New Jersey S 959: Establishes New Jersey Caregiver Task Force to evaluate and provide recommendations on caregiver support services.

Bill Text

S959 

SENATE, No. 959 

STATE OF NEW JERSEY

222nd LEGISLATURE

� 

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Senator JON M. BRAMNICK

District 21 (Middlesex, Morris, Somerset and Union)

SYNOPSIS

���� "New Jersey Respect for Physicians Act"; 
requires prompt response by insurers to requests for prior authorization of 
health care services.

CURRENT VERSION OF TEXT 

���� Introduced Pending Technical Review by Legislative 
Counsel.

�� 

An Act concerning health insurance authorizations and 
amending and supplementing P.L.2005, c.352.� 

���� Be It 
Enacted by the Senate and General Assembly of 
the State of New Jersey:

���� 1.��� This act shall be known 
and may be cited as the �New Jersey Respect for Physicians Act.�

���� 2.��� Section 5 of P.L.2005, 
c.352 (C.17B:30-52) is amended to read as follows:

���� 5.��� a.� A payer shall 
respond to a hospital or physician request for authorization of health care 
services by either approving or denying the request based on the covered 
person's health benefits plan.� Any denial of a request for authorization or 
limitation imposed by a payer on a requested service shall be made by a 
physician under the clinical direction of the medical director who shall be 
licensed in this State and communicated to the hospital or physician by 
facsimile, E-mail or any other means of written communication agreed to by the 
payer and hospital or physician, as follows:

���� (1)�� in the case of a request 
for prior authorization for a covered person who will be receiving inpatient 
hospital services, the payer shall communicate the denial of the request or the 
limitation imposed on the requested service to the hospital or physician within 
a time frame appropriate to the medical exigencies of the case but no later 
than [15 
days] 48 
hours following the time the request was made;

���� (2)�� in the case of a request 
for authorization for a covered person who is currently receiving inpatient 
hospital services or care rendered in the emergency department of a hospital, 
the payer shall communicate the denial of the request or the limitation imposed 
on the requested service to the hospital or physician within a time frame 
appropriate to the medical exigencies of the case but no later than 24 hours 
following the time the request was made;

���� (3)�� in the case of a request 
for prior authorization for a covered person who will be receiving health care 
services in an outpatient or other setting, including, but not limited to, a 
clinic, rehabilitation facility or nursing home, the payer shall communicate 
the denial of the request or the limitation imposed on the requested service to 
the hospital or physician within a time frame appropriate to the medical 
exigencies of the case but no later than [15 
days] 48 
hours following the time the request was made; and

���� (4)�� if the payer requires 
additional information to approve or deny a request for authorization, the 
payer shall so notify the hospital or physician by facsimile, E-mail or any 
other means of written communication agreed to by the payer and hospital or 
physician within the applicable time frame set forth in paragraph (1), (2) or 
(3) of this subsection and shall identify the specific information needed to 
approve or deny the request for authorization. 

���� If the payer is unable to 
approve or deny a request for authorization within the applicable time frame 
set forth in paragraph (1), (2) or (3) of this subsection because of the need 
for this additional information, the payer shall have an additional period 
within which to approve or deny the request, as follows:

���� (a)�� in the case of a request 
for prior authorization for a covered person who will be receiving inpatient 
hospital services, within a time frame appropriate to the medical exigencies of 
the case but no later than [15 
days] 48 
hours beyond the time of receipt by the payer from the hospital or 
physician of the additional information that the payer has identified as needed 
to approve or deny the request for authorization;

���� (b)�� in the case of a request 
for authorization for a covered person who is currently receiving inpatient 
hospital services or care rendered in the emergency department of a hospital, 
no more than 24 hours beyond the time of receipt by the payer from the hospital 
or physician of the additional information that the payer has identified as 
needed to approve or deny the request for authorization; and

���� (c)�� in the case of a request 
for authorization for a covered person who will be receiving health care 
services in another setting, within a time frame appropriate to the medical 
exigencies of the case but no more than [15 
days] 48 
hours beyond the time of receipt by the payer from the hospital or 
physician of the additional information that the payer has identified as needed 
to approve or deny the request for authorization.

���� b.��� Payers and hospitals 
shal