Schaer Introduces Legislation to Make Sure New Jersey’s Health Insurance Networks Meet Consumers’ Needs

Assemblyman Gary Schaer introduced legislation this week to help ensure New Jersey’s health insurance networks are meeting the changing needs of healthcare in the 21st century.

Schaer’s legislation would establish the New Jersey Commission on Health Insurance Network Adequacy in order to review the state’s network adequacy regulations, which were adopted by the Department of Banking and Insurance in 1999 and have remained substantially unchanged since.

These regulations establish standards for adequacy of a provider network with respect to the scope and type of health care benefits provided by a carrier, the geographic service area covered by the provider network, and access to medical specialists.

Schaer developed the bill after holding numerous stakeholder meetings with healthcare organizations, providers, hospitals, insurance groups, and consumer groups.

“Through these meetings, it became clear that there are access issues within both behavioral healthcare and general healthcare networks,” said Schaer (D-Bergen/Passaic). “However, we heard a number of differing opinions and information on the root of the issue and how to ensure the scope and breadth of healthcare networks is comprehensive enough to meet today’s needs. This commission will take a much-needed and long overdue look at network adequacy regulations in New Jersey. My hope is that the commission will develop a blueprint for needed changes that will provide quicker, more reliable, and more accessible care for every resident seeking in-network treatment.”

The commission’s goal would be to evaluate the appropriateness and effectiveness of those regulations in maintaining network adequacy standards, including the assessment of:
1) the current network adequacy standards in the State; examples implemented in other states; and section 5 of the National Association of Insurance Commissioners’ Health Benefit Plan Network Access and Adequacy Model Act, which provides specific provisions relating to network adequacy; and
2) the adequacy of access to various medical specialties in each region of the State, including, but not limited to, access to behavioral health care specialists and facilities.

The commission will be comprised of thirteen members as follows: the Commissioner of Banking and Insurance, or the commissioner’s designee; one member of the Senate appointed by the President of the Senate; one member of the General Assembly appointed by the Speaker of the General Assembly; and ten public members appointed by the Governor with expertise in issues relating to the work of the commission.

The commission is to report its findings and recommendations, as determined by a majority of the members, to the Governor and Legislature no later than 12 months after its organization, including any proposed modifications to any department rules or regulations, and if recommended, any proposals for legislation necessary to improve or maintain adequate access to medical specialists, facilities, and other health care services for covered persons throughout the state. Any findings and recommendations determined by a minority of the commission’s members may be included in the report, but are required to be reported as such.

The commission would expire upon the issuance of its report.