Bill Text: NJ S4434 | 2026-2027 | Regular Session | Introduced
Bill Title: Requires health insurance and Medicaid reimbursement of clinical laboratories regardless of managed care plan participation.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced) 2026-06-08 - Introduced in the Senate, Referred to Senate Commerce Committee [S4434 Detail]
Download: New_Jersey-2026-S4434-Introduced.html
Sponsored by:
Senator JOHN F. MCKEON
District 27 (Essex and Passaic)
SYNOPSIS
Requires health insurance and Medicaid reimbursement of clinical laboratories regardless of managed care plan participation.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning clinical laboratories and supplementing P.L.1997, c.192 (C.26:2S-1 et seq.) and P.L.1968, c.413 (C.30:4D-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. Notwithstanding any law to the contrary, a carrier that offers a managed care plan shall provide payment for laboratory services to a clinical laboratory licensed pursuant to the "New Jersey Clinical Laboratory Improvement Act," P.L.1975, c.166 (C.45:9-42.26 et seq.), regardless of whether the clinical laboratory is a participating provider in the managed care plan.
b. (1) The carrier shall pay the clinical laboratory for laboratory services at the same rate it would pay a participating clinical laboratory for comparable services.
(2) The carrier shall retain the right to review all services provided pursuant to this section for medical necessity.
c. As used in this section, "carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State or any entity contracted to administer health benefits in connection with the State Health Benefits Program or School Employees' Health Benefits Program.
2. a. Any contract or other arrangement entered into by a managed care organization for the provision of laboratory services under the Medicaid program shall provide:
(1) payment for laboratory services to a clinical laboratory licensed pursuant to the "New Jersey Clinical Laboratory Improvement Act," P.L.1975, c.166 (C.45:9-42.26 et seq.), regardless of whether the clinical laboratory is a participating provider in the managed care plan; and
(2) reimbursement of the clinical laboratory for laboratory services at the same rate it would provide to a participating clinical laboratory for comparable services.
b. Services provided pursuant to this section may be reviewed for medical necessity.
c. The Division of Medical Assistance and Health Services in the Department of Humans Services shall be prohibited from requiring a clinical laboratory licensed pursuant to the "New Jersey Clinical Laboratory Improvement Act," P.L.1975, c.166 (C.45:9-42.26 et seq.), to participate in the managed care delivery system in order to receive reimbursement under Medicaid or to transition from the fee-for-service delivery system to the managed care delivery system in order to receive reimbursement under Medicaid.
d. As used in this section, "Medicaid" means the program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
3. This act shall take effect on the 180th day next following the date of enactment, and shall be applicable to health benefits plans, contracts, or arrangements entered into or renewed on or after that date.
STATEMENT
This bill requires health insurance and Medicaid reimbursement of clinical laboratory services regardless of managed care plan participation.
The bill requires carriers that offer managed care plans and contracts entered into by managed care organizations with the State Medicaid program to provide payment for laboratory services to clinical laboratories regardless of whether the laboratory is a participating provider with the managed care plan or organization.
The bill requires payment for the laboratory services to be at the same rate that would be paid to a participating clinical laboratory for comparable services. Carriers and managed care organizations retain the right to review the services for medical necessity.
The bill also prohibits the Division of Medical Assistance and Health Services in the Department of Humans Services from requiring a clinical laboratory to participate in the managed care delivery system in order to receive reimbursement under Medicaid or to transition from the fee-for-service delivery system to the managed care delivery system in order to receive reimbursement under Medicaid.
As used in the bill, "carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State or any entity contracted to administer health benefits in connection with the State Health Benefits Program or School Employees' Health Benefits Program.
