This bill establishes a Medicaid Managed Care Organization (MCO) Oversight Program within the Division of Medical Assistance and Health Services in the New Jersey 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 services, including inadequate access to hospital networks 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, MCOs 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 potential for a five-year ban from contracting with the department for persistent offenders. 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.