Bill Text: NJ S3590 | 2022-2023 | Regular Session | Introduced
Bill Title: Provides for enrollment as NJ FamilyCare provider in conjunction with licensure application; Requires health insurance carriers to determine provider enrollment within six months of application.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2023-02-13 - Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee [S3590 Detail]
Download: New_Jersey-2022-S3590-Introduced.html
Sponsored by:
Senator ANDREW ZWICKER
District 16 (Hunterdon, Mercer, Middlesex and Somerset)
SYNOPSIS
Provides for enrollment as NJ FamilyCare provider in conjunction with licensure application; Requires health insurance carriers to determine provider enrollment within six months of application.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning provider enrollment, supplementing Title 30 of the Revised Statute, and amending P.L.1997, c.192.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. (New section) a. Within 365 days of the effective date of this act, the Division of Medical Assistance and Health Services in the Department of Human Services, in collaboration with the State Board of Medical Examiners, shall develop and implement a streamlined process for a physician to enroll as an NJ FamilyCare provider and to apply for State licensure in a single application.
b. For all applications submitted pursuant to subsection a. of this section:
(1) the State Board of Medical Examiners shall provide the Division of Medical Assistance and Health Services with a copy of the applicant's license, within five days of issuing the license to the applicant. If the applicant is not approved for licensure, the State Board of Medical Examiners shall provide the Division of Medical Assistance and Health Services with the appropriate documentation within five days of the determination; and
(2) to the extent possible and in accordance with the documentation submitted with the application, the Division of Medical Assistance and Health Services shall immediately begin to process the portion of the application regarding NJ FamilyCare provider enrollment. Within 10 days of receiving an applicant's licensure from the State Board of Medical Examiners, the division shall notify an applicant in writing, if applicable, of any additional information or documentation required by the division to enroll the applicant as an approved NJ FamilyCare physician.
c. The provisions of this act shall not be construed to alter the application requirements for State licensure or the enrollment requirements for a NJ FamilyCare provider.
d. As used in this act, "NJ FamilyCare" means the program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), which includes the Medicaid program and the Children's Health Insurance Program.
2. Section 7 of P.L.1997,c.192 (C.26:2S-7) is amended to read as follows:
7. Each application for participation by a licensed health care professional that is submitted to a carrier which offers a managed care plan shall be reviewed by a committee of the carrier that includes appropriate representation of health care professionals with knowledge in the applicant's scope of professional practice. The committee shall provide an applicant for participation a notice of determination within six months of receiving an application.
(cf: 1997, c.192, s.7)
3. This act shall take effect immediately.
STATEMENT
Under the bill, within 365 days of its effective date, the Division of Medical Assistance and Health Services (division) in the Department of Human Services, in collaboration with the State Board of Medical Examiners, is required to develop and implement a streamlined process for a physician to enroll as an NJ FamilyCare provider and to apply for State licensure in a single application.
For all applications submitted under the bill, the State Board of Medical Examiners is to provide the division with a copy of the applicant's license, within five days of issuing the license to the applicant. If the applicant is not approved for licensure, the bill directs the State Board of Medical Examiners to provide the division with the appropriate documentation within five days of the determination.
Moreover, to the extent possible and in accordance with the documentation submitted with the application, the bill directs the division to immediately begin to process the portion of the application regarding NJ FamilyCare provider enrollment. Within 10 days of receiving an applicant's licensure from the State Board of Medical Examiners, the division is to notify an applicant in writing, if applicable, of any additional information or documentation required by the division to enroll the applicant as an approved NJ FamilyCare physician.
The bill explicitly provides that these provisions of the bill are not to be construed to alter the application requirements for State licensure or the enrollment requirements for a NJ FamilyCare provider.
The bill also amends the "Health Care Quality Act" to require the committee of a carrier, which reviews applications submitted by licensed health care professionals for participation in a carrier's plan, to provide an applicant for participation a notice of determination within six months of receiving an application. Under existing law, "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.
