New JerseyInsurers would explain denials of advance approval for private duty nursing
When a doctor says a covered person's private duty nursing is medically needed, insurers would have to explain why they reject an advance approval request.
What it does
Insurers would fully explain why they deny advance approval for private duty nursing that a patient's doctor finds medically needed. If they dispute medical need, they would explain why and share approval rules and examples.
Argument forPeople could use the stated rules and examples to understand a denial and prepare a stronger request for nursing care.
Argument againstInsurers could spend more staff time explaining denials, especially when they must address a doctor's finding and provide approval examples.
More detail
Insurers would give a full explanation when they deny advance approval for private duty nursing. This applies when the covered person's doctor has found the nursing medically needed. If an insurer says the care is not medically needed, it must explain why it rejects the doctor's finding. For those denials, it must also give its review criteria and examples of approvals, including the documents needed. The requirement would start on the 90th day after enactment.
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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
- Oct 5Introduced in the Senate, Referred to Senate Commerce CommitteeIntroduced
Healthcare