On Thursday, Chol Hamoed, the Assembly Financial Institutions and Insurance Committee is scheduled to discuss a bill that would delineate the requirements of health insurance carriers to provide an adequate network of physicians.
This bill could affect families with children with special medical needs - and comments from the public are welcome and may be submitted online.
The bill is A4485, and it is sponsored by Assemblyman Herb Conway Jr. (District 7) and Assemblywoman Angela McKnight (District 31).
The bill defines "Carrier" to mean 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, and shall include the State Health Benefits Program, the School Employees’ Health Benefits Program, the Medicaid program, and a Medicaid managed care organization.
Under the bill, a carrier is required to ensure that a network have a sufficient number of physicians to ensure that 100 percent of covered persons reside no more than:
(1) a 20 minute drive or 10 miles, whichever is less, from at least three primary care physicians within each type of primary care specialty as defined in the bill and within the geographic boundaries of the State; and
(2) a 30 minute drive or 15 miles, whichever is less, from at least three office-based medical specialists within each specialty as defined in the bill and within the geographic boundaries of the State.
Under the bill, a network will be required to have a sufficient number of physicians to:
(1) meet the health needs of covered persons;
(2) provide an appropriate choice of physicians sufficient to render services covered by the health benefits plan; and
(3) reasonably ensure that covered persons have timely access to in-network facilities. (Requests for a routine appointment are to be scheduled within two weeks; and requests for a routine physical examination are to be scheduled within three months.)
The bill provides that a carrier will be required to submit a plain language description of the network to the commissioner with information sufficient to allow the commissioner to determine whether the network is in compliance with the provisions of the bill. The commissioner will investigate the information supplied in the description to ensure compliance. Annually thereafter, the carrier will be required to submit an updated, plain language description of the network to the commissioner and must certify that the network described remains compliant with the provisions of the bill.
Additionally, the bill requires the Commissioner of Banking and Insurance and the Commissioner of Human Services to establish a system by which a covered person may file a formal complaint concerning network adequacy with the Department of Banking and Insurance or the Department of Human Services. The bill also requires a carrier to display the plain language description of each network available to the public in a conspicuous location within its internet website within 20 days of the submission of the description to the commissioner.
If passed by the Legislature and signed into law by the governor, the bill will take effect on the first day of the third month next following the date of enactment.
An individual interested in registering their position with the Committee may fill out the Registration Form located on the New Jersey Legislature Home Page under the applicable Committee heading. For those individuals who wish to testify, please check the box "Do you wish to testify?" on the Registration Form. The Registration Link will close at 3:00 PM, Wednesday, October 12, 2022. An individual is not required to pre-register in order to register their position with the Committee. Witness slips will be available in the Committee Room and written testimony will be accepted at the Committee Meeting.
Members of the public may also submit comments at https://www.njleg.state.nj.us/committees/assembly-committees/contact?committee=ASE
Last fall, Governor Murphy signed into law S3000 which codified and established similar network adequacy standards for pediatric primary and specialty care in Medicaid programs. That bill was a major relief for Lakewood families with children with special needs who relied on the specialty services provided by CHOP in Philadelphia.
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