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S4403
SENATE, No. 4403
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED JUNE 4, 2026
Sponsored by:
Senator� TROY SINGLETON
District 7 (Burlington)
SYNOPSIS
���� Establishes all-payer claims database.
CURRENT VERSION OF TEXT
���� As introduced.
��
An Act
concerning all-payer claims databases and
supplementing Title 17B of the New Jersey Statutes.
����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:
���� 1.��� As used in this act:
���� �All-payer claims database�
means a database that receives and stores data from a reporting entity
concerning health insurance claims, prescription drug claims, and other health
insurance claims information from covered persons.� �All-payer claims database�
shall also include data concerning health care provider information such as the
provider�s name, specialty, and practice address.
���� �Carrier� means an insurance
company, health service corporation, hospital service corporation, medical
service corporation, or health maintenance organization authorized to issued
health benefits plans in this State, and shall include the State Health Benefits
Program, School Employees Program, and State Medicaid program established
pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
���� �Covered person� means a
person on whose behalf a carrier is obligated to pay benefits or provide
services pursuant to a health benefits plan.
���� �Department� means the
Department of Health.
���� "Health benefits
plan" means a benefits plan which pays hospital or medical expense
benefits for covered services, or prescription drug benefits for covered
services, and is delivered or issued for delivery in this State by or through a
carrier or any other sponsor.� For the purposes of this act, �health benefits
plan� shall include, to the maximum extent permitted by federal law, a
high-deductible health plan, except if the plan is used to establish a medical
savings account pursuant to section 220 of the federal Internal Revenue Code of
1986 (26 U.S.C. s.220).� �Health benefits plan� shall not include the following
plans, policies or contracts: accident only, credit disability, long-term care,
Medicare supplement coverage, TRICARE supplement coverage, coverage for
Medicare services pursuant to a contract with the United States government,
coverage arising out of a worker's compensation or similar law, coverage under
a policy of private passenger automobile insurance issued pursuant to P.L.1972,
c.70 (C.39:6A-1 et seq.), or hospital confinement indemnity coverage.�
���� �Institutional review board�
means
group regulated pursuant to
45 C.F.R. s.46 to review and monitor research involving human subjects.
���� �Longitudinal identifier�
means a unique, persistent, and tokenized identifier used to link a covered
person�s health insurance claims, prescription drug claims, and other health
insurance claims information submitted to the all-payer claims database.
���� �Reporting entity" means
a carrier, health care provider licensed pursuant to Title 45 or Title 26 of
the Revised Statutes, pharmacy benefits manager, and third-party
administrator.� �Reporting entity� shall not include self-insured health
benefits plans governed by the provisions of the federal "Employee
Retirement Income Security Act of 1974" (29 U.S.C. s.1001 et seq.).
���� �Third party administrator�
means a person or entity that processes health insurance claims and pays claims
on behalf of a carrier without assumption of financial risk.� �Third party
administrator� shall include: (1) an entity not licensed as a carrier that is
not a subsidiary or affiliate of a carrier, that process claims on behalf of
the carrier; (2) an entity that is a subsidiary or affiliate of a carrier that,
as part of its purpose, processes claims on behalf of the carrier; and (3) an
entity that is a subsidiary or affiliate of a carrier that only processes
claims on behalf of a carrier other than an insurance company, health service
corporation, hospital service corporation, medical service corporation, or
health maintenance organization.� �Third party administrator� shall not include
a pharmacy benefits manager, collection agency, or subsidiary or affiliate of a
carrier that is formed solely for the purpose of processing and paying claims
on behalf of the carrier.
���� 2.��� a.� The department shall
establish an all-payer claims database for the purpose of collecting,
assessing, and reporting:
���� (1)�� medical claims,
including behavioral health claims;
���� (2)�� prescription drug
claims;
���� (3)�� dental and vision
claims;
���� (4)�� eligibility and
enrollment;
���� (5)�� information about health
care providers;
���� (6)�� non-claims payments; and
���� (7)�� other data related to
non-claims payments to health care providers.�
���� b.��� Pursuant to subsection
a., the department shall:
���� (1)�� oversee the planning,
implementation, and administration of the all-payer claims database;
���� (2)�� ensure that data
received is securely collected, compiled, and stored in accordance with State
and federal law;
���� (3)�� ensure that the database
is formatted in accordance with the most recent version of the All-Payer Claims
Database Council�s common data layout protocol;
���� (4)�� conduct audits of data
submitted by reporting entities to verify accuracy;
���� (5)�� publish data reported
pursuant to paragraph (1) of subsection d. of this section on a public
dashboard within the Internet website of the department; and
���� (6)�� maintain written
procedures for the administration of the all-payer claims database.� Pursuant
to this paragraph, the written procedures shall include but not be limited to:
���� (a)�� reporting requirements
for reporting entities; and
���� (b)�� requirements for
providing notice to a reporting entity regarding any alleged failure on the
part of the reporting entity to comply with the reporting requirements pursuant
to subparagraph (a) of this paragraph.
���� c.���� (1) The department
shall seek funding from the federal government and other public sources to
cover cost associated with the planning, implementation, and administration of
the all-payer claims database.
���� (2)�� (a)� The department
shall allow researchers and research institutions, after receiving a written
request from the researcher or research institution that is made in a form and
manner prescribed by the department, to access data collected through the all-payer
claims database established pursuant to subsection a. of this section, if:
���� (i)��� the researcher or
research institution has received approval to do specific research or
statistical work from an institutional review board;
���� (ii)�� the request for data
access is for a specified period; and
���� (iii)� the researcher or
research institution agrees in writing to protect the confidentiality of the
data pursuant to State and federal law.
���� (b)�� The department shall
collect a fee for each researcher or research institution seeking access
pursuant to subparagraph (a) of this paragraph, provided that the total fees
collected pursuant to this subparagraph do not exceed the cost of administering
the database.
���� d.��� (1)� Upon adoption of
the reporting requirements established pursuant to subparagraph (a) of
paragraph (6) of subsection b. of this section, a reporting entity shall report
data for inclusion in the all-payer claims database in a form and manner
prescribed by the department.
���� (2)�� A self-insured health
benefits plan governed by the provisions of the federal �Employee Retirement
Income Security Act of 1974� (29 U.S.C. s.1001 et seq.) may voluntarily report,
to the maximum extent that is permitted by federal law, data to the department
pursuant to paragraph (1) of this subsection.
���� e.���� (1) The department
shall utilize data in the all-payer claims database to provide covered persons
and potential covered persons with information concerning the cost and quality
of health care services for the purpose of allowing covered persons to make economically
sound and medically appropriate health care decisions.�
���� (2)�� Any disclosures of the
data within the all-payer claims database made pursuant to paragraph (5) of
subsection b. of this section shall be made in a manner to protect the
confidentiality of the data pursuant to State and federal law.�
���� (3)�� To effectuate the
provisions of paragraph (1) of this subsection, data submitted pursuant to
paragraph (1) of subsection e. of this section shall include a unique
longitudinal identifier for the use of each covered person to track health care
usage over time.
���� f.���� The department may
enter into a contract with a private entity or entities to plan, implement, or
administer the all-payer claims database.
���� g.��� Nothing in this section,
and no action taken by the department pursuant to this section, shall be
construed to preempt, supersede, or affect the authority of the Department of
Banking and Insurance.
���� 3.��� The Commissioner of Health
may, after notice and hearing, impose a civil penalty on any reporting entity
that fails to report health insurance information as prescribed pursuant to paragraph
(1) of subsection d. of section 2 of this act, in an amount that is not to exceed
$1,000 per day that the violation continues.� All penalties assessed under this
section shall be payable to the department and may be recovered with costs in a
summary proceeding commenced by the commissioner pursuant to the �Penalty
Enforcement Law of 1999,� P.L.1999, c.274 (C.2A:58-10 et seq.).
���� 4.��� The department shall promulgate
rules and regulations, pursuant to the �Administrative Procedure Act,�
P.L.1968, c.410 (C.52:14B-1 et seq.) and in consultation with the Department of
Banking and Insurance, to effectuate the provisions of this act.
���� 5.��� This act shall take
effect on the first day of the thirteenth month next following enactment.
STATEMENT
���� This bill establishes an
all-payer claims database.
���� Under the bill, DOH will be
required to oversee the planning, implementation, and administration of an
all-payer claims database for the purpose of collecting, assessing, and
reporting:
���� (1)�� medical claims,
including behavioral health claims;
���� (2)�� prescription drug
claims;
���� (3)�� dental and vision
claims;
���� (4)�� eligibility and
enrollment;
���� (5)�� information about health
care providers;
���� (6)�� non-claims payments; and
���� (7)�� other data related to
non-claims payments to health care providers.�
���� The department will:
���� (1)�� ensure that data
received is securely collected, compiled, and stored in accordance with State
and federal law;
���� (2)�� ensure that the database
is formatted in accordance with the most recent version of the All-Payer Claims
Database Council�s common data layout protocol;
���� (3)�� conduct audits of data
submitted by reporting entities to verify accuracy;
���� (4)�� publish data reported
pursuant to the bill on a public dashboard within the Internet website of the
department; and
���� (5)�� maintain written
procedures for the administration of the all-payer claims database.�
���� The bill requires reporting
entities to report data for inclusion in the all-payer claims database in the
form and manner to be prescribed by the department. The bill also allows a
self-insured health benefits plan governed by the provisions of the federal
�Employee Retirement Income Security Act of 1974� (29 U.S.C. s.1001 et seq.) to
voluntarily report data to the all-payer claims database, to the maximum extent
that is permitted by federal law.
���� The bill also requires the
department to utilize data in the all-payer claims database to provide covered
persons with information concerning the cost and quality of health care
services for the purpose of allowing covered persons to make economically sound
and medically appropriate health care decisions.� To achieve this, data
submitted to the all-payer claims database under this bill will include a
unique longitudinal identifier for the use of each covered person to track
health care usage over time.
���� Finally, the commissioner of
the department may, after notice and hearing, impose a penalty on any reporting
entity that fails to report health insurance information as prescribed pursuant
to the bill, not to exceed $1,000 per day that the violation continues.�
���� For the purposes of this bill:
���� �All-payer claims database�
means a database that receives and stores data from a reporting entity
concerning health insurance claims, prescription drug claims, and other health
insurance claims information from covered persons.� �All-payer claims database�
shall also include data concerning health care provider information such as the
provider�s name, specialty, and practice address.
���� �Reporting entity" means
a carrier, health care provider licensed pursuant to Title 45 or Title 26 of
the Revised Statutes, pharmacy benefits manager, and third-party
administrator.� �Reporting entity� shall not include self-insured health
benefits plans governed by the provisions of the federal "Employee
Retirement Income Security Act of 1974" (29 U.S.C. s.1001 et seq.).