New Jersey Assembly Bill A2610

New Jersey 2022-2023 Regular Session

• Introduced: 2/14/22
• Refer: 2/14/22

Caption

Requires DOBI to develop system to require carriers to consult with health care providers on tiered network managed care plans.

Impact

Upon enactment, A2610 would amend the existing Health Care Quality Act by requiring health insurance carriers to disclose various details about their tier placement criteria. Insurance providers would need to submit comprehensive information to the Commissioner, such as the methodologies used to determine tier placement, the objective standards considered, and the projected impact of these standards on the adequacy of their networks. This would significantly affect how managed care plans operate in New Jersey and could lead to improvements in care accessibility and quality for patients enrolled in these plans.

Summary

Assembly Bill A2610, introduced in New Jersey, aims to establish a tiered network review system for health insurance carriers offering managed care plans. The bill mandates that before any tiered network plan can be offered, the Commissioner of Banking and Insurance must arrange consultations with health care providers. This consultation process is designed to enhance transparency and ensure that the selection standards used for placing health care providers into tiers are adequately reviewed by both experts and the public. The bill's intent is to address concerns regarding the adequacy and fairness of tiered networks in managed care plans.

Contention

The introduction of A2610 has sparked discussions among stakeholders in the healthcare and insurance industries. Proponents argue that increased oversight in the tier placement process will enhance network adequacy and patient care, while opponents express concerns about potential administrative burdens on insurance carriers. There is apprehension that overly rigid standards might limit the flexibility necessary for carriers to manage costs and innovate in their service offerings. The ongoing debate signifies the need to balance regulatory oversight with the operational realities faced by health insurance providers.