A 3574 New Jersey General Assembly · 2024-2025 Regular Session

Establishes Medicaid Managed Care Organization Oversight Program.

This bill establishes a Medicaid Managed Care Organization (MCO) Oversight Program within New Jersey's Department of Human Services to ensure quality care for Medicaid and NJ FamilyCare enrollees. It requires MCOs (the five private insurers contracted to provide care) to submit quarterly data on providers and beneficiaries, including updated contact information and directory accuracy. The program must independently verify 20% of provider location data annually and confirm all directory providers are Medicaid-eligible, while also checking that provider panel sizes comply with limits. MCOs failing to submit required data face minimum $50,000 fines per violation, with potential contract termination after an administrative hearing.
Bill status in committee 1 of 4 stages cleared
Introduction
Feb 2024
Committee Review
Floor Vote
Governor
Introduced Feb 8, 2024 Last action Feb 8, 2024
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Feb 8, 2024
Introduced
Introduced in the Assembly, Referred to Assembly Aging and Human Services Committee
lower
3 primary · 0 co-sponsors

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