New Jersey A 2150: Establishes certain consumer protections related to arbitration organizations.

Bill Text

A2150 

ASSEMBLY, No. 2150 

STATE OF NEW JERSEY

222nd LEGISLATURE

� 

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblywoman ELIANA PINTOR MARIN

District 29 (Essex and Hudson)

Assemblywoman VERLINA REYNOLDS-JACKSON

District 15 (Hunterdon and Mercer)

SYNOPSIS

���� Requires Medicaid and NJ FamilyCare managed care 
organizations to offer patient-centered medical home model or other alternative 
payment model to primary care providers.

CURRENT VERSION OF TEXT 

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

�� 

An Act concerning patient-centered medical homes and 
supplementing Title 30 of the Revised Statutes.

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

���� 1.��� As used in this act:

���� �Alternative payment model� 
means a payment approach that gives providers financial incentives to deliver 
high-quality and cost-efficient care and may apply to a specific clinical 
condition, care episode, or population. 

���� "Department" means 
the Department of Human Services.

���� �Division� means the Division 
of Medical Assistance and Health Services in the Department of Human Services.

���� "Managed care 
organization" means a Medicaid managed care organization, as that term is 
defined pursuant to 42 U.S.C. s.1396b(m)(1)(A).

���� "Patient-centered medical 
home model" means a type of alternative payment model that supports a 
clinical model of team-based health care, led by a health care provider,� to 
provide comprehensive, person-centered, and continuous medical care to patients 
in order to achieve maximal health outcomes.

���� �Primary care provider� means a 
licensed medical doctor, doctor of osteopathy, or a licensed medical 
practitioner who, within the scope of practice and in accordance with State 
certification or licensure requirements, standards, and practices, is 
responsible for maintaining continuity of patient care and providing all 
required primary care services to enrollees, including periodic examinations, 
preventive health care and counseling, immunizations, diagnosis, and treatment 
of illness or injury, coordination of overall medical care, record maintenance, 
and initiation of referrals to specialty providers. A primary care provider 
shall include general or family practitioners, pediatricians, internists, and 
shall include specialist physicians, physician assistants, certified nurse 
midwives, certified nurse practitioners, or clinical nurse specialists, 
provided that the practitioner carries out all primary care provider 
responsibilities in accordance with licensure requirements.

���� 2.��� A 
managed care organization that provides benefits to persons who are eligible 
for Medicaid under P.L.1968, c.413 (C.30:4D-1 et seq.) or NJ FamilyCare under P.L.2005, 
c.156 (C.30:4J-8 et al.) shall offer a patient-centered medical home model to 
primary care providers in the managed care organization�s network.� The 
division, in its sole discretion, may waive the requirements of this section if 
a managed care organization can demonstrate that the managed care organization 
offers an alternative payment model to primary care providers that is not a 
patient-centered medical home model but that similarly incentivizes high 
quality, efficient, and holistic care.

���� 3.��� a.� A managed care 
organization shall submit annually to the division a description of the managed 
care organization�s patient-centered medical home model or, if waived by the 
division to offer a patient-centered medical home model, the other alternative 
payment model offered to primary care providers, which description shall 
include, but not be limited to:

���� (1)� the basic financial 
structure of the� model, which shall include incentive or population management 
payments which may be available to providers participating in the �model;

���� (2)� whether participating 
providers are required to obtain any certifications to participate in the� 
model;

���� (3)� quality or other 
performance metrics which affect provider payment under the alternative payment 
model;

���� (4)� the requirements for a 
provider to be eligible to participate in the� model, including but not limited 
to the number of unique patients seen by a provider or past quality 
performance;

���� (5)� whether the �model 
qualifies as an �Other Payer Advanced APM� as defined in 42 CFR 414.1305;

���� (6)� a list of all providers 
participating in the� model; and

���� (7)� the number of enrollees 
provided services by� providers participating in the model, listed by county.

���� b.��� The managed care 
organization shall make the description required pursuant to subsection a. of 
this section available to the public on the managed care organization�s 
Internet website, after division approval. The division may also post such 
descriptions on its Internet website.

���� c.��� The division may, in its 
discretion, establish a standardized format for