Requires health insurance and Medicaid reimbursement of clinical laboratories regardless of managed care plan participation.

S4434

SENATE, No. 4434

STATE OF NEW JERSEY

222nd LEGISLATURE

�

INTRODUCED JUNE 8, 2026

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.