its provider network, at its own expense, by a private auditing firm approved by the Commissioner of Banking and Insurance. If the audit finds that a carrier failed to maintain an adequate network in accordance with State and federal law, including specialists as enumerated in N.J.A.C.11:24-6.2, the Commissioner of Banking and Insurance will be required to assess a civil penalty of not less than $500 and not more than $10,000 for each instance in which the carrier fails to maintain an adequate network. The bill additionally provides that the State Auditor is to perform an annual performance review audit of every health maintenance organization (HMO) that contracts with the Department of Human Services to provide health care services for Medicaid recipients, in order to determine whether HMOs individually and as a group have established and maintained adequate provider networks, including specialists as enumerated in N.J.A.C.11:24-6.2, which are accepting recipients of the Medicaid program as patients in accordance with the provisions of their contracts. The performance review will be conducted at the expense of the HMO. The Commissioner of Human Services will be required to assess a civil penalty of not less than $500 and not more than $10,000 against an HMO for each instance in which the HMO has not established and maintained an adequate provider network in accordance with its contract.
Health and Senior Services
Introduced, Referred to Assembly Health and Senior Services Committee  (on 1/27/2016)
 
 
Date Chamber Action Description
1/27/2016 A Introduced, Referred to Assembly Health and Senior Services Committee
Date Motion Yea Nay Other
None specified