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A 4163

Allows certain firearm licensees to open carry

2025 Regular Session Introduced by Ken Blankenbush and 2 co-sponsors

NJ health insurers must cover biomarker precision testing when clinically indicated for diagnosis or disease management, per FDA/CMS guidance and comparable cost sharing.

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Bill Summary · A 4163

Summary — A4163 (P.L.2025, c.49)

Topic: Health insurance coverage for biomarker precision medical testing

Main purpose

Requires health insurers doing business in New Jersey — including commercial carriers, health service/medical service corporations, HMOs, entities administering the State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP), and Medicaid (NJ FamilyCare) — to provide coverage for biomarker precision medical testing when the test is appropriate for diagnosing, treating, managing, or monitoring a disease or condition.

Key provisions

  • Coverage required for “biomarker precision medical testing,” defined to include analysis of tissue, blood, or other biospecimens for biomarkers (e.g., gene mutations, protein expression) and methods such as single‑analyte tests, multiplex panels, protein expression assays, whole exome/genome/transcriptome sequencing.
  • Coverage limited to use for diagnosis, treatment, appropriate management, or ongoing monitoring to guide clinical treatment decisions; expressly excludes asymptomatic screening.
  • Tests must be recognized as efficacious/appropriate by one or more of the following:
    • labeled indications for an FDA‑approved or FDA‑cleared test;
    • indicated tests tied to an FDA‑approved drug;
    • actions addressing warnings/precautions on FDA drug labels;
    • CMS National Coverage Determinations or Medicare Administrative Contractor Local Coverage Determinations; or
    • nationally recognized clinical practice guidelines.
  • Coverage must be provided in a manner that limits care disruption (for example, avoiding multiple biopsies or duplicate biospecimen collection).
  • When utilization review (prior authorization) is required, decisions must follow the timelines and procedures set in P.L.2023, c.296 (the “Ensuring Transparency in Prior Authorization Act”); insureds and treating providers must have clear information on appeals for adverse determinations.
  • Benefits for biomarker testing are to be provided to the same extent as for other medical conditions under the contract (including applicable copayments, deductibles, coinsurance, and clinical review criteria).
  • The requirement applies to eligible contracts delivered, issued, executed, or renewed in New Jersey on or after the law’s effective date.

Who is affected

  • Health insurers, health service and medical service corporations, HMOs, and entities administering SHBP/SEHBP.
  • Medicaid/NJ FamilyCare managed care plans.
  • Individuals covered by those plans — patients who may need biomarker testing to inform care.
  • State and local employers participating in SHBP and SEHBP (potential impacts on employer health costs).

Fiscal impact

  • Office of Legislative Services (OLS) estimates: indeterminate annual expenditure increases for State, local governments, and school districts (SHBP/SEHBP); indeterminate impact for GetCoveredNJ (State marketplace).
  • NJ FamilyCare (Medicaid/CHIP) estimated net annual cost increase: $372,000 to $670,000 after anticipated increases in federal Medicaid reimbursements ($755,000 to $1.4 million).
  • Broader state/local cost estimates vary in consultant analyses cited (examples: ~$0.5M state / ~$0.9M local in one proxy; ~$2.5M state / ~$4.1M local in another), but actual costs depend on utilization, current coverage, benefit design, and prior authorization practices.

Legislative status / timeline

  • Introduced in Assembly: April 8, 2024.
  • Reported with committee amendments (Oct–Dec 2024); Assembly and Senate passed the bill (March 24, 2025).
  • Approved/Enacted as law: P.L.2025, c.49 (approved April 23, 2025).
  • Companion/related bills: S3098, S2021; prior-session A10307.

Sponsors

Primary sponsors in the introduced/reprinted versions include Assemblywoman Shavonda E. Sumter (and multiple co‑sponsors); see bill text for full sponsor/co-sponsor list.

If you want, I can extract the exact statutory text inserted (full section citations) or produce a one‑page plain‑language explainer for patients and providers describing what testing will now be covered and how appeals/prior authorization must proceed.

Compiled from official sources — confirm details with the bill’s official record.

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