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S3477
SENATE, No. 3477
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED FEBRUARY 12, 2026
Sponsored by:
Senator� JAMES BEACH
District 6 (Burlington and Camden)
SYNOPSIS
���� Requires health benefits plans and carriers to meet
certain requirements concerning network adequacy and mental health care.
CURRENT VERSION OF TEXT
���� As introduced.
��
An Act
concerning network adequacy and supplementing
P.L.1997, c.192 (C.26:2S-1 et seq.).
����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:
���� 1.��� As used in this act:
���� �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 shall include the State Health
Benefits Program, the School Employees' Health Benefits Program, the Medicaid
program, and a Medicaid managed care organization.
���� "Covered person"
means a person on whose behalf a carrier offering the plan is obligated to pay
benefits or provide services pursuant to the health benefits plan.
���� "Health benefits
plan" means a benefits plan which pays or provides hospital and medical
expense benefits for covered services, and is delivered or issued for delivery
in this State by or through a carrier.� Health benefits plan includes, but is
not limited to, Medicare supplement coverage and risk contracts to the extent
not otherwise prohibited by federal law.� For the purposes of this act, health
benefits plan shall not include the following plans, policies, or contracts:�
accident only, credit, disability, long-term care, TRICARE supplement coverage,
coverage arising out of a workers' compensation or similar law, automobile
medical payment insurance, personal injury protection insurance issued pursuant
to P.L.1972, c.70 (C.39:6A-1 et seq.), or hospital confinement indemnity
coverage.
���� "Medicaid" means the
Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
���� "Mental health
condition" means a condition defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
current version of the Diagnostic and Statistical Manual of Mental Disorders.
���� �Mental health provider� means
professionals licensed in this State to diagnose or treat mental health
conditions.
���� "Network adequacy"
means the adequacy of the provider network with respect to the scope and type
of health care benefits provided by a carrier, the geographic service area
covered by the provider network, and access to hospital based and medical
specialists pursuant to the standards in the regulations promulgated pursuant
to section 19 of P.L.1997, c.192 (C.26:2S-18) and in the existing contract
between a managed care organization and the Division of Medical Assistance and
Health Services in the Department of Human Services.
���� "Telehealth" means
the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
���� "Telemedicine" means
the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
���� 2.��� a.� The Commissioner of
Banking and Insurance or the Commissioner of Human Services, as appropriate,
shall, in determining the adequacy of a proposed provider network or the
ongoing adequacy of an in-force provider network, approve a network for a
health benefits plan only if the plan has a sufficient number of mental health
providers to ensure that 100 percent of the covered persons have access to:
���� (1)�� an in-network mental
health provider that can provide services delivered in person, within 15 miles
of the covered person�s residence, within the geographic boundaries of the
State, and within 30 days of the initial request by the covered person; or
���� (2)�� if in-person delivery
pursuant to paragraph (1) of this subsection is not available, an in-network or
out-of-network mental health provider that can provide services delivered
through telemedicine or telehealth within 30 days of the initial request by the
covered person.�
���� (a)�� A carrier that provides
coverage for out-of-network mental health care services delivered through
telemedicine or telehealth pursuant to paragraph (2) of this subsection shall
provide coverage 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 under this section may 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.�
���� (b)�� A carrier shall not
charge any deductible, copayment, or coinsurance for a mental health care
service, delivered through telemedicine or telehealth pursuant to paragraph (2)
of this subsection, in an amount that exceeds the deductible, copayment, or
coinsurance amount that is applicable to an in-person, in-network consultation.
���� b.��� An entity providing or
administering a self-funded health benefits plan which is subject to the
"Employee Retirement Income Security Act of 1974" (29 U.S.C. s.1001
et seq.) may elect to meet the requirements of this act.
���� 3.��� A carrier that violates
any provision of this act shall be liable for the penalties provided pursuant
to section 16 of P.L.1997, c.192 (C.26:2S-16).
���� 4.��� The Commissioner of
Banking and Insurance, in conjunction with the Commissioner of Human Services,
shall adopt rules and regulations pursuant to the "Administrative
Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to effectuate the
purposes of this act.
���� 5.��� This act shall take
effect on the first day of the third month next following the date of
enactment, except that the Commissioner of Banking and Insurance and the
Commissioner of Human Services may take such anticipatory administrative action
in advance thereof as shall be necessary for the implementation of this act.
STATEMENT
���� 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.�