Bill Text: NJ A4495 | 2014-2015 | Regular Session | Introduced
Bill Title: Requires health care facilities make efforts to ensure inclusion in managed care plan networks.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2015-06-04 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A4495 Detail]
Download: New_Jersey-2014-A4495-Introduced.html
Sponsored by:
Assemblywoman SHAVONDA E. SUMTER
District 35 (Bergen and Passaic)
SYNOPSIS
Requires health care facilities make efforts to ensure inclusion in managed care plan networks.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning 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. A health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et al.) shall make reasonable efforts to ensure that the facility is included as a participating provider in each managed care plan offered in the State, and shall make reasonable efforts to ensure that physicians and other licensed health professionals who are under contract to, or have another arrangement with, the facility are included as participating providers in each managed care plan offered in the State.
b. A carrier or an affiliated entity of a carrier that offers a managed care plan in the State shall not deny a health care facility or a licensed health care professional 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 facility or professional is willing to meet the terms and conditions of the provider contract offered by that carrier or entity to its participating health care providers.
c. Nothing in this section shall be construed to require or authorize a health care facility to terminate a contract or other arrangement with a licensed health care professional solely on the basis that the professional is not included as a participating provider in a managed care plan.
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 first day of the fourth month next following the date of enactment.
STATEMENT
This bill requires licensed health care facilities to make reasonable efforts to ensure that the facility is included as a participating provider in every managed care plan made available in the State, and to make reasonable efforts to ensure that any licensed health care professionals under contract with or otherwise affiliated with the facility are also included as participating providers. Facilities would not be permitted or required to terminate a contract or arrangement with a licensed health care professional solely on the basis that the professional is not included as a participating provider in a managed care plan.
The bill additionally provides that health insurance plans may not deny a health care facility or health care professional 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 facility or professional is willing to meet the terms and conditions of the provider contract offered by the carrier or entity to participating health care providers.
It is the sponsor's belief that facilitating access to needed in-network health care will help reduce the burden of health care costs and ensure patients have access to affordable services and treatment options.
