Sponsored by:
Senator JOSEPH F. VITALE
District 19 (Middlesex)
SYNOPSIS
Requires Medicaid and health insurance network contracts to provide participating health care providers with certain notifications.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning managed care plan contracts 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. The contract between a participating health care provider and a carrier or the State Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) or the FamilyCare Health Coverage Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.) that offers a managed care plan shall require the carrier or program to provide a participating health care provider with notice, at least six months in advance, of any change in the policy that could result in the denial of coverage for services provided by the provider to a covered person.
As used in this section, 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 and the School Employees' Health Benefits Program.
2. This act shall take effect on the 120th day next following enactment and shall apply to contracts entered into or renewed after that date.
STATEMENT
This bill requires a contract between a health care provider and a carrier that offers a managed care plan or the State Medicaid program or FamilyCare Health Coverage Program to require the carrier or program to provide a participating health care provider with notice at least six months in advance of any change in the policy that could result in the denial of coverage for services provided by the provider to a covered person.
As used in 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 shall include the State Health Benefits Program and the School Employees' Health Benefits Program.