New JerseyInsurers would explain why they deny private duty nursing
Patients whose doctors find private duty nursing medically necessary would receive a full explanation if their health insurer denies advance approval for that care.
What it does
Insurers would have to explain denied requests for advance approval of private duty nursing care a doctor finds necessary. If insurers say care is unnecessary, they would also have to explain why and share review criteria and approval examples.
Argument forClear reasons and approval examples could help patients understand a denial and what documents might support another request.
Argument againstPreparing review criteria, approval examples, and documentation details could add work for insurers when they deny nursing care as medically unnecessary.
More detail
Health insurers would have to fully explain why they deny advance approval for private duty nursing care. The requirement would cover requests for advance approval when the patient's doctor has found the nursing care medically necessary. If the insurer says the care is not medically necessary, it would also have to explain why the doctor's finding is invalid. That explanation would have to include its review criteria, examples of approved requests, and the documents submitted for those approvals. These requirements would take effect on the 90th day after the bill becomes law.
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Where it stands
- Introduced
- Passed 1st Chamber
- Passed 2nd Chamber
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Sep 10Reported and Referred to Assembly Financial Institutions and Insurance CommitteeLatest
- Jun 4Introduced, Referred to Assembly Oversight, Reform and Federal Relations CommitteeIntroduced
Healthcare