Bill
A 5376
Establishes a state office and a commission to monitor, publish price data, benchmark hospital and price growth, and impose penalties to curb excessive health care costs.
Status: Introduced Feb 27, 2025; reported from Assembly Financial Institutions & Insurance Committee with amendments (June 19, 2025) and referred to Assembly Appropriations. Committee amendments removed a prior appropriation and made technical changes.
Establish an institutional framework to monitor, analyze, and contain health care price growth in New Jersey by (1) creating an Office of Health Care Affordability and Transparency to collect and publish data and support policymaking, and (2) creating a Health Care Cost Containment and Price Transparency Commission to set benchmarks, identify entities exceeding those benchmarks, and require remediation (including civil penalties). The bill also requires hospitals to comply with federal price-transparency rules and links noncompliance to both penalties and limits on medical debt collection.
Office of Health Care Affordability and Transparency (in Dept. of Health)
- Executive director appointed by the Governor.
- Establishes data submission guidelines and schedules for payers and providers.
- Collects hospital pricing data for the State Health Benefits Plan (in-network and out-of-network allowed amounts) by service category: inpatient, outpatient, emergency room, and associated physician services. Service-level amounts must use standard codes (CPT, HCPCS, DRG, NDC, etc.).
- Prioritizes existing data sources (e.g., Drug Affordability Council, State Health Benefits Program, potential All Payer Claims Database) to avoid redundancy.
- Publishes data publicly and may conduct studies and programs to reduce per-capita health care spending growth and lower consumer costs.
Health Care Cost Containment and Price Transparency Commission
- 18 members (mix of gubernatorial appointees, legislative appointees, nominees from stakeholder organizations, the Commissioner of Health or designee, with the State Comptroller and two office representatives as non-voting members).
- Members serve staggered five-year terms; commission must meet at least quarterly and hold at least one annual public meeting (with opportunity for public input).
- Duties: set a health care cost growth benchmark and a hospital price growth benchmark (using total facility + physician price as a percent of Medicare baseline), identify entities exceeding benchmarks, compel testimony from entities exceeding benchmarks, and require corrective action/remediation.
- Enforcement: may impose civil penalties under the Penalty Enforcement Law (P.L.1999, c.274) on entities that fail to respond to requests for corrective action plans or fail to comply with such plans.
Hospital-specific requirements and penalties
- Dept. of Health must require hospitals to comply with federal hospital price-transparency requirements; issue written warnings or request corrective action plans for noncompliance.
- Hospitals are prohibited from attempting to collect medical debt from a patient if, at the time services were provided, the hospital was not in compliance with the bill’s transparency provisions.
- Civil penalty for hospital noncompliance: $10 per day per hospital bed for each offense (enforceable under the Penalty Enforcement Law).
Compiled from official sources — confirm details with the bill’s official record.
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