Bill
Bill > S3477
NJ S3477
NJ S3477Requires health benefits plan and carriers to meet certain requirements concerning network adequacy and mental health care.
summary
Introduced
02/12/2026
02/12/2026
In Committee
02/12/2026
02/12/2026
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 through telemedicine 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 mandates that health benefits plans, offered by entities called "carriers" (which include insurance companies, health maintenance organizations, and state programs like Medicaid), must ensure adequate access to mental health care providers for all individuals covered by the plan. Specifically, plans must have enough mental health providers to guarantee that 100% of covered individuals can either see an in-network provider in person within 30 days and within 15 miles of their residence, or, if in-person access isn't available, access a provider through telemedicine or telehealth within 30 days. For services provided via telemedicine or telehealth, especially those out-of-network, coverage must be on the same terms as in-person care, with reimbursement rates at least as high as Medicaid rates, and out-of-pocket costs like deductibles and copayments cannot exceed those for in-person, in-network consultations. The relevant state commissioners will approve these networks based on these requirements, and violations will incur penalties.
Committee Categories
Business and Industry
Sponsors (1)
Last Action
Introduced in the Senate, Referred to Senate Commerce Committee (on 02/12/2026)
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/S3477 |
| BillText | https://pub.njleg.gov/Bills/2026/S3500/3477_I1.HTM |
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