Bill
Bill > A1356
NJ A1356
NJ A1356Requires health benefits plans and carriers to meet certain requirements concerning network adequacy and mental health care.
summary
Introduced
01/13/2026
01/13/2026
In Committee
01/13/2026
01/13/2026
Crossed Over
Passed
Dead
Introduced Session
2026-2027 Regular Session
Bill Summary
This bill requires carriers to take certain action to ensure that health benefits plans meet certain network adequacy requirements and mental health care. Under the bill, "carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State, and includes the State Health Benefits Program, the School Employees' Health Benefits Program, the Medicaid program, and a Medicaid managed care organization. The bill requires the Commissioner of Banking and Insurance or the Commissioner of Human Services, as appropriate, to approve a network for a health benefits plan only if the plan meets certain requirements concerning access to mental health providers. Under the bill a plan is required to have a sufficient number of mental health providers to ensure that 100 percent of the covered persons have access to either in-network mental health providers that can provide services delivered in person and within certain geographic and temporal requirements, or access to in-network or out-of-network mental health providers that can provide services delivered through telemedicine or telehealth. A plan that provides access to in-network or out-of-network mental health providers that can provide services delivered through telemedicine or telehealth is required to provide coverage for out-of-network mental health care services delivered through telemedicine or telehealth on the same basis as when the services are delivered through in-person contact and consultation in New Jersey and at a provider reimbursement rate of not less than the corresponding Medicaid provider reimbursement rate. Reimbursement payments are to be provided either to the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs the individual practitioner who delivered the reimbursable services, as appropriate. In addition, a carrier is not to charge any deductible, copayment, or coinsurance for a mental health care service, delivered throughtelemedicine or telehealth, in an amount that exceeds the deductible, copayment, or coinsurance amount that is applicable to an in-person, in-network consultation.
AI Summary
This bill requires health benefits plans, which are insurance plans that cover medical and hospital expenses, to ensure adequate access to mental health care for all individuals covered by the plan. A "carrier" is defined broadly to include insurance companies, health maintenance organizations, and state programs like Medicaid. The bill mandates that either the Commissioner of Banking and Insurance or the Commissioner of Human Services must approve a plan's network only if it meets specific criteria for mental health provider access. This means plans must have enough mental health providers to ensure that 100% of covered individuals can access either an in-person provider within 30 days and within 15 miles of their residence, or a provider through telemedicine or telehealth within 30 days if in-person access isn't available. For services provided via telemedicine or telehealth, coverage must be on the same terms as in-person care, with reimbursement rates for out-of-network providers no less than Medicaid rates, and patient cost-sharing (like deductibles and copayments) for these virtual services cannot exceed those for in-person, in-network consultations. The bill also allows self-funded plans governed by federal law to opt-in to these requirements and establishes penalties for violations, with the relevant commissioners tasked with creating rules to implement the act.
Committee Categories
Business and Industry
Sponsors (2)
Last Action
Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 01/13/2026)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.njleg.state.nj.us/bill-search/2026/A1356 |
| BillText | https://pub.njleg.gov/Bills/2026/A1500/1356_I1.HTM |
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