Legislation


S 1095 – New Jersey

Status: Inactive / Dead
Year Introduced: 2020
Link: https://www.njleg.state.nj.us/bills/BillView.asp?BillNumber=S1095

Requires audits of managed care plan provider networks. The bill provides specifically that a carrier which offers a managed care plan must provide for an annual audit of its provider network, at its own expense, by a private auditing firm. If the audit finds that a carrier failed to maintain an adequate network in accordance with applicable federal or State law, including specialists as enumerated in N.J.A.C.11:24-6.2, the Commissioner of Banking and Insurance is to impose a civil penalty of not less than $500 nor more than $10,000 upon the carrier for each instance in which the audit determines that the carrier failed to maintain an adequate network. A carrier that has failed to maintain an adequate network is prohibited from delivering, executing, or renewing health benefits plans in this State if the carrier does not comply with the requirements set forth in this bill within 90 days of the imposition of the civil penalty.


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