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Bill

A 4000

"Gary Letizia Pre-Hospital Blood Transfusion Act"; authorizes advanced life support providers, under medical oversight, to administer blood products to patients in pre-hospital settings, and establishes certain reimbursement for such providers.

2026-2027 Regular Session Introduced by Al Barlas and 2 co-sponsors

Allows trained pre-hospital providers to transfuse blood under medical oversight to reduce hemorrhage deaths, with funding, oversight, and proper protocols.

Introduced, Referred to Assembly Health Committee
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Bill Summary · A 4000

Summary of Bill A 4000 (Session 222) — Gary Letizia Pre-Hospital Blood Transfusion Act (New Jersey)

Purpose and Intent

  • Establishes a formal framework for advanced life support (ALS) providers to administer blood products in pre-hospital settings under medical oversight.
  • Aims to reduce deaths from uncontrolled hemorrhage and acute blood loss by enabling timely pre-hospital transfusions and improving access to low-titer O whole blood and other blood products.
  • Named in honor of Gary Letizia, recognizing the life-saving role of timely transfusions and first responders.

Key Provisions and Changes

Definitions

  • Creates specific terms for the program, including:
    • Advanced life support agency/provider
    • Blood product (whole blood, components, plasma derivatives)
    • Medical oversight (trauma/emergency-trained physician oversight)
    • Low-titer O whole blood (universally transferrable in emergencies)

Program Establishment and Oversight (Section 3)

  • ALS agencies seeking to transfuse must:

    • Notify the Department of Health (DOH) at least 60 days before starting.
    • Designate a blood bank medical director as medical director of the transfusion program (with ultimate authority retained by the hospital blood bank medical director; delegation allowed for EMS duties).
    • Use only providers who completed a DOH-approved blood administration course.
    • Ensure at least two trained ALS providers are present during transfusion.
    • Maintain appropriate storage, warming equipment, and FDA-approved equipment.

  • Blood product storage and handling:

    • Use FDA-approved anticoagulant preservative solutions (e.g., CPDA-1, CPD) and allow preparation into PRBCs as appropriate.
    • Comply with FDA storage/handling regs, AABB standards, and DOH guidelines.
    • Mandate protocols for recognizing and managing transfusion reactions.

Operations and Compliance (Section 3, ongoing duties)

  • ALS providers must conduct quarterly audits and submit reports per existing reporting cadences (clinical, equipment, quality).
  • Implement transfusion reaction protocols.

Patient Care and Consent (Section 4)

  • ALS providers may administer blood products when indicated by clinical signs, after DOH-approved training, and under established DOH-approved protocols.
  • No requirement for on-scene physician approval; must notify the receiving trauma/emergency center.
  • Informed consent should be obtained when feasible; otherwise, proceed under implied consent in emergencies.

Reimbursement and Funding (Sections 6-7)

  • Medicaid/FamilyCare and private carriers must cover pre-hospital transfusions on the same basis as hospital-based transfusions, aligned with Medicare/Medicaid guidance (ALOS 2 billing code and related reimbursement rules).
  • Reimbursement rates based on Medicaid/Medicare guidelines, including blood product costs and administration.

Grants, Inventory, and Waste Reduction (Sections 5, 8-9)

  • DOH to create a grant program to help with initial implementation costs (storage, warming, transport, training).
  • DOH to ensure adequate supply of low-titer O whole blood and other products in coordination with blood banks/hospitals.
  • Establish a rigorous stewardship program:
    • Real-time tracking of blood products
    • Regular rotation with hospital blood banks
    • Procedures to move nearing-expiration units to partner hospitals
    • Standardized protocols and digital inventory systems for exchange and restocking

Administrative and Effective Date (Sections 10-12)

  • DOH/Human Services to pursue any necessary Medicaid/state plan amendments or waivers.
  • DOH to adopt implementing regulations within 180 days of enactment.
  • Effective date: first day of the seventh month after enactment, with anticipatory actions allowed.

Targeted Impact

  • Affects: Advanced life support agencies/providers, DOH, hospitals with blood banks, EMS agencies, Medicaid/FamilyCare and private carriers, blood banks, and partner hospitals.
  • Financial: Shifts to include Medicaid/private payer coverage for pre-hospital transfusions; establishes state grant support for initial setup.
  • Operational: Enables real-time blood product management, staffing/training requirements, and formal oversight for pre-hospital transfusions.

Timeline at a Glance

  • 60 days prior: Notice to DOH to begin program.
  • Within 180 days: DOH to adopt implementing regulations.
  • Post-enactment: Anticipatory actions allowed; program commences per regulatory readiness.
  • Ongoing: Quarterly audits, ongoing reporting, and continuous inventory stewardship.

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

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