New Jersey legislation · 2026-2027 Regular Session
New Jersey A5209: Health insurers-provide reason for denial of coverage for private duty nursing
Status: In committee, September 10, 2026
Requires health insurers to provide reason for denial of coverage for private duty nursing.
What the bill says
An Act concerning health insurance coverage and private duty nursing and supplementing P.L.2023, c.296 (C.17B:30-55.1 et seq.).
From the introduced text, June 4, 2026:
An Act concerning health insurance coverage and private duty nursing and supplementing P.L.2023, c.296 (C.17B:30-55.1 et seq.). Be It Enacted by the Senate and General Assembly of the State of New Jersey: 1. a. If a payer denies a prior authorization request for private duty nursing services that has been determined to be medically necessary by the covered persons physician, the payer shall provide a full description of the reason for the denial. If the denial is based on a finding that the private duty nursing services are not medically necessary, the payer shall provide, in addition to its reason for that finding, an explanation of why the determination of the covered persons physician is invalid. The explanation shall include the criteria the payer uses in evaluating prior authorization requests for private duty nursing services and shall provide examples of when prior authorization requests for private duty nursing are approved, including the submitted documentation necessary for those approvals. 2. This act shall take effect on the 90th day next following the date of enactment. STATEMENT This bill requires health insurers to provide a reason for the denial of coverage for private duty nursing services. Specifically, if a payer denies a prior authorization request for private duty nursing services that has been determined to be medically necessary by the covered persons …
Sponsors
- Alexander Schnall (D, 30) · primary sponsor
- Cody D. Miller (D, 4) · primary sponsor
- Roy Freiman (D, 16) · primary sponsor
Latest actions
- : REP REF AFI
- : INT 1RA REF AOF
Votes
- Assembly Oversight, Reform and Federal Relations Committee: Reported favorably (September 10, 2026): 6 yea, 0 nay, passed
Subjects: INSURANCE - HEALTH INSURANCE
Common questions
- What is A5209?
- A5209 is a bill in the New Jersey Legislature (2026-2027 Regular Session): Health insurers-provide reason for denial of coverage for private duty nursing.
- What does A5209 do?
- In its own words: An Act concerning health insurance coverage and private duty nursing and supplementing P.L.2023, c.296 (C.17B:30-55.1 et seq.).
- What is the status of A5209?
- In committee as of September 10, 2026. Latest action: REP REF AFI (September 10, 2026).
- Who sponsored A5209?
- Alexander Schnall (D, 30), with 2 co-sponsors.
- Where is the official record for A5209?
- On the New Jersey Legislature website: https://www.njleg.state.nj.us/bill-search/2026/A5209
Source: official New Jersey record. Tracked by Delilah, AI for legislation across all 50 states and Congress.