Establishes additional health insurance carrier network adequacy standards with respect to certain physician specialists.

A1503

ASSEMBLY, No. 1503

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblyman ROY FREIMAN

District 16 (Hunterdon, Mercer, Middlesex and Somerset)

SYNOPSIS

���� Establishes additional health insurance carrier
network adequacy standards with respect to certain physician specialists.

CURRENT VERSION OF TEXT

���� Introduced Pending Technical Review by Legislative
Counsel.

��

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 shall
enforce the provisions of
[
this
act
]

P.L.1997,
c.192 (C.26:2S-1 et seq.)
.

����
[
Within six months of the
effective date of this act, in consultation with the Commissioner of Banking
and Insurance, the
]

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
]

P.L.1997,
c.192 (C.26:2S-1 et seq.)
.� 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.

���� The regulations 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;
ensuring covered persons have reasonable and timely in-network
access to physician specialists, including anesthesiologists, radiologists,
pathologists, emergency medicine physicians, and services under their
supervision, at in-network hospitals and facilities;
utilization management
as required in
[
this
act
]

P.L.1997,
c.192 (C.26:2S-1 et seq.)
; a covered person complaint system; a patient
appeals system as required in
[
this
act
]

P.L.1997,
c.192 (C.26:2S-1 et seq.)
; the establishment of consumer rights of covered
persons; carrier disclosure as required in
[
this
act
]

P.L.1997,
c.192 (C.26:2S-1 et seq.)
; and outcomes and data reporting requirements as
required in
[
this
act
]

P.L.1997,
c.192 (C.26:2S-1 et seq.)
.

(cf: P.L.1997, c.192, s.19)

���� 2.��� This act shall take
effect immediately.

STATEMENT

���� This bill establishes
additional network adequacy standards for health insurance carriers that offer
a managed care plan. �Current law requires regulations for those carriers to
include standards for the 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.� This bill requires the Commissioner of Banking and Insurance to
adopt regulations to ensure that covered persons have reasonable and timely
access to physician specialists at in-network hospitals and facilities,
including anesthesiologists, radiologists, pathologists, emergency medicine
physicians, and services under their supervision.