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 to enhance the accessibility and quality of health care for individuals enrolled in the NJ FamilyCare and Medicaid programs. The initiative arises from an audit conducted by the Office of the State Auditor, which revealed that MCOs were failing to provide adequate access to necessary services, maintain accurate provider directories, and report claims inactivity. To address these issues, the bill mandates that each MCO contractor submit updated provider and beneficiary data quarterly, share beneficiary information with county welfare offices, and implement an independent verification system to ensure the accuracy of the information provided.

Furthermore, the bill imposes penalties for non-compliance, including a minimum fine of $50,000 for each failure to submit required information, with the potential for MCO contractors to be barred from participation for up to five years if fines are not paid. The Medicaid MCO Oversight Program will also require annual verification of provider eligibility and panel sizes, ensuring that MCOs adhere to established criteria. An annual report will be submitted to the Legislature, and a follow-up audit will be conducted three years post-enactment to assess the effectiveness of the oversight measures.