Bill Text: NJ A4247 | 2010-2011 | Regular Session | Introduced
Bill Title: Prohibits insurers offering managed care plans from denying participation in network to health care providers willing to meet terms of contract.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2011-11-10 - Introduced, Referred to Assembly Regulated Professions Committee [A4247 Detail]
Download: New_Jersey-2010-A4247-Introduced.html
Sponsored by:
Assemblyman RUBEN J. RAMOS, JR.
District 33 (Hudson)
SYNOPSIS
Prohibits insurers offering managed care plans from denying participation in network to health care providers willing to meet terms of contract.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning participation by health care providers in managed care plan networks 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. A carrier or an affiliated entity of a carrier that offers a managed care plan including, but not limited to, a certified organized delivery system and a licensed organized delivery system as defined in section 1 of P.L.1999, c.409 (C.17:48H-1), shall not deny a health care provider the right to enter into a contract to participate in the carrier's or entity's network of health care providers if that health care provider is willing to meet the terms and conditions of the provider contract offered by that carrier or entity to its participating health care providers.
2. The Commissioner of Banking and Insurance, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations necessary to effectuate the purposes of this act.
3. This act shall take effect on the 180th day after enactment, but the Commissioner of Banking and Insurance may take such anticipatory administrative action in advance as shall be necessary for the implementation of the act.
STATEMENT
This bill prohibits a carrier that offers a managed care plan and an affiliated entity of a carrier that offers a managed care plan from denying a health care provider the right to enter into a contract to participate in the carrier's or entity's network of health care providers if that health care provider is willing to meet the terms and conditions of the provider contract offered by that carrier or entity to its participating health care providers. The bill also provides that an affiliated entity of a carrier includes, but is not limited to, a certified organized delivery system and a licensed organized delivery system as defined in section 1 of P.L.1999, c.409 (C.17:48H-1).
