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 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 the verification of provider eligibility and claims inactivity reports. MCO contractors that fail to comply with these requirements will face fines starting at $50,000 for each infraction, and repeated non-compliance could result in a ban from contracting with the department for up to five years. Additionally, the bill mandates an annual report to the Legislature and a follow-up audit by the Office of State Auditor three years post-enactment to evaluate the effectiveness of the oversight program.