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A5209 • 2026

Requires health insurers to provide reason for denial of coverage for private duty nursing.

Requires health insurers to provide reason for denial of coverage for private duty nursing.

Passed Legislature

This bill passed both chambers and reached final enrollment, even if later executive action is not shown here.

Sponsor
Schnall, Alexander
Last action
2026-06-04
Official status
Introduced, Referred to Assembly Oversight, Reform and Federal Relations Committee
Effective date
Not listed

Plain English Breakdown

Using official source text because the generated explanation was unavailable or could not be confirmed against the official bill text.

Requires health insurers to provide reason for denial of coverage for private duty nursing.

Requires health insurers to provide reason for denial of coverage for private duty nursing.

What This Bill Does

  • Requires health insurers to provide reason for denial of coverage for private duty nursing.
  • Topic: Oversight, Reform and Federal Relations Fiscal note: This bill has not been certified by OLS for a fiscal note.

Limits and Unknowns

  • This entry is temporarily using official source text because the generated explanation could not be confirmed against the official bill text during the last sync.

Bill History

  1. 2026-06-04 New Jersey Legislature

    Introduced, Referred to Assembly Oversight, Reform and Federal Relations Committee

Official Summary Text

Requires health insurers to provide reason for denial of coverage for private duty nursing.
Topic:
Oversight, Reform and Federal Relations
Fiscal note:
This bill has not been certified by OLS for a fiscal note.

Current Bill Text

Read the full stored bill text 
A5209

ASSEMBLY, No. 5209

STATE OF NEW JERSEY

222nd LEGISLATURE

�

INTRODUCED JUNE 4, 2026

Sponsored by:

Assemblyman� ALEXANDER "AVI" SCHNALL

District 30 (Monmouth and Ocean)

SYNOPSIS

���� Requires health insurers to provide reason for denial
of coverage for private duty nursing.

CURRENT VERSION OF TEXT

���� As introduced.

��

An Act
concerning health insurance coverage and private duty
nursing and supplementing P.L.2023, c.296 (C.17B:30-55.1 et seq.).

����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:

���� 1.��� a. If a payer denies a
prior authorization request for private duty nursing services that has been
determined to be medically necessary by the covered person�s physician, the
payer shall provide a full description of the reason for the denial.� If the
denial is based on a finding that the private duty nursing services are not
medically necessary, the payer shall provide, in addition to its reason for
that finding, an explanation of why the determination of the covered person�s
physician is invalid.� The explanation shall include the criteria the payer
uses in evaluating prior authorization requests for private duty nursing
services and shall provide examples of when prior authorization requests for
private duty nursing are approved, including the submitted documentation
necessary for those approvals.

���� 2.��� This act shall take
effect on the 90th day next following the date of enactment.

STATEMENT

���� This bill requires health
insurers to provide a reason for the denial of coverage for private duty
nursing services.

���� Specifically, if a payer
denies a prior authorization request for private duty nursing services that has
been determined to be medically necessary by the covered person�s physician,
the bill requires the payer to provide a full description of the reason for the
denial.� If the denial is based on a finding that the private duty nursing
services are not medically necessary, the payer is required to provide its
rationale for that finding, including an explanation of why the determination
of the covered person�s physician is invalid.� The payer is also required to
provide examples of when prior authorization requests for private duty nursing
are approved, including the submitted documentation necessary for those
approvals.