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Bill

A 5218

Relates to concealment and/or mutilation of a human corpse

2025 Regular Session Introduced by Joe Angelino and 4 co-sponsors

Strengthen and codify health insurer network adequacy standards in New Jersey, improving in-network access to specialists and consumer protections.

REFERRED TO CODES
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Bill Summary · A 5218

Bill A 5218 — Summary

Note: The bill title provided (“Relates to concealment and/or mutilation of a human corpse”) appears not to align with the content of the introduced version presented here. The introduced version of A 5218 concerns health insurance carrier network adequacy.

What the bill would do (introduced version)

  • Purpose: Strengthen and codify additional network adequacy standards for health insurance carriers that offer a managed care plan or use a utilization management system. The regulation of these standards would be aligned with consumer protections and quality expectations similar to those governing health maintenance organizations in New Jersey.

  • Key provisions:

    • The commissioner of banking and insurance would adopt rules and regulations, pursuant to the Administrative Procedure Act, to carry out the act’s purposes.
    • Regulations would establish standards for:
    • Quality management programs and provider participation in networks
    • Adequacy of the provider network with respect to:
      • The scope and type of health care benefits offered
      • Geographic service area covered
      • Access to medical specialists
    • In-network access to physician specialists at in-network hospitals/facilities, including:
      • Anesthesiologists, radiologists, pathologists, emergency medicine physicians, and services under their supervision
    • Utilization management
    • Covered person complaint system
    • Patient appeals system
    • Consumer rights of covered persons
    • Carrier disclosure requirements
    • Outcomes and data reporting requirements
    • Standards must be consistent with those governing health maintenance organizations in the state.

  • Effective date: The act is stated to take effect immediately upon enactment.

Procedural and timeline details

  • Introduced: January 23, 2025
  • Status: Referenced to Assembly committees
    • Initially referred to Assembly Financial Institutions and Insurance Committee
    • Subsequently referred to CODES (twice-listed on February 12, 2025)
  • Sponsors:
    • Primary sponsor: Michael Durso
    • Cosponsors: Joe DeStefano, David McDonough, Lester Chang, Joe Angelino
  • Related/companion legislation:
    • S 3416 (companion bill)
    • S 505 (companion; listed as related in prior sessions)
    • A 9426 (prior-session companion)

Who would be affected

  • Covered entities: Health insurance carriers that offer managed care plans or use utilization management systems in New Jersey.
  • Covered persons: Policyholders and enrollees of these carriers, who would benefit from enhanced access to in-network specialists and stronger consumer protections.
  • Providers: Hospitals and facilities that host in-network services, particularly for specialists named in the standards (anesthesiologists, radiologists, pathologists, emergency medicine physicians, etc.).

Potential impact and considerations

  • Consumer protection: Aims to improve access to in-network specialists and provide clearer complaint and appeals processes.
  • Network adequacy: Establishes detailed standards for geographic coverage, specialty access, and network sufficiency beyond current law.
  • Regulatory burden: May increase compliance costs and administrative requirements for carriers due to new reporting, disclosure, and data-collection standards.
  • Timeline: Immediate effect upon enactment; regulatory rules would be developed under the APA process, subject to standard comment and adoption timelines.

If you’d like, I can compare these provisions to the current NJ regulations or outline a side-by-side with the companion bills (S 3416, S 505) for a fuller context.

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

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