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Bill

Bill

A 5087

Establishes all-payer claims database.

2026-2027 Regular Session

Establishes a state all-payer claims database to collect, publish cost and quality data from multiple payers, guiding consumer choices and research.

Introduced, Referred to Assembly Financial Institutions and Insurance Committee
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Bill Summary · A 5087

Summary of Bill A-5087 (Session 222) – New Jersey

Purpose and intent

  • Establishes an all-payer claims database (APCD) to collect, assess, and publish comprehensive health care data.
  • Aims to provide transparent information on the cost and quality of health care services to help covered individuals make informed health care decisions.

Key provisions and changes

  • Definition and scope
    • Creates an official all-payer claims database (APCD) and defines related terms:
    • APCD: a database that stores health insurance claims data (medical, prescription drug, dental, vision, etc.), plus information about health care providers (name, specialty, address) and non-claims payments.
    • Reporting entity: carriers, licensed health care providers, pharmacy benefits managers, and third-party administrators. Excludes self-insured plans under ERISA from mandatory reporting (though voluntary reporting is allowed to the extent permitted by federal law).
    • Longitudinal identifier: a unique, persistent token to link a covered person’s claims data over time.
  • Data collected by the APCD (Section 2a)
    • Medical claims (including behavioral health)
    • Prescription drug claims
    • Dental and vision claims
    • Eligibility and enrollment data
    • Health care provider information
    • Non-claims payments and other related data
  • Department responsibilities (Section 2b)
    • The Department of Health (DOH) shall plan, implement, and administer the APCD.
    • Ensure secure data collection, storage, and compliance with state and federal law.
    • Align data formats with the All-Payer Claims Database Council’s common data layout protocol.
    • Audit data submissions for accuracy.
    • Publish data on a public dashboard accessible via the department’s website.
    • Maintain written procedures for APCD administration, including reporting requirements and notices for noncompliance.
  • Funding and research access (Section 2c)
    • Seek funding from federal and other public sources to cover planning, implementation, and ongoing administration.
    • Researchers may access APCD data after obtaining IRB approval, for a defined period, and agreeing to confidentiality protections.
    • The department may charge a fee for researcher access, capped to cover administration costs.
  • Reporting requirements and voluntary participation (Section 2d)
    • After DOH adopts reporting requirements, reporting entities must submit data in the form prescribed.
    • Self-insured plans under ERISA may voluntarily report data to the extent allowed by federal law.
  • Use of data for consumers (Section 2e)
    • DOH must use APCD data to provide information on the cost and quality of health care to help consumers choose economically sound, medically appropriate care.
    • Disclosures must protect confidentiality per state and federal law.
    • Data disclosed for consumer use must include a longitudinal identifier to track usage over time.
  • Contracting authority (Section 2f)
    • DOH may contract with private entities to plan, implement, or administer the APCD.
  • Non-preemption (Section 2g)
    • The act does not preempt or affect the authority of the Department of Banking and Insurance.
  • Penalties (Section 3)
    • The Commissioner of Health may impose civil penalties up to $1,000 per day on reporting entities that fail to report as required.
    • Penalties are payable to the DOH and enforceable under the Penalty Enforcement Law of 1999.
  • Rules and regulations (Section 4)
    • DOH must promulgate rules and regulations, in consultation with the Department of Banking and Insurance, to implement the act.
  • Effective date (Section 5)
    • The act takes effect on the first day of the thirteenth month after enactment.

Who would be affected

  • Reporting entities: Carriers, licensed providers and facilities, pharmacy benefits managers, and third-party administrators would be required (or allowed to voluntarily report, where applicable) data to the APCD.
  • Self-insured plans (ERISA): Mandatory reporting is not required, but voluntary reporting is permitted to the extent allowed by federal law.
  • Consumers/covered persons: Individuals with health benefits could benefit from cost and quality information derived from the APCD, aiding decision-making.
  • Researchers and institutions: Access to de-identified or appropriately protected APCD data for approved research, subject to IRB approval and cost-recovery fees.
  • State agencies: Department of Health would administer and oversee the APCD; potential interactions with the Department of Banking and Insurance due to regulatory cross-overs.

Procedural and timeline aspects

  • Establishment and administration of the APCD by DOH, with audits, secure data handling, and a public dashboard.
  • Adoption of reporting requirements by DOH before reporting entities must submit data (timeline to be determined within the rulemaking process).
  • Penalty framework in place for noncompliance, up to $1,000 per day.
  • Funding discussions with federal and public sources to support implementation.
  • Rulemaking to occur under the Administrative Procedure Act, with coordination with the Department of Banking and Insurance.
  • Effective date: begins 13 months after enactment.

Practical implications

  • Moves New Jersey toward centralized, transparent health data to enhance cost and quality transparency for consumers.
  • Creates potential for improved health cost containment, provider performance insights, and research opportunities, while safeguarding privacy under existing laws.
  • Compliance burden on reporting entities will depend on final reporting specifications and phased implementation.

Compiled from official sources — confirm details with the bill’s official record.

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