This bill establishes a Medicaid Managed Care Organization (MCO) Oversight Program within the Division of Medical Assistance and Health Services in the Department of Human Services. The program aims to ensure accessible and quality health care for individuals enrolled in the NJ FamilyCare and Medicaid programs. Following an audit that revealed significant deficiencies in the MCOs' provision of care, including inadequate access to hospital services and inaccurate provider directories, the bill mandates that each MCO contractor submit updated provider and beneficiary data quarterly. This data will be used to assess network adequacy and ensure that MCOs meet their contractual obligations.

To enhance oversight, the bill requires the establishment of an independent verification system to annually confirm the accuracy of the information provided by MCO contractors, including a minimum verification of 20% of provider data. Additionally, MCO contractors must report claims inactivity and ensure that provider panel sizes do not exceed established criteria. Non-compliance will result in fines of at least $50,000 for each failure to submit required information, with the possibility of barring non-compliant MCOs from contracting for up to five years. An annual report will be submitted to the Legislature, and a follow-up audit will be conducted three years post-enactment to evaluate the effectiveness of the oversight program.