SENATE, No. 1626
STATE OF NEW JERSEY
221st LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2024 SESSION
Sponsored by:
Senator ANDREW ZWICKER
District 16 (Hunterdon, Mercer, Middlesex and Somerset)
Senator JOSEPH F. VITALE
District 19 (Middlesex)
Co-Sponsored by:
Senators McKnight and O'Scanlon
SYNOPSIS
Requires DHS and State Board of Medical Examiners to develop and implement process to improve efficiency of reviewing NJ FamilyCare provider applications.
CURRENT VERSION OF TEXT
As reported by the Senate Health, Human Services and Senior Citizens Committee on February 3, 2025, with amendments.
An Act concerning provider enrollment 1[,] and1 supplementing Title 30 of the Revised 1[Statute, and amending P.L.1997, c.192] Statutes1.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. 1[(New section)]1 a. Within 365 days of the effective date of this act, the Division of Medical Assistance and Health Services in the Department of Human Services 1[, in collaboration with] and1 the State Board of Medical Examiners1[,]1 shall develop and implement a 1[streamlined]1 process 1[for a physician] to improve the efficiency of reviewing NJ FamilyCare provider applications which shall include the State Board of Medical Examiners sharing information, as required pursuant to this section, with the Division of Medical Assistance and Health Services regarding physician licensure applicants who apply1 to enroll as 1[an]1 NJ FamilyCare 1[provider and to apply for State licensure in a single application.
b. For all applications submitted pursuant to subsection a. of this section:] providers, such that, at a minimum:1
(1) the State Board of Medical Examiners shall 1[provide] make available to1 the Division of Medical Assistance and Health Services 1[with a copy of]1 the applicant’s license 1number1, within five days of issuing the 1applicant’s1 license 1[to the applicant] number1. If the applicant is 1[not approved for] denied1 licensure, the State Board of Medical Examiners shall 1[provide] notify1 the Division of Medical Assistance and Health Services 1[with the appropriate documentation]1 within five days of the 1final1 determination; and
(2) to the extent possible and in accordance with the documentation submitted with the 1NJ FamilyCare provider1 application, the Division of Medical Assistance and Health Services shall immediately begin to process 1[the portion of the] each NJ FamilyCare provider1 application 1[regarding NJ FamilyCare provider enrollment] upon receipt of the application, provided that the application contains the necessary licensure information or demonstrates that the applicant is pending licensure approval from the State Board of Medical Examiners1. Within 1[10] 151 days of receiving an applicant’s 1[licensure] license number from1 the State Board of Medical Examiners, the division shall notify an applicant in writing, if applicable, of any additional information or documentation required by the division to enroll the applicant as an approved NJ FamilyCare physician.
1[c.] b.1 The provisions of this act shall not be construed to alter the application requirements for State licensure or the enrollment requirements for a NJ FamilyCare provider1, or to require the Division of Medical Assistance and Health Services to approve an applicant for NJ FamilyCare provider enrollment before the division has received the National Provider Identifier number for the applicant.1
1[d.] c.1 As used in this act, “NJ FamilyCare” means the program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), which includes the Medicaid program and the Children’s Health Insurance Program.
1[2. Section 7 of P.L.1997,c.192 (C.26:2S-7) is amended to read as follows:
7. Each application for participation by a licensed health care professional that is submitted to a carrier which offers a managed care plan shall be reviewed by a committee of the carrier that includes appropriate representation of health care professionals with knowledge in the applicant's scope of professional practice. The committee shall provide an applicant for participation a notice of determination within six months of receiving an application.
(cf: P.L.1997, c.192, s.7)]1
1[3.] 2.1 This act shall take effect immediately.