NJ
New Jersey Assembly Bill A3574

New Jersey 2024-2025 Regular Session

New Jersey Assembly Bill A3574

Introduced
2/8/24  

Caption

Establishes Medicaid Managed Care Organization Oversight Program.

Impact

If enacted, A3574 will impose rigorous reporting requirements on MCO contractors, mandating them to submit updated provider and beneficiary data quarterly. This information is essential for the MCO Oversight Program to assess whether beneficiaries are receiving the necessary healthcare services and to maintain network adequacy. The bill also mandates the establishment of an independent verification system to confirm that at least 20% of the provider contact information is accurate and ensures that a substantial portion of providers listed in the directories are eligible Medicaid providers, thus enhancing the accountability of MCOs and improving care accessibility for enrollees.

Summary

Assembly Bill A3574 aims to establish a Medicaid Managed Care Organization (MCO) Oversight Program under the Division of Medical Assistance and Health Services within the New Jersey Department of Human Services. This initiative is driven by the necessity for enhanced oversight of the care provision to beneficiaries of the NJ FamilyCare and Medicaid programs. The findings from a state audit highlighted significant deficiencies in access to healthcare services managed by the MCOs, prompting the need for legislative action to rectify these issues. Notably, the audit reported inadequate access to acute care hospital services and dental providers, as well as the failure of MCOs to maintain accurate online provider directories.

Contention

There are potential points of contention surrounding the enforcement provisions within A3574. The bill outlines strict penalties for MCO contractors, including fines of no less than $50,000 for failing to comply with reporting requirements. Additionally, noncompliance may lead to a five-year ban from contracting with the department following an administrative hearing. Critics may argue that such measures could lead to restrictions on MCO operations, potentially impacting overall service delivery, while proponents advocate for stronger oversight to ensure that these organizations adhere to quality care standards.

Companion Bills

NJ S1818

Same As Establishes Medicaid Managed Care Organization Oversight Program.

NJ A4467

Carry Over Establishes Medicaid Managed Care Organization Oversight Program.

Previously Filed As

NJ S1818

Establishes Medicaid Managed Care Organization Oversight Program.

NJ A4467

Establishes Medicaid Managed Care Organization Oversight Program.

NJ A2491

Requires all Medicaid managed care organizations to permit all pharmacies in State to dispense prescriptions for all covered medications.

NJ A2332

Requires all Medicaid managed care organizations to permit all pharmacies in State to dispense prescriptions for all covered medications.

NJ S1076

Requires all Medicaid managed care organization to permit all pharmacies in State to dispense prescriptions for all covered medications.

NJ A2064

Requires Medicaid and NJ FamilyCare managed care organizations to offer patient-centered medical home model or other alternative payment model to primary care providers.

NJ A1250

Requires Medicaid and NJ FamilyCare managed care organizations to offer patient-centered medical home model or other alternative payment model to primary care providers.

NJ S2821

Requires Medicaid and NJ FamilyCare managed care organizations to offer patient-centered medical home model or other alternative payment model to primary care providers.

NJ A1409

Requires Medicaid fee-for-service coverage of managed long term services and supports when beneficiary is pending enrollment in managed care organization.

NJ S413

Requires Medicaid fee-for-service coverage of managed long term services and supports when beneficiary is pending enrollment in managed care organization.

Similar Bills

NJ S1818

Establishes Medicaid Managed Care Organization Oversight Program.

NJ A4467

Establishes Medicaid Managed Care Organization Oversight Program.

NJ A4838

Requires prescription drug coverage for serious mental illness without prior authorization or utilization management, including step therapy.

NJ S1192

Requires prescription drug coverage for serious mental illness without prior authorization or utilization management, including step therapy.

NJ A5661

Requires prescription drug coverage for serious mental illness without prior authorization or utilization management, including step therapy.

NJ S2118

Requires DHS to conduct annual Medicaid eligibility redeterminations.

NJ A3678

Requires DHS to conduct annual Medicaid eligibility redeterminations.

NJ S3438

Requires Medicaid coverage for motorized wheelchairs for nursing facility residents under certain circumstances.