New Jersey § 26:2s-18

§ 26:2s-18.

The commissioner shall enforce the provisions of this act. Within six months of the effective date of this act, in consultation with the Commissioner

of Banking and Insurance, the commissioner shall adopt rules and regulations, pursuant

to the “Administrative Procedure Act,” P.L.1968, c. 410 ( C.52:14B-1 et seq. ), necessary to carry out the purposes of this act. The regulations shall establish consumer protection and quality standards governing

carriers which offer a managed care plan or use a utilization management system that

are consistent with the standards governing health maintenance organizations in the

State. The regulations shall include standards for: a quality management program; provider

participation in a network; adequacy of the provider network with respect to the

scope and type of health care benefits provided by the carrier, the geographic service

area covered by the provider network and access to medical specialists, when appropriate;

utilization management as required in this act; a covered person complaint system;

a patient appeals system as required in this act; the establishment of consumer rights

of covered persons; carrier disclosure as required in this act; and outcomes and

data reporting requirements as required in this act.