Bill
A 2804
DHS and SBME must develop a streamlined process to speed NJ FamilyCare provider enrollment by sharing license numbers within 5 days and expediting reviews.
Title: Requires DHS and State Board of Medical Examiners to develop and implement a process to improve efficiency of reviewing NJ FamilyCare provider applications
Status and Timeline
- Introduced: January 9, 2024
- Passed Assembly: September 26, 2024 (76–0–0)
- Reported out of Senate Committees (with amendments) and placed on Senate 2nd Reading: February 3, 2025 and November 13, 2025 (referred back to Budget & Appropriations 11/10/25)
- Effective date: immediate upon enactment; agencies must implement the required process within 365 days of the act’s effective date.
Purpose and Intent
- To speed and make more efficient the review and enrollment of physicians as NJ FamilyCare providers (the State’s Medicaid and Children’s Health Insurance Program), by improving information sharing and coordination between the Department of Human Services (DHS) — Division of Medical Assistance and Health Services — and the State Board of Medical Examiners (SBME) in the Division of Consumer Affairs.
Key Provisions
- Agency collaboration: DHS (Division of Medical Assistance and Health Services) and the SBME must develop and implement a process to improve NJ FamilyCare provider application review efficiency within 365 days of the bill’s effective date.
- License-number sharing: SBME must make an applicant’s medical license number available to DHS within 5 days of issuing the license. If licensure is denied, SBME must notify DHS within 5 days of the final denial determination.
- Early processing: To the extent possible and consistent with submitted documentation, DHS must immediately begin processing the NJ FamilyCare enrollment portion of an application if it contains necessary licensure information or demonstrates licensure is pending.
- Applicant notification: Within 15 days of receiving an applicant’s license number from SBME, DHS must notify the applicant in writing, if applicable, of any additional information or documentation required for NJ FamilyCare enrollment.
- Non-substantive limits: The bill does not change State licensure requirements or NJ FamilyCare enrollment standards and does not require DHS to approve enrollment before receiving the applicant’s National Provider Identifier (NPI).
Who is Affected
- Direct: Division of Medical Assistance and Health Services (DHS), State Board of Medical Examiners (Division of Consumer Affairs), physicians applying for NJ medical licensure and NJ FamilyCare provider enrollment, Gainwell Technologies (NJ FamilyCare systems administrator/contractor).
- Indirect: NJ FamilyCare beneficiaries and provider networks (potentially faster access to newly licensed physicians).
Fiscal Impact
- Office of Legislative Services (OLS) estimate: Potential but indeterminate State cost and revenue impacts.
- Costs to SBME/DCA to develop/implement process could likely be absorbed by existing resources; historically the Board’s revenues have exceeded expenditures.
- If costs rise, the Division of Consumer Affairs may increase medical licensure fees. Current (CY2024) fees cited by OLS: $325 nonrefundable application fee; $225 one-time endorsement fee; $290 annual registration fee.
- DHS could incur additional contract costs to Gainwell Technologies for expanded provider-enrollment processing. Federal Medicaid rules make state Medicaid administrative costs eligible for federal matching, so the State would bear 50% of any increased administrative costs.
- Net fiscal effect: indeterminate; OLS notes likely absorbable but acknowledges potential for fee increases or contract-cost changes.
Committee Amendments / Notable Changes
- Clarified the information sharing applies to licensure applicants who apply to enroll (not merely those who indicate intent).
- Changed SBME’s denial notice requirement from providing “appropriate documentation” to a 5‑day notification of final denial.
- Extended DHS applicant-notification period from 10 to 15 days.
- Technical and clarifying edits; explicitly preserved existing licensure and enrollment requirements.
Sponsorship & Related Legislation
- Primary sponsors: Assemblymen Louis D. Greenwald and Chris Tully; Assemblywoman Shanique Speight. Multiple cosponsors listed.
- Companion bill: S1626.
Compiled from official sources — confirm details with the bill’s official record.
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