New Jersey 222nd Legislature Status: Introduced 4 D cosponsors

S 4415 — Strengthens oversight and enforcement of network adequacy requirements for health insurance carriers; requires health insurance carriers to make network directory available.*

Last action — REF SBA

  1. 1
    Introduced
  2. 2
    In Committee
  3. 3
    Passed Senate
  4. 4
    Passed General Assembly
  5. 5
    To Executive
  6. 6
    Enacted

This bill has been introduced in the Senate. Introduced June 08, 2026. It must pass committee before a floor vote.

Next likely step: a committee referral and hearing.

Odds of enactment

Low chance

Based on the sponsor, cosponsors, and committee posture, this bill has a low chance of becoming law.

Upgrade to see the exact probability and what's driving it.

A statistical estimate from our own model of past outcomes — an insight, not a guarantee. Policymaking is volatile.

Prognosis

Advancing 34% · moderate confidence

  • Introduced

    Current position in the legislative process.

  • 4 sponsors

    2 primary, 2 co-sponsors signed on.

  • Single-party support

    Sponsorship is currently within one party (4 D).

  • Cleared a recorded vote

    Passed 1 recorded vote so far.

Based on stage, sponsorship breadth, committee status, recorded votes, and cross-state momentum — a description of the observable signals, not a prediction.

In plain language

Enhances oversight of health insurance network adequacy and requires accessible network directories.

This bill aims to improve the oversight and enforcement of health insurance carriers' network adequacy requirements. It also mandates that these carriers provide a directory of their networks for better accessibility.

What this means for you
  • Consumers: Consumers will have better access to information about available providers in their health plans.
  • Healthcare: Healthcare providers may see changes in network participation standards, impacting how they engage with insurers.

Summary

Mental health insurance coverage for minors-monitor/evaluate/submit report

Bill Text

What changed in the latest version

272 added · 330 removed

Plain-language change summary

The amendment removes a provision that required the Department of Banking and Insurance (DOBI) to monitor and report annually on mental health insurance coverage for minors, while emphasizing the need for health insurance carriers to strengthen oversight and enforcement of network adequacy requirements. It also requires carriers to make their provider directories available. This matters because it shifts the focus from monitoring mental health coverage specifically for minors to enhancing overall network adequacy and accessibility of health care services.

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S4415 SENATE, No.
S4415 SCS SENATE COMMITTEE SUBSTITUTE FOR SENATE, No.
4415 STATE OF NEW JERSEY 222nd LEGISLATURE    INTRODUCED JUNE 8, 2026     Sponsored by:
4415 STATE OF NEW JERSEY 222nd LEGISLATURE   ADOPTED JUNE 11, 2026     Sponsored by:
SCUTARI District 22 (Somerset and Union)         SYNOPSIS      Requires DOBI to monitor, evaluate, and submit annual report concerning mental health insurance coverage for minors;
SCUTARI District 22 (Somerset and Union)   Co-Sponsored by:
requires carriers to maintain provider directory.
Senators Diegnan and McKnight         SYNOPSIS      Strengthens oversight and enforcement of network adequacy requirements for health insurance carriers;
  CURRENT VERSION OF TEXT      As introduced.
requires health insurance carriers to make network directory available.
    An Act concerning mental health parity and amending and supplementing P.L.2019, c.58.
  CURRENT VERSION OF TEXT      Substitute as adopted by the Senate Health, Human Services and Senior Citizens Committee.
       An Act concerning access to health care services and amending P.L.2018, c.32.
       1.    Section 11 of P.L.2019, c.58 (C.26:2S-10.8) is amended to read as follows:
       1.  Section 2 of P.L.2018, c.32 (C.26:2SS-2) is amended to read as follow:
     11.  a.
     2.    The Legislature finds and declares that:
For the purposes of this section:
     a.     (1)  The health care delivery system in New Jersey needs reforms that will enhance consumer protections, ensure that residents receive adequate access to critical health care services in all regulated markets, ensure that carriers comply with State contracts and plan provisions regarding provision of adequate, accessible, timely networks, create a system to resolve certain health care billing disputes, contain rising costs, include robust penalties to ensure that carriers comply with network adequacy requirements, enhance transparency regarding these important requirements, promote accountability to the public, and measure success with respect to these goals;
     "Benefit limits" includes both quantitative treatment limitations and non-quantitative treatment limitations.
     (2)  Objective evidence, including independent audits, third-party secret shopper surveys, claims data analysis, and more informal, anecdotal evidence has demonstrated that many carriers are not providing adequate health care networks for some or many types of services.
     "Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State or any entity contracted to administer health benefits in connection with the State Health Benefits Program or School Employees' Health Benefits Program.
 These same examinations have demonstrated that State oversight agencies, including the Department of Banking and Insurance and the Division of Medical Assistance and Health Services in the Department of Human Services, are not adequately overseeing carriers through annual network adequacy submissions, market conduct reviews, secret shopper surveys, and other means to ensure that carriers they regulate are meeting their statutory and contractual network adequacy requirements.
     "Classification of benefits" means the classifications of benefits found at 45 C.F.R.
 Collectively, these failures lead patients to bear long wait times for appointments, unnecessary visits to emergency departments, forego medical care, and poor health care outcomes and higher costs;
146.136(c)(2)(ii)(A) and 45 C.F.R.
     b.    Despite existing State and federal laws and regulations to protect against certain surprise out-of-network charges, these charges continue to pose a problem for health care consumers in New Jersey.  Many consumers find themselves with surprise bills for hospital emergency room procedures or for charges by providers that the consumer had no choice in selecting;
s.146.136(c)(3)(iii).
     c.     While the Patient Protection and Affordable Care Act added new patient protections requiring federally-regulated group health plans to reimburse for out-of-network emergency service by paying the greatest of three possible amounts:
 (1) the amount negotiated with in-network providers for the emergency service furnished;
(2) the amount for the emergency service calculated using the same method the plan generally uses to determine payments for out-of-network services;
or (3) the amount that would be paid under Medicare for the emergency service, patients continue to face out-of-network charges for surprise bills;
     d.    Out-of-network benefits are a health insurance benefit enhancement for which insureds pay an additional premium, but in recent years, out-of-network coverage has been used inappropriately as a means to diminish consumers' health insurance coverage, exposing consumers to additional costs;
     e.     Carriers and consumers continue to report exorbitant charges by certain health care professionals and facilities for out-of-network services, including balance billing, and in certain cases, consumers' bills are referred to collection, which contributes to the increasing costs of health care services and insurance and imposes hardships on health care consumers;
     f.     Health care providers and hospitals report that inadequate reimbursement from carriers and government payers is causing financial stress on safety net hospitals, deteriorating morale among providers and reduced quality of care for consumers;
     g.    It is, therefore, in the public interest to reform the health care delivery system in New Jersey to enhance consumer protections, create a system to resolve certain health care billing disputes, contain rising costs, and measure success with respect to these goals.
(cf:  P.L.2018, c.32, s.2)        2.  Section 3 of P.L.2018, c.32, s.3 (C.26:2SS-3) is amended to read as follows      3.    As used in [this act] P.L.2018, c.32 (C.26:2SS-1 et seq.):
     "Carrier" means an entity that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services under a health benefits plan, including:
an insurance company authorized to issue health benefits plans;
a health maintenance organization;
a health, hospital, or medical service corporation;
a multiple employer welfare arrangement;
the State Health Benefits Program and the School Employees' Health Benefits Program;
or any other entity providing a health benefits plan.  Except as provided under the provisions of [this act] P.L.2018, c.32 (C.26:2SS-1 et seq.), "carrier" shall not include any other entity providing or administering a self-funded health benefits plan.
     "Commissioner" means the Commissioner of Banking and Insurance.
     "Covered person" means a person on whose behalf a carrier is obligated to pay health care expense benefits or provide health care services.
     "Mental health condition" means a condition defined to be consistent with generally recognized independent standards of current medical practice referenced in the current version of the Diagnostic and Statistical Manual of Mental Disorders.
     "Director" means the Director of the Division of Mental Health and Addiction Services in the Department of Human Services.
     "Non-quantitative treatment limitations" or "NQTL" means processes, strategies, or evidentiary standards, or other factors that are not expressed numerically, but otherwise limit the scope or duration of benefits for treatment.
     "DMAHS" means the Division of Medical Assistance and Health Services in the Department of Human Services.
NQTLs shall include, but shall not be limited to:
     "Emergency or urgent basis" means all emergency and urgent care services including, but not limited to, the services required pursuant to N.J.A.C.11:24-5.3.
     (1)   Medical management standards limiting or excluding benefits based on medical necessity or medical appropriateness, or based on whether the treatment is experimental or investigative;
     "Health benefits plan" means a benefits plan which pays or provides hospital and medical expense benefits for covered services, and is delivered or issued for delivery in this State by or through a carrier.  For the purposes of [this act] P.L.2018, c.32 (C.26:2SS-1 et seq.), "health benefits plan" shall not include the following plans, policies or contracts:
     (2)   Formulary design for prescription drugs;
Medicaid, Medicare, Medicare Advantage, accident only, credit, disability, long-term care, TRICARE supplement coverage, coverage arising out of a workers' compensation or similar law, automobile medical payment insurance, personal injury protection insurance issued pursuant to P.L.1972, c.70 (C.39:6A-1 et seq.), a dental plan as defined pursuant to section 1 of P.L.2014, c.70 (C.26:2S-26) and hospital confinement indemnity coverage.
     (3)   For plans with multiple network tiers, such as preferred providers and participating providers, network tier design;
     "Health care facility" means a general acute care hospital, satellite emergency department, hospital based off-site ambulatory care facility in which ambulatory surgical cases are performed, or ambulatory surgery facility, licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).
     (4)   Standards for provider admission to participate in a network, including reimbursement rates;
     "Health care professional" means an individual, acting within the scope of his licensure or certification, who provides a covered service defined by the health benefits plan.       "Health care provider" or "provider" means a health care professional or health care facility.
     (5)   Plan methods for determining usual, customary, and reasonable charges;
     "Inadvertent out-of-network services" means health care services that are:
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     (6)   Refusal to pay for higher-cost therapies until it can be shown that a lower-cost therapy is not effective, also known as fail-first policies or step therapy protocols;
 covered under a managed care health benefits plan that provides a network;
     (7)   Exclusions based on failure to complete a course of treatment;
and provided by an out-of-network health care provider in the event that a covered person utilizes an in-network health care facility for covered health care services and, for any reason, in-network health care services are unavailable in that facility.
     (8)   Restrictions based on geographic location, facility type, provider specialty, and other criteria that limit the scope or duration of benefits for services provided under the plan or coverage;
 "Inadvertent out-of-network services" shall include laboratory testing ordered by an in-network health care provider and performed by an out-of-network bio-analytical laboratory.
     (9)   In and out-of-network geographic limitations;
     "Knowingly, voluntarily, and specifically selected an out-of-network provider" means that a covered person chose the services of a specific provider, with full knowledge that the provider is out-of-network with respect to the covered person's health benefits plan, under circumstances that indicate that covered person had the opportunity to be serviced by an in-network provider, but instead selected the out-of-network provider.  Disclosure by a provider of network status shall not render a covered person's decision to proceed with treatment from that provider a choice made "knowingly" pursuant to this definition.       "Machine-readable" means a format for documents that can be automatically read and processed by a computer without human intervention while ensuring no semantic meaning is lost.
     (10)  Limitations on inpatient services for situations where the participant is a threat to self or others;
       "Medicaid" means the State Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
     (11)  Exclusions for court-ordered and involuntary holds;
     "Medical necessity" or "medically necessary" means or describes a health care service that a health care provider, exercising his or her prudent clinical judgment, would provide to a covered person for the purpose of evaluating, diagnosing, or treating an illness, injury, disease, or its symptoms and that is:
     (12)  Experimental treatment limitations;
in accordance with the generally accepted standards of medical practice;
     (13)  Service coding;
clinically appropriate, in terms of type, frequency, extent, site, and duration, and considered effective for the covered person's illness, injury, or disease;
     (14)  Exclusions for services provided by a licensed professional who provides mental health condition or substance use disorder services;
not primarily for the convenience of the covered person or the health care provider;
     (15)  Network adequacy;
and not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that covered person's illness, injury, or disease.
and      (16)  Provider reimbursement rates.
     "Medicare" means the federal Medicare program established pursuant to Pub.L.89-97 (42 U.S.C.
     "Substance use disorder" means a disorder defined to be consistent with generally recognized independent standards of current medical practice referenced in the most current version of the Diagnostic and Statistical Manual of Mental Disorders.
s.1395 et seq.).
     b.    A carrier shall approve a request for an in-plan exception if the carrier's network does not have any providers who are qualified, accessible and available to perform the specific medically necessary service.
     "Self-funded health benefits plan" or "self-funded plan" means a self-insured health benefits plan governed by the provisions of the federal "Employee Retirement Income Security Act of 1974," 29 U.S.C.
A carrier shall communicate the availability of in-plan exceptions:
s.1001 et seq.
     (1)   on its website where lists of network providers are displayed;
and      (2)   to beneficiaries when they call the carrier to inquire about network providers.
     c.     A carrier that provides hospital or medical expense benefits through individual or group contracts shall submit an annual report to the department on or before March 1.
The annual report shall contain, to the extent that the commissioner determines practicable, the following information:
     (1)   A description of the process used to develop or select the medical necessity criteria for mental health benefits, the process used to develop or select the medical necessity criteria for substance use disorder benefits, and the process used to develop or select the medical necessity criteria for medical and surgical benefits;
     (2)   Identification of all NQTLs that are applied to mental health benefits, all NQTLs that are applied to substance use disorder benefits, and all NQTLs that are applied to medical and surgical benefits, including, but not limited to, those listed in subsection a.
of this section;
     (3)   The results of an analysis that demonstrates that for the medical necessity criteria described in paragraph (1) of this subsection and for selected NQTLs identified in paragraph (2) of this subsection, as written and in operation, the processes, strategies, evidentiary standards, or other factors used to apply the medical necessity criteria and selected NQTLs to mental health condition and substance use disorder benefits are comparable to, and are no more stringently applied than the processes, strategies, evidentiary standards, or other factors used to apply the medical necessity criteria and selected NQTLs, as written and in operation, to medical and surgical benefits.
A determination of which selected NQTLs require analysis will be determined by the department;
at a minimum, the results of the analysis shall entail the following, provided that some NQTLs may not necessitate all of the steps described below:
     (a)   identify the factors used to determine that an NQTL will apply to a benefit, including factors that were considered but rejected;
     (b)   identify and define the specific evidentiary standards, if applicable, used to define the factors and any other evidentiary standards relied upon in designing each NQTL;
     (c)   provide the comparative analyses, including the results of the analyses, performed to determine that the processes and strategies used to design each NQTL, as written, for mental health and substance use disorder benefits are comparable to and applied no more stringently than the processes and strategies used to design each NQTL as written for medical and surgical benefits;
     (d)   provide the comparative analyses, including the results of the analyses, performed to determine that the processes and strategies used to apply each NQTL, in operation, for mental health and substance use disorder benefits are comparable to and applied no more stringently than the processes or strategies used to apply each NQTL in operation for medical and surgical benefits;
and      (e)   disclose the specific findings and conclusions reached by the carrier that the results of the analyses above indicate that the carrier is in compliance with this section and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C.
s.18031(j), and its implementing and related regulations, which includes 45 C.F.R.
s.146.136, 45 C.F.R.
s.147.160, and 45 C.F.R.
s.156.115(a)(3);
and      (4)   Any other information necessary to clarify data provided in accordance with this section requested by the Commissioner of Banking and Insurance including information that may be proprietary or have commercial value, provided that no proprietary information shall be made publicly available by the department.
     d.    The department shall implement and enforce applicable provisions of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C.
18031(j), any amendments to, and federal guidance or regulations issued under that act, including 45 C.F.R.
Parts 146 and 147, 45 C.F.R.
s.156.115(a)(3), P.L.1999, c.106 (C.17:48-6v et al.), and section 2 of P.L.1999, c.441 (C.52:14-17.29e), which includes:
     (1)   Ensuring compliance by individual and group contracts, policies, plans, or enrollee agreements delivered, issued, executed, or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.), P.L.1940, c.74 (C.17:48A-1 et seq.), P.L.1985, c.236 (C.17:48E-1 et seq.), chapter 26 of Title 17B of the New Jersey Statutes (N.J.S.17B:26-1 et seq.), chapter 27 of Title 17B of the New Jersey Statutes (N.J.S.17B:27-26 et seq.), P.L.1992, c.161 (C.17B:27A-2 et seq.), P.L.1992, c.162 (C.17B:27A-17 et seq.), P.L.1973, c.337 (C.26:2J-1 et seq.), and P.L.1961, c.49 (C.52:14-17.25 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance.
     (2)   Detecting violations of the law by individual and group contracts, policies, plans, or enrollee agreements delivered, issued, executed, or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.), P.L.1940, c.74 (C.17:48A-1 et seq.), P.L.1985, c.236 (C.17:48E-1 et seq.), chapter 26 of Title 17B of the New Jersey Statutes (N.J.S.17B:26-1 et seq.), chapter 27 of Title 17B of the New Jersey Statutes (N.J.S.17B:27-26 et seq.), P.L.1992, c.161 (C.17B:27A-2 et seq.), P.L.1992, c.162 (C.17B:27A-17 et seq.), P.L.1973, c.337 (C.26:2J-1 et seq.), and P.L.1961, c.49 (C.52:14-17.25 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance.
     (3)   Accepting, evaluating, and responding to complaints regarding violations.
     (4)   Maintaining and regularly reviewing for possible parity violations a publicly available consumer complaint log regarding mental health condition and substance use disorder coverage, provided that the names of specific carriers will be redacted and not disclosed on the complaint log.
     (5)   The commissioner shall adopt rules as may be necessary to effectuate any provisions of this section and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 that relate to the business of insurance.
     e.     Not later than May 1 of each year, the department shall issue a report to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1).
The report shall:
     (1)   Describe the methodology the department is using to check for compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C s.18031(j), and any federal regulations or guidance relating to the compliance and oversight of that act.
     (2)   Describe the methodology the department is using to check for compliance with P.L.1999, c.106 (C.17:48-6v et al.) and section 2 of P.L.1999, c.441 (C.52:14-17.29e).
     (3)   Identify market conduct examinations conducted or completed during the preceding 12-month period regarding compliance with parity in mental health and substance use disorder benefits under state and federal laws and summarize the results of such market conduct examinations.
This shall include:
     (a)   The number of market conduct examinations initiated and completed;
     (b)   The benefit classifications examined by each market conduct examination;
     (c)   The subject matters of each market conduct examination, including quantitative and non-quantitative treatment limitations;
     (d)   A summary of the basis for the final decision rendered in each market conduct examination;
and      (e)   Individually identifiable information shall be excluded from the reports consistent with state and Federal privacy protections.
     (4)   Detail any educational or corrective actions the department has taken to ensure compliance with Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C s.18031(j), P.L.1999, c.106 (C.17:48-6v et al.) and section 2 of P.L.1999, c.441 (C.52:14-17.29e).
     (5)   Detail the department's educational approaches relating to informing the public about mental health condition and substance use disorder parity protections under State and federal law.
     (6)   Be written in non-technical, readily understandable language and shall be made available to the public by, among such other means as the department finds appropriate, posting the report on the department's website.
     f.     The department shall post on its Internet website a report disclosing the department's conclusions as to whether the analyses collected from the carriers as specified in paragraph (3) of subsection c.
of this section demonstrate compliance with the Mental Health Parity and Addiction Equity Act of 2008 and its implementing regulations, specifically including whether or not there is compliance with 45 C.F.R.
146.136(c)(4).
The name and identity of carriers shall be confidential, shall not be made public by the department, and shall not be subject to public inspection.
     g.    (1) In addition to any mental health parity compliance monitoring required by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C s.18031(j), or any other law, the department shall conduct regular market conduct reviews, including secret shopper surveys, to assess access to mental health services for covered persons who are 18 years of age or younger.  The market reviews shall assess network adequacy and appointment access standards.  The market reviews shall be conducted for various populations, age groups of minors, and geographic areas, and shall collect data on those various classifications, as determined by the department.
     (2)   The department shall require carriers to submit an annual report on mental health services for minors with data on:
     (a)   usage rates for mental health services for minors, categorized by type of service;
     (b)   prior authorization requirements and denial of coverage requests pursuant to those requirements;
     (c)   appeals from coverage denials and outcomes of those appeals;
     (d)   how quickly prior authorization and appeal determinations are made from the time of request;
and      (e)   approval rates for specialty services, including, but not limited to, intensive outpatient, partial hospitalization, residential treatment, and eating disorder care.
     (3)   The department shall review the data compiled pursuant to this section to identify barriers to medically necessary care and to ensure that prior authorization and medical necessity criteria are applied consistently with mental health parity requirements.  Recommendations may be included in the report issued pursuant to paragraph (4) of this subsection.
     (4)   No later than one year following the effective date of P.L.     , c.    (C.          ) (pending before the Legislature as this bill), and annually thereafter, the department shall submit a report to the Governor and, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), to the Legislature, as required by this subsection.
 The report shall be accessible to the public on the department’s website.
P.L.2019, c.58, s.11)        2.    (New section)  a.  A carrier shall maintain an accurate and regularly verified provider directory.  The directory shall be provided in non-technical, readily understandable language and shall be made available to the public on the carrier’s website.
P.L.2018, c.32, s.3)        3.  Section 16 of P.L.2018, c.32 (C.26:2SS-16) is amended to read as follows:
     b.    The directory shall also be made available in a downloadable, machine-readable format to support independent research, verification, and monitoring of network adequacy and access.
     16.  [A carrier which offers a managed care plan] a.  For the purposes of this section, a "carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State, and shall include the State Health Benefits Program, the School Employees' Health Benefits Program, the Medicaid program, and a Medicaid managed care organization.
       3.    (New section)  A carrier that violates the provisions of P.L.     , c.    (C.          ) (pending before the Legislature as this bill) shall be subject to the penalties established pursuant to section 16 of P.L.1997, c.192 (C.26:2S-16).
     b.  A carrier shall provide for an annual audit of its provider network by an independent private auditing firm.  The audit shall be at the expense of the carrier and the carrier shall submit the audit findings to the commissioner or director, as applicable.  The commissioner or director shall make the results of the audit available on the respective department's website.
       4.    This act shall take effect on the first day of fourth month next following the date of enactment, except that the department may take any administrative action as may be necessary to implement the provisions of this act.
 If the audit contains a determination that a carrier has failed to maintain an adequate network of providers in accordance with applicable federal or State law, in addition to any other penalties or remedies available under federal or State law, it shall be a violation of [this act] P.L.2018, c.32 (C.26:2SS-1 et seq.) and the commissioner or director, as applicable, may initiate such action as the commissioner or director deems appropriate to ensure compliance with [this act] P.L.2018, c.32 (C.26:2SS-1 et seq.) and network adequacy laws.
    STATEMENT        This bill provides that, in addition to any mental health parity compliance monitoring required pursuant to current law, the Department of Banking and Insurance is required to conduct regular market conduct reviews, including secret shopper surveys, to assess access to mental health services for covered persons who are 18 years of age or younger.  The bill provides that the market reviews are required to assess network adequacy and appointment access standards, and are to be conducted for various populations, age groups of minors, and geographic areas, and to collect data on those various classifications, as determined by the department.
     c.  At a minimum, any carrier that fails to meet network adequacy requirements in accordance with applicable federal or State law shall 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 bill requires health insurance carriers to submit an annual report on mental health services for minors with data on:
     d.  Within 90 days of the effective date of P.L.    , c.    (C.        ) (pending before the Legislature as this bill), the commissioner and director shall jointly prepare a guidance document that establishes the format for the submission of the annual audit pursuant to subsection a.
     (1)   usage rates for mental health services for minors, categorized by type of service;
of this section, such guidance document shall be published on the respective department’s website and submitted to the Legislature, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1).
     (2)   prior authorization requirements and denial of coverage requests pursuant to those requirements;
     e.  The commissioner and director shall provide to the Legislature, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), a report by May 31st of each year that explains how the commissioner or director has enforced the terms of their respective network adequacy oversight requirements through claims analysis, market conduct reviews, secret shopper surveys, and any other means utilized.
     (3)   appeals from coverage denials and outcomes of those appeals;
     f.  Each carrier’s network directory shall 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.
     (4)   how quickly prior authorization and appeal determinations are made from the time of request;
 A carrier shall 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.
and      (5)   approval rates for specialty services, including, but not limited to, intensive outpatient, partial hospitalization, residential treatment, and eating disorder care.
(cf:
     The department is required to review the data compiled pursuant to the bill to identify barriers to medically necessary care and to ensure that prior authorization and medical necessity criteria are applied consistently with mental health parity requirements.       The department is also required to submit an annual report to the Governor and the Legislature on the findings and recommendations based on the bill’s requirements.  The report is to be accessible to the public on the department’s website.
P.L.2018, c.32, s.16)        4.  Section 17 of P.L.2018, c.32 (C.26:2SS-17) is amended to read as follows:
     The bill stipulates that a carrier is to maintain an accurate and regularly verified provider directory.  The directory must be provided in non-technical, readily understandable language and must be made available to the public on the carrier’s website.  Additionally, the directory will be made available in a downloadable, machine-readable format to support independent research, verification, and monitoring of network adequacy and access.
     17.
     A carrier that violates the provisions of the bill is subject to the penalties established by the "Health Care Quality Act."  Those penalties include civil fines of not less than $250 and not greater than $10,000 for each day that the carrier is in violation.  Additionally, the commissioner may issue an order directing a carrier to cease and desist from engaging in any act or practice that is in violation of the provisions of the bill.
a.
A person or entity that violates any provision of [this act] P.L.2018, c.32 (C.26:2SS-1 et seq.), or the rules and regulations adopted pursuant hereto, shall be liable to a penalty as provided in this subsection.  The penalty shall be collected by the commissioner in the name of the State in a summary proceeding in accordance with the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.).
     (1)   A health care facility or carrier that violates any provision of [this act] P.L.2018, c.32 (C.26:2SS-1 et seq.) shall be liable to a penalty of not more than $1,000 for each violation.  Every day upon which a violation occurs shall be considered a separate violation, but no facility or carrier shall be liable to a penalty greater than $25,000 for each occurrence.
     (2)   A person or entity not covered by paragraph (1) of this subsection that violates the requirements of [this act] P.L.2018, c.32 (C.26:2SS-1 et seq.) shall be liable to a penalty of not more than $100 for each violation.  Every day upon which a violation occurs shall be considered a separate violation, but no person or entity shall be liable to a penalty greater than $2,500 for each occurrence.
     (3)  In the case of a carrier found to be out of compliance with network adequacy requirements pursuant to section 16 of P.L.2018, c.32 (C.26:2SS-16), penalties shall be imposed as set forth in section 16 of P.L.2018, c.32 (C.26:2SS-16).
     b.    Upon a finding that a person or entity has failed to comply with the requirements of [this act] P.L.2018, c.32 (C.26:2SS-1 et seq.), including the payment of a penalty as determined under subsection a.
of this section, the commissioner may:
     (1)   in the case of a carrier, initiate such action as the commissioner determines appropriate;
     (2)   in the case of a health care facility, refer the matter to the Commissioner of Health for such action as the Commissioner of Health determines appropriate;
or      (3)   in the case of a health care professional, refer the matter to the appropriate professional or occupational licensing board within the Division of Consumer Affairs in the Department of Law and Public Safety for such action as that board determines appropriate.
(cf:
P.L.2018, c.32, s.17)        2.  This act shall take effect immediately.
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  • Committee Substitute Comm Sub Current html June 12, 2026
  • Introduced View text html June 09, 2026

Action History

  1. REF SBA

  2. REP/SCS 2RS

  3. INT 1RS REF SHH

Sponsors

Sponsorship breakdown

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2 sponsors · 2 co-sponsors · 116 not signed on

Sponsors (2)

Co-sponsors (2)

Not signed on (116)

116 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

Committee vote — SHH

Passed 5 Yea · 0 Nay · 3 Other
Party YeaNayPresentNot Voting
Democrat 5000
Republican 0003
Total 5003
% of votes cast 63%0%0%38%
How each member voted (8)
Member Party Vote
Burgess, Renee C. Democrat Yea
McKeon, John F. Democrat Yea
McKnight, Angela V. Democrat Yea
Mukherji, Raj Democrat Yea
Vitale, Joseph F. Democrat Yea
Henry, Owen Republican Not Voting
Schepisi, Holly T. Republican Not Voting
Singer, Robert W. Republican Not Voting

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Subjects

healthcare health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

What does S 4415 do?
Mental health insurance coverage for minors-monitor/evaluate/submit report
Who sponsors S 4415?
S 4415 is sponsored by McKnight, Angela V. (Democrat), Diegnan Jr., Patrick J. (Democrat), Scutari, Nicholas P. (Democrat), and Vitale, Joseph F. (Democrat).
What is the current status of S 4415?
This bill has been introduced in the Senate. Introduced June 08, 2026. It must pass committee before a floor vote.
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