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A4980
ASSEMBLY, No. 4980
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED MAY 7, 2026
Sponsored by:
Assemblywoman� HEATHER SIMMONS
District 3 (Cumberland, Gloucester and Salem)
SYNOPSIS
���� Establishes and requires coverage for routine opt-out
HIV testing during provision of medical care in certain settings.
CURRENT VERSION OF TEXT
���� As introduced.
��
An Act
concerning HIV testing and supplementing and
amending various parts of statutory law.
����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:
���� 1.� a.� The Legislature finds
and declares:
���� (1)� HIV (human
immunodeficiency virus) is a virus that attacks the body's immune system that without
treatment can lead to acquired immunodeficiency syndrome (AIDS).
���� (2)� There is currently no
effective cure and once people get HIV, they have it for life, but proper
medical care can control the virus.
���� (3)�� Testing for HIV is the
only way to determine if a person is living with the virus.
���� (4)� If individuals do not
know their HIV status, HIV transmission cannot be eliminated.
���� (5)� The Centers for Disease
Control and Prevention (CDC) recommend that every person between the ages of 13
and 64 years old receive an HIV test at least once, regardless of risk.
���� (6)� The Legislature
therefore determines that is in the public interest to establish routine HIV
testing in the State in order to promote early detection and treatment of HIV,
reduce transmission of HIV by increasing individual awareness of HIV status,
and align with CDC recommendations for HIV screening.
���� b.� As a part of routine
medical care involving the collection of specimen from a patient for laboratory
examination:
���� (1)�� the testing of HIV shall
be included for patients receiving care in the following settings:
���� (a)�� primary care settings;
���� (b)�� emergency departments of
licensed general hospitals in this State; and
���� (c)�� any other appropriate
health care setting as determined by the Commissioner of Health;
���� (2) separate written consent
for HIV testing shall not be required when a patient, or the patient�s parent
or legal guardian as applicable, has already provided general consent for
medical care in settings listed pursuant to paragraph (1) of this subsection;
���� (3)�� each patient listed
under paragraph (1) of this subsection shall be tested for HIV, unless:
���� (a)�� the patient, or the
patient�s parent or legal guardian as applicable, opts out of the testing;
���� (b)�� if the patient is an
adult, the patient lacks decision-making capacity;
���� (c)� the patient requires
emergency care that prevents the testing from occurring;
���� (d)� the patient is receiving
hospice care through a licensed hospice; or
���� (e)� the patient already has a
confirmed diagnosis of HIV;
���� (4)� testing of a patient for
HIV conducted pursuant to this section shall be voluntary and free of coercion;
���� (5)� the provision of pre-test
counseling shall not be required prior to HIV testing conducted pursuant to
this section; and
���� (6)� a patient shall be
notified that testing shall be performed unless the patient, or the patient�s
parent or legal guardian as applicable, declines the testing.� The health care
provider performing the test shall maintain documentation consistent with any
applicable federal and State HIV clinical practice guidelines concerning
medical record documentation.� If a patient declines to be tested for HIV, the
declination shall be documented in the patient�s medical record.�
���� b. The Commissioner of Health
shall establish guidelines regarding:
���� (1)� health care providers
providing timely notification to a patient, or the patient�s parent or legal
guardian as applicable, whose test result is positive, counseling about the
significance of the test result, providing referrals to appropriate follow-up
care, and coordinating with the Department of Health as necessary; and
���� (2)� a model notice for
providers to use when informing patients of the HIV test.
���� 3. �a.� No group or individual
hospital service corporation contract providing hospital or medical expense
benefits shall be delivered, issued, executed, or renewed in this State or
approved for issuance or renewal in this State by the Commissioner of Banking
and Insurance, on or after the effective date of this act, unless the contract
provides benefits to any subscriber or other person covered thereunder for HIV
testing required pursuant to section 2 of P.L.��� , c.��� (C.������� ) (pending
before the Legislature as this bill).�
���� b.� The benefits provided
under this section shall be provided to the same extent as for any other
medical condition under the contract.
���� c.� The provisions of this
section shall apply to all contracts in which the hospital service corporation
has reserved the right to change the premium.
����
���� 4. �a.� No group or individual
medical service corporation contract providing hospital or medical expense
benefits shall be delivered, issued, executed, or renewed in this State or
approved for issuance or renewal in this State by the Commissioner of Banking
and Insurance, on or after the effective date of this act, unless the contract
provides benefits to any subscriber or other person covered thereunder for HIV
testing required pursuant to section 2 of P.L.��� , c.��� (C.������� ) (pending
before the Legislature as this bill).
���� b.� The benefits provided
under this section shall be provided to the same extent as for any other
medical condition under the contract.
���� c.���� The provisions of this
section shall apply to all contracts in which the group or individual medical
service corporation has reserved the right to change the premium.
���� 5.� a.� No group or individual
health service corporation contract providing hospital or medical expense
benefits shall be delivered, issued, executed, or renewed in this State or
approved for issuance or renewal in this State by the Commissioner of Banking and
Insurance, on or after the effective date of this act, unless the contract
provides benefits to any subscriber or other person covered thereunder for HIV
testing required pursuant to section 2 of P.L.��� , c.��� (C.������� ) (pending
before the Legislature as this bill).
���� b.� The benefits provided
under this section shall be provided to the same extent as for any other
medical condition under the contract.
���� c.���� The provisions of this
section shall apply to all contracts in which the health service corporation
has reserved the right to change the premium.
���� 6. �a. �Except as provided in
paragraph (2) of this subsection, no individual health insurance policy
providing hospital or medical expense benefits shall be delivered, issued,
executed, or renewed in this State or approved for issuance or renewal in this
State by the Commissioner of Banking and Insurance, on or after the effective
date of this act, unless the policy provides benefits to any named insured or
other person covered thereunder for HIV testing required pursuant to section 2
of P.L.��� , c.��� (C.� ������) (pending before the Legislature as this bill).
���� b.� The benefits provided
under this section shall be provided to the same extent as for any other
medical condition under the contract.
���� c.� The provisions of this
section shall apply to all policies in which the insurer has reserved the right
to change the premium.
���� 7.� a.� No group health
insurance policy providing hospital or medical expense benefits shall be
delivered, issued, executed, or renewed in this State or approved for issuance
or renewal in this State by the Commissioner of Banking and Insurance, on or
after the effective date of this act, unless the policy provides benefits to
any named insured or other person covered thereunder for HIV testing required
pursuant to section 2 of P.L.��� , c.��� (C.������� ) (pending before the
Legislature as this bill).
���� b.� The benefits provided
under this section shall be provided to the same extent as for any other
medical condition under the contract.
���� c.� The provisions of this
section shall apply to all policies in which the insurer has reserved the right
to change the premium.
���� 8. �a. �Every individual
health benefits plan that is delivered, issued, executed, or renewed in this
State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) or approved for
issuance or renewal in this State, on or after the effective date of this act,
shall provide benefits to any person covered thereunder for expenses incurred
for HIV testing required pursuant to section 2 of P.L.��� , c.��� (C.������� )
(pending before the Legislature as this bill).
���� b.� The benefits provided
under this section shall be provided to the same extent as for any other
medical condition under the contract.
���� c.� The provisions of this
section shall apply to all health benefit plans in which the carrier has
reserved the right to change the premium.
���� 9. �a. �Every small employer
health benefits plan that is delivered, issued, executed, or renewed in this
State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) or approved for
issuance or renewal in this State, on or after the effective date of this act,
shall provide benefits to any person covered thereunder for HIV testing
required pursuant to section 2 of P.L.��� , c.��� (C.������� ) (pending before
the Legislature as this bill).
���� b.� The benefits provided
under this section shall be provided to the same extent as for any other
medical condition under the contract.
���� c.� The provisions of this
section shall apply to all health benefit plans in which the carrier has
reserved the right to change the premium.
����
���� 10. �a. �Notwithstanding any
provision of law to the contrary, a certificate of authority to establish and
operate a health maintenance organization in this State shall not be issued or
continued by the Commissioner of Banking and Insurance on or after the effective
date of this act unless the health maintenance organization provides health
care services to any enrollee for expenses incurred for HIV testing required
pursuant to section 2 of P.L.��� , c.��� (C.������� ) (pending before the
Legislature as this bill).
���� b.� The benefits provided
under this section shall be provided to the same extent as for any other
medical condition under the contract.
���� c.� The provisions of this
section shall apply to those contracts for health care services by health
maintenance organizations under which the health maintenance organization has
reserved the right to change the schedule of charges for enrollee coverage.
���� 11. �a.� Notwithstanding any
provision of law to the contrary, the School Employees� Health Benefits
Commission shall ensure that every contract purchased by the commission on or
after the effective date of this act that provides hospital or medical expense
benefits shall provide benefits under the contract for expenses incurred for
HIV testing required pursuant to section 2 of P.L.��� , c.��� (C.������� )
(pending before the Legislature as this bill).
���� b.� The benefits provided
under this section shall be provided to the same extent as for any other
medical condition under the contract.
���� 12.� a. �Notwithstanding any
State law or regulation to the contrary, the Department of Human Services shall
ensure the provision of benefits for HIV testing required pursuant to section 2
of P.L.��� , c.��� (C.������� ) (pending before the Legislature as this bill)
to eligible persons under the Medicaid program, established pursuant to
P.L.1968, c.413 (C.30:4D-1 et seq.).
���� b.� The benefits provided
under this section shall be provided to the same extent as for any other
medical condition under the contract.
���� c.� The Commissioner of Human
Services shall apply for such State plan amendments or waivers as may be
necessary to implement the provisions of this section and to secure federal
financial participation for State Medicaid expenditures under the federal Medicaid
program.
���� 13. �a. �The State Health
Benefits Commission shall provide benefits to each person covered under the
State Health Benefits Program for expenses incurred for HIV testing required
pursuant to section 2 of P.L.��� , c.��� (C.������� ) (pending before the
Legislature as this bill).
���� b.� The benefits provided
under this section shall be provided to the same extent as for any other
medical condition under the contract.
���� 14. �The Commissioner of
Health may adopt rules and regulations, pursuant to the �Administrative
Procedure Act,� P.L.1968, c.410 (C.52:14B-1 et seq.), as may be necessary to
implement the provisions of this act.
���� 15.� This act shall take
effect immediately.
STATEMENT
���� This bill establishes and
requires coverage for routine opt-out HIV testing during the provision of
medical care in certain settings.
���� HIV (human immunodeficiency
virus) is a virus that attacks the body's immune system that without treatment
can lead to AIDS (acquired immunodeficiency syndrome).� There is currently no
effective cure and once people get HIV, they have it for life, but proper
medical care can control the virus.� Testing for HIV is the only way to
determine if a person is living with the virus.� If individuals do not know
their HIV status, HIV transmission cannot be eliminated.� The Centers for
Disease Control and Prevention (CDC) recommend that every person between the
ages of 13 and 64 years old receive an HIV test at least once, regardless of
risk. It is the sponsor�s intent that establishing routine HIV testing in the
State will promote early detection and treatment of HIV, reduce transmission of
HIV by increasing individual awareness of HIV status, and align with CDC
recommendations for HIV screening.
���� The bill provides that, as a
part of routine medical care involving the collection of specimen from a
patient for laboratory examination, HIV testing will be included for� patients
receiving care in the following settings:� primary care settings;� emergency
departments of licensed general hospitals in this State; and any other
appropriate health care setting as determined by the Commissioner of Health.�
Under the bill, separate written consent for HIV testing will not be required
when a patient, or the patient�s parent or legal guardian as applicable, has
already provided general consent for medical care.� Each patient will be tested
for HIV, unless:
���� 1)��� the patient, or the
patient�s parent or legal guardian as applicable, opts out of the testing;
���� 2)��� if the patient is an
adult, the patient lacks decision-making capacity;
���� 3)� the patient requires
emergency care that prevents the testing from occurring;
���� 4)� the patient is receiving
hospice care through a licensed hospice; or
���� 5)� the patient already has a
confirmed diagnosis of HIV.� Testing of a patient for HIV will be voluntary and
free of coercion.� The provision of pre-test counseling will not be required
prior to HIV testing.� The patient will be notified that testing will be
performed unless the patient, or the patient�s parent or legal guardian as
applicable, declines the testing.� The health care provider performing the test
will maintain documentation consistent with any applicable federal and State
HIV clinical practice guidelines concerning medical record documentation.� If a
patient declines to be tested for HIV, the declination shall be documented in the
patient�s medical record.�
���� The bill requires the
Commissioner of Health to establish guidelines regarding:� health care
providers providing timely notification to a patient, or the patient�s parent
or legal guardian as applicable, whose test result is positive, counseling
about the significance of the test result, providing referrals to appropriate
follow-up care, and coordinating with the Department of Health as necessary;
and a model notice for providers to use when informing patients of the HIV test.
���� Under the bill, health
insurance carriers in the State will be required to cover the routine HIV
testing required under the bill.