Bill Text: NJ A4394 | 2016-2017 | Regular Session | Introduced
Bill Title: Establishes New Jersey Commission on Health Insurance Network Adequacy.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2016-12-12 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A4394 Detail]
Download: New_Jersey-2016-A4394-Introduced.html
Sponsored by:
Assemblyman GARY S. SCHAER
District 36 (Bergen and Passaic)
SYNOPSIS
Establishes New Jersey Commission on Health Insurance Network Adequacy.
CURRENT VERSION OF TEXT
As introduced.
An Act establishing a commission to review and make recommendations regarding health insurance network adequacy regulations.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. There is established the New Jersey Commission on Health Insurance Network Adequacy. The purpose of this commission is to review the network adequacy regulations adopted by the Department of Banking and Insurance pursuant to section 19 of P.L.1997, c.192 (C.26:2S-18) establishing standards for adequacy of a provider network with respect to the scope and type of health care benefits provided by a carrier, the geographic service area covered by the provider network, and access to medical specialists. The review shall evaluate the appropriateness and effectiveness of those regulations in maintaining those standards and include an assessment of:
a. the current network adequacy standards in the State; examples implemented in other states; and section 5 of the National Association of Insurance Commissioners' Health Benefit Plan Network Access and Adequacy Model Act, which provides specific provisions relating to network adequacy; and
b. the adequacy of access to various medical specialties in each region of the State, including, but not limited to, access to behavioral health care specialists and facilities.
2. a. The commission shall consist of thirteen members as follows:
(1) the Commissioner of Banking and Insurance, or the commissioner's designee, who shall serve ex officio;
(2) one member of the Senate, to be appointed by the President of the Senate; and one member of the General Assembly, to be appointed by the Speaker of the General Assembly; and
(3) ten public members, who shall be appointed by the Governor no later than the 60th day after the effective date of this act, as follows: one person representing employers and the business community; one person representing general health care consumers; one person representing behavioral health care consumers; one person representing hospitals; one person representing safety net hospitals; two people representing the insurance industry; one person representing the long-term care insurance industry; one person representing general health care providers; and one person representing behavioral health care providers.
b. The commission shall organize as soon as practicable following the appointment of its members and shall select a chairperson and a vice-chairperson from among the members. The chairperson shall appoint a secretary who need not be a member of the commission.
c. The public members shall serve without compensation, but shall be reimbursed for necessary expenses incurred in the performance of their duties and within the limits of funds available to the commission.
d. The commission shall be entitled to call to its assistance and avail itself of the services of the employees of any State, county or municipal department, board, bureau, commission or agency it may require and as may be available to it for its purposes.
e. The commission may meet and hold hearings at the places it designates during the sessions or recesses of the Legislature.
f. The Office of Legislative Services shall provide staff support to the commission.
g. Vacancies in the membership of the commission shall be filled in the same manner provided for the original appointments.
3. The commission shall report its findings and recommendations as determined by a majority of the commission's members to the Governor and Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1) no later than 12 months after the date of organization of the commission. The findings and recommendations shall include any proposed modifications to any department rules or regulations, and if recommended, any proposals for legislation necessary to improve or maintain adequate access to medical specialists, facilities, and other health care services for covered persons throughout the State. Any findings and recommendations determined by a minority of the commission's members may be included in the report and shall be reported as such.
4. This act shall take effect immediately and shall expire upon the issuance of the commission report.
STATEMENT
This bill establishes the New Jersey Commission on Health Insurance Network Adequacy. The purpose of this commission is to review the network adequacy regulations adopted by the Department of Banking and Insurance pursuant to section 19 of P.L.1997, c.192 (C.26:2S-18), which is part of the "Health Care Quality Act." These regulations, which have remained substantially unchanged since their adoption in 1999, establish standards for adequacy of a provider network with respect to the scope and type of health care benefits provided by a carrier, the geographic service area covered by the provider network, and access to medical specialists. The commission's goal is to evaluate the appropriateness and effectiveness of those regulations in maintaining network adequacy standards, including the assessment of:
(1) the current network adequacy standards in the State; examples implemented in other states; and section 5 of the National Association of Insurance Commissioners' Health Benefit Plan Network Access and Adequacy Model Act, which provides specific provisions relating to network adequacy; and
(2) the adequacy of access to various medical specialties in each region of the State, including, but not limited to, access to behavioral health care specialists and facilities.
The commission will be comprised of thirteen members as follows: the Commissioner of Banking and Insurance, or the commissioner's designee; one member of the Senate appointed by the President of the Senate; one member of the General Assembly appointed by the Speaker of the General Assembly; and ten public members appointed by the Governor. In order to provide the expertise in issues relating to the work of the commission, the Governor's appointees are to include one individual representing each of the following: employers and the business community; general health care consumers; behavioral health care consumers; hospitals; safety net hospitals; the long-term care insurance industry; general health care providers; and behavioral health care providers. In addition, the Governor's appointees are to include two people representing the insurance industry.
The commission is to report its findings and recommendations as determined by a majority of the members to the Governor and Legislature no later than 12 months after the date of organization of the commission. The findings and recommendations are to include any proposed modifications to any department rules or regulations, and if recommended, any proposals for legislation necessary to improve or maintain adequate access to medical specialists, facilities, and other health care services for covered persons throughout the State. Any findings and recommendations determined by a minority of the commission's members may be included in the report, but are required to be reported as such. The commission will expire upon the issuance of its report.
