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A4269
ASSEMBLY, No. 4269
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED FEBRUARY 19, 2026
Sponsored by:
Assemblywoman� SHANIQUE SPEIGHT
District 29 (Essex and Hudson)
SYNOPSIS
���� Authorizes home care for individuals who are disabled
or elderly and requires health insurance coverage therefor.�
CURRENT VERSION OF TEXT
���� As introduced.
��
An Act
concerning home health care and supplementing various
parts of the statutory law.
����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:
����� 1.�� a.�
As used in this section:
����� "Disabled"
means total and permanent inability to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment,
including blindness.
����� "Elderly"
means a person age 65 years or older with mobility issues.
����� "Health
care facility" means a physician's office or any other health care
facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).
����� "Health
care professional" means a person licensed to practice a health care
profession pursuant to Title 45 of the Revised Statutes, or a nurse
practitioner/clinical nurse specialist.
����� b.�� A
health care professional shall be permitted to provide care or treatment to an
individual who is disabled or elderly in the home of the individual if the
individual is unable to present for an in-person visit in a health care
facility, as documented by a health care professional in the medical record of
the individual based upon the good faith clinical judgment of the health care
professional, and if the health care professional is able to provide adequate
medical care or treatment in the home of the individual in a manner that is
consistent with the clinical standards for treatment in the applicable
specialty.�
����� 2.�� a.�� No
group or individual hospital service corporation contract providing hospital or
medical expense benefits shall be delivered, issued, executed, or renewed in
this State, or approved for issuance or renewal in this State by the
Commissioner of Banking and Insurance, on or after the effective date of this
act, unless the contract provides benefits to any subscriber or other person
covered thereunder for expenses incurred in conducting
home care.
����� b.�� The
benefits shall be provided to the same extent as for any other medical
condition under the contract. The provisions of this section shall not be
interpreted as imposing any new network adequacy requirements related
specifically to the provision of home care.
����� c.�� The
provisions of this section shall apply to all contracts in which the hospital
service corporation has reserved the right to change the premium.
����� d.�� As
used in this section:
����� "Disabled"
means total and permanent inability to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment,
including blindness.
����� "Elderly"
means a person age 65 years or older with mobility issues.
����� "Health
care facility" means a physician's office or any other health care
facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).
����� "Health
care professional" means a person licensed to practice a health care
profession pursuant to Title 45 of the Revised Statutes, or a nurse
practitioner/clinical nurse specialist.
���� �Home
care� means preventative, primary, specialty, or urgent care or treatment
provided by a health care professional to an individual who is disabled or
elderly in the home of the individual if the individual is unable to present
for an in-person visit in a health care facility, as reasonably documented by a
health care professional in the medical record of the individual based upon the
good faith clinical judgment of the health care professional, and if the health
care professional is able to provide adequate medical care or treatment in the
home of the individual in a manner that is consistent with the clinical
standards for treatment in the applicable specialty.� �Home care� excludes
custodial care.�
����� 3.�� a.�� No
group or individual medical service corporation contract providing hospital or
medical expense benefits shall be delivered, issued, executed, or renewed in
this State, or approved for issuance or renewal in this State by the
Commissioner of Banking and Insurance, on or after the effective date of this
act, unless the contract provides benefits to any subscriber or other person
covered thereunder for expenses incurred in conducting home care.
����� b.�� These
benefits shall be provided to the same extent as for any other medical
condition under the contract.
����� c.�� The
provisions of this section shall apply to all contracts in which the medical
services corporation has reserved the right to change the premium.
����� d.�� As
used in this section:
����� "Disabled"
means total and permanent inability to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment,
including blindness.
����� "Elderly"
means a person age 65 years or older with mobility issues.
����� "Health
care facility" means a physician's office or any other health care
facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).
����� "Health
care professional" means a person licensed to practice a health care
profession pursuant to Title 45 of the Revised Statutes, or a nurse
practitioner/clinical nurse specialist.
����� �Home
care� means preventative, primary, specialty, or urgent care or treatment
provided by a health care professional to an individual who is disabled or
elderly in the home of the individual if the individual is unable to present
for an in-person visit in a health care facility, as reasonably documented by a
health care professional in the medical record of the individual based upon the
good faith clinical judgment of the health care professional, and if the health
care professional is able to provide adequate medical care or treatment in the
home of the individual in a manner that is consistent with the clinical
standards for treatment in the applicable specialty.� �Home care� excludes
custodial care.
�
����� 4.�� a.�� No
group or individual health service corporation contract providing hospital or
medical expense benefits shall be delivered, issued, executed, or renewed in
this State, or approved for issuance or renewal in this State by the
Commissioner of Banking and Insurance, on or after the effective date of this
act, unless the contract provides benefits to any subscriber or other person
covered thereunder for expenses incurred in conducting home care.
����� b.�� These
benefits shall be provided to the same extent as for any other medical
condition under the contract.
����� c.�� The
provisions of this section shall apply to all contracts in which the health
services corporation has reserved the right to change the premium.
����� d.�� As
used in this section:
����� "Disabled"
means total and permanent inability to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment,
including blindness.
����� "Elderly"
means a person age 65 years or older with mobility issues.
����� "Health
care facility" means a physician's office or any other health care
facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).
����� "Health
care professional" means a person licensed to practice a health care
profession pursuant to Title 45 of the Revised Statutes, or a nurse
practitioner/clinical nurse specialist.
���� �Home
care� means preventative, primary, specialty, or urgent care or treatment
provided by a health care professional to an individual who is disabled or
elderly in the home of the individual if the individual is unable to present
for an in-person visit in a health care facility, as reasonably documented by a
health care professional in the medical record of the individual based upon the
good faith clinical judgment of the health care professional, and if the health
care professional is able to provide adequate medical care or treatment in the
home of the individual in a manner that is consistent with the clinical
standards for treatment in the applicable specialty.� �Home care� excludes
custodial care.
����� 5.�� a.�
No individual health insurance policy providing hospital or medical expense
benefits shall be delivered, issued, executed, or renewed in this State, or
approved for issuance or renewal in this State by the Commissioner of Banking
and Insurance, on or after the effective date of this act, unless the policy
provides benefits to any named insured or other person covered thereunder for
expenses incurred in conducting home care.
����� b.�� These
benefits shall be provided to the same extent as for any other medical
condition under the policy.
����� c.�� The
provision of this section shall apply to all policies in which the insurer has
reserved the right to change the premium.
����� d.�� As
used in this section:
����� "Health
care facility" means a physician's office or any other health care
facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).
����� "Disabled"
means total and permanent inability to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment,
including blindness.
����� "Elderly"
means a person age 65 years or older with mobility issues.
����� "Health
care professional" means a person licensed to practice a health care
profession pursuant to Title 45 of the Revised Statutes, or a nurse
practitioner/clinical nurse specialist.
����� �Home
care� means preventative, primary, specialty, or urgent care or treatment
provided by a health care professional to an individual who is disabled or
elderly in the home of the individual if the individual is unable to present
for an in-person visit in a health care facility, as reasonably documented by a
health care professional in the medical record of the individual based upon the
good faith clinical judgment of the health care professional, and if the health
care professional is able to provide adequate medical care or treatment in the
home of the individual in a manner that is consistent with the clinical
standards for treatment in the applicable specialty.� �Home care� excludes
custodial care.
����� 6.�� a.�
No group health insurance policy providing hospital or medical expense benefits
shall be delivered, issued, executed, or renewed in this State, or approved for
issuance or renewal in this State by the Commissioner of Banking and Insurance,
on or after the effective date of this act, unless the policy provides benefits
to any named insured or other person covered thereunder for expenses incurred
in conducting home care.
����� b.�� These
benefits shall be provided to the same extent as for any other medical
condition under the policy.
����� c.�� The
provisions of this section shall apply to all policies in which the insurer has
reserved the right to change the premium.
����� d.�� As
used in this section:
����� "Disabled"
means total and permanent inability to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment,
including blindness.
����� "Elderly"
means a person age 65 years or older with mobility issues.
����� "Health
care facility" means a physician's office or any other health care
facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).
����� "Health
care professional" means a person licensed to practice a health care
profession pursuant to Title 45 of the Revised Statutes, or a nurse
practitioner/clinical nurse specialist.
����� �Home
care� means preventative, primary, specialty, or urgent care or treatment
provided by a health care professional to an individual who is disabled or
elderly in the home of the individual if the individual is unable to present
for an in-person visit in a health care facility, as reasonably documented by a
health care professional in the medical record of the individual based upon the
good faith clinical judgment of the health care professional, and if the health
care professional is able to provide adequate medical care or treatment in the
home of the individual in a manner that is consistent with the clinical
standards for treatment in the applicable specialty.� �Home care� excludes
custodial care.���
����� 7.�� a.�
Notwithstanding any provision of law to the contrary, a certificate of
authority to establish and operate a health maintenance organization in this
State shall not be issued or continued by the Commissioner of Banking and
Insurance on or after the effective date of this act unless the health
maintenance organization provides health care services to any enrollee for the
use of home care.
����� b.�� These
health care services shall be provided to the same extent as for any other
medical condition under the enrollee agreement.
����� c.�� The
provisions of this section shall apply to all enrollee agreements in which the
health maintenance organization has reserved the right to change the schedule
of charges.
����� d.�� As
used in this section:
����� "Disabled"
means total and permanent inability to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment,
including blindness.
����� "Elderly"
means a person age 65 years or older with mobility issues.
����� "Health
care facility" means a physician's office or any other health care
facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).
����� "Health
care professional" means a person licensed to practice a health care
profession pursuant to Title 45 of the Revised Statutes, or a nurse
practitioner/clinical nurse specialist.
����� �Home
care� means preventative, primary, specialty, or urgent care or treatment
provided by a health care professional to an individual who is disabled or
elderly in the home of the individual if the individual is unable to present
for an in-person visit in a health care facility, as reasonably documented by a
health care professional in the medical record of the individual based upon the
good faith clinical judgment of the health care professional, and if the health
care professional is able to provide adequate medical care or treatment in the
home of the individual in a manner that is consistent with the clinical
standards for treatment in the applicable specialty.� �Home care� excludes
custodial care.
����� 8.�� a.�
Every individual health benefits plan that is delivered, issued, executed, or
renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) or
approved for issuance or renewal in this State, on or after the effective date
of this act, shall provide benefits to any person covered thereunder for
expenses incurred in conducting home care.
����� b.�� The
benefits shall be provided to the same extent as for any other medical
condition under the health benefits plan.
����� c.�� The
provisions of this section shall apply to all health benefit plans in which the
carrier has reserved the right to change the premium.
����� d.�� As
used in this section:
����� "Disabled"
means total and permanent inability to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment,
including blindness.
����� "Elderly"
means a person age 65 years or older with mobility issues.
����� "Health
care facility" means a physician's office or any other health care
facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).
����� "Health
care professional" means a person licensed to practice a health care
profession pursuant to Title 45 of the Revised Statutes, or a nurse
practitioner/clinical nurse specialist.
����� �Home
care� means preventative, primary, specialty, or urgent care or treatment
provided by a health care professional to an individual who is disabled or
elderly in the home of the individual if the individual is unable to present
for an in-person visit in a health care facility, as reasonably documented by a
health care professional in the medical record of the individual based upon the
good faith clinical judgment of the health care professional, and if the health
care professional is able to provide adequate medical care or treatment in the
home of the individual in a manner that is consistent with the clinical
standards for treatment in the applicable specialty.� �Home care� excludes
custodial care.���
����� 9.�� a.
Every small employer health benefits plan that is delivered, issued, executed,
or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) or
approved for issuance or renewal in this State, on or after the effective date
of this act, shall provide benefits to any person covered thereunder for
expenses incurred in conducting home care.
����� b.�� The
benefits shall be provided to the same extent as for any other medical
condition under the health benefits plan.
����� c.�� The
provisions of this section shall apply to all health benefit plans in which the
carrier has reserved the right to change the premium.
����� d.�� As
used in this section:
����� "Disabled"
means total and permanent inability to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment,
including blindness.
����� "Elderly"
means a person age 65 years or older with mobility issues
1
.
����� "Health
care facility" means a physician's office or any other health care
facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).
����� "Health
care professional" means a person licensed to practice a health care
profession pursuant to Title 45 of the Revised Statutes, or a nurse
practitioner/clinical nurse specialist
1
.
����� �Home
care� means preventative, primary, specialty, or urgent care or treatment
provided by a health care professional to an individual who is disabled or
elderly in the home of the individual if the individual is unable to present
for an in-person visit in a health care facility, as reasonably documented by a
health care professional in the medical record of the individual based upon the
good faith clinical judgment of the health care professional, and if the health
care professional is able to provide adequate medical care or treatment in the
home of the individual in a manner that is consistent with the clinical
standards for treatment in the applicable specialty.� �Home care� excludes
custodial care.�� ���
����� 10.�� a.�
The State Health Benefits Commission shall ensure that every contract purchased
by the commission on or after the effective date of this act that provides
hospital and medical expense benefits shall provide coverage for expenses
incurred in conducting home care.
����� b.�� The
benefits shall be provided to the same extent as for any other medical
condition under the contract.
����� c.�� As
used in this section:
����� "Disabled"
means total and permanent inability to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment,
including blindness.
����� "Elderly"
means a person age 65 years or older with mobility issues
1
.
����� "Health
care facility" means a physician's office or any other health care
facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).
����� "Health
care professional" means a person licensed to practice a health care
profession pursuant to Title 45 of the Revised Statutes, or a nurse
practitioner/clinical nurse specialist.
����� �Home
care� means preventative, primary, specialty, or urgent care or treatment
provided by a health care professional to an individual who is disabled or
elderly in the home of the individual if the individual is unable to present
for an in-person visit in a health care facility, as reasonably documented by a
health care professional in the medical record of the individual based upon the
good faith clinical judgment of the health care professional, and if the health
care professional is able to provide adequate medical care or treatment in the
home of the individual in a manner that is consistent with the clinical
standards for treatment in the applicable specialty.� �Home care� excludes
custodial care.���
���� 11.���� This act shall take
effect immediately.
STATEMENT
����� This bill authorizes home care for individuals who
are disabled or elderly with mobility issues and requires health insurance
coverage therefor.
����� Under the bill, a health care professional is to be
permitted to provide care or treatment to an individual who is disabled or
elderly with mobility issues in the home of the individual if the individual is
unable to present for an in-person visit in a health care facility, as
documented by a health care professional in the medical record of the
individual based upon the good faith clinical judgment of the health care
professional, and if the health care professional is able to provide adequate
medical care or treatment in the home of the individual who is disabled or
elderly with mobility issues in a manner that is consistent with the clinical
standards for treatment in the applicable specialty.
����� Further, the bill requires health insurance carriers,
including insurance companies, health service corporations, hospital service
corporations, medical service corporations, health maintenance organizations
authorized to issue health benefits plans in New Jersey, and any entity
contracted to administer health benefits in connection with the State Health
Benefits Program or School Employees� Health Benefits Program, to cover home
care.�
����� The bill defines �home care� to mean preventative,
primary, specialty, or urgent care or treatment provided by a health care
professional to an individual who is disabled or elderly with mobility issues
in the home of the individual if the individual is unable to present for an
in-person visit in a health care facility, as reasonably documented by a health
care professional in the medical record of the individual based upon the good
faith clinical judgment of the health care professional, and if the health care
professional is able to provide adequate medical care or treatment in the home
of the individual in a manner that is consistent with the clinical standards
for treatment in the applicable specialty.� �Home care� excludes custodial
care.