SENATE HEALTH, HUMAN SERVICES AND SENIOR CITIZENS COMMITTEE

STATEMENT TO

SENATE COMMITTEE SUBSTITUTE FOR

SENATE, No. 4415

STATE OF NEW JERSEY

DATED:  JUNE 11, 2026

      The Senate Health, Human Services and Senior Citizens Committee reports favorably a Senate Committee Substitute for Senate Bill No. 4415.

      The substitute bill amends P.L.2018, c.32 to strengthen the oversight and enforcement of network adequacy requirements for health insurance carriers in this State and require health insurance carriers to make available their provider directories in a certain format provided by the bill.

      The substitute bill extends the scope of certain provisions of  P.L.2018, c.32, concerning the submission of an annual audit of a carrier’s provider network and the enforcement of certain network adequacy laws, to certain carriers, which includes insurance companies, health service corporations, hospital service corporations, medical service corporations, or health maintenance organizations authorized to issue health benefits plans in this State, and includes the State Health Benefits Program, the School Employees' Health Benefits Program, the Medicaid program, and a Medicaid managed care organization. 

      The substitute bill provides that, at a minimum, any carrier that fails to meet network adequacy requirements in accordance with applicable federal or State law will be penalized no less than $5,000 per day until the carrier has demonstrated full compliance with the network adequacy requirements.  In addition to such penalty imposed, any resident, who can demonstrate that the resident suffered harm as a result of a carrier’s failure to meet its network adequacy requirement, may file a private cause of action seeking damages for demonstrated harm.

      The substitute bill requires the Commissioner of Banking and Insurance (commissioner) and the Director of the Division of Mental Health and Addiction Services in the Department of Human Services (director) to jointly prepare a guidance document that establishes the format for the submission of the annual audit and establishes reporting requirements for the commissioner and director concerning their enforcement activities related to the enforcement of network adequacy oversight requirements provided under current law.

      The substitute bill requires that each carrier’s network directory be made available in a downloadable, machine-readable format to support independent research, public accountability, and government oversight and ensure that carriers are meeting statutory and contractual network adequacy and access requirements.  The substitute bill provides that a carrier will be expressly prohibited from seeking to protect the non-commercial use, publication, or dissemination of the carrier’s network directory through copyright or any other means.