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Bill

A 4877

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

2026-2027 Regular Session Introduced by Lou Greenwald

Mandates health insurers and Medicaid reimburse clinical laboratories at parity, regardless of whether the lab participates in the plan’s network.

Introduced, Referred to Assembly Financial Institutions and Insurance Committee
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Bill Summary · A 4877

Summary of New Jersey A4877 (Session 222)

Overview

  • Bill: A4877
  • Session: 222
  • Jurisdiction: New Jersey
  • Status: Introduced and referred to the Assembly Financial Institutions and Insurance Committee on May 4, 2026
  • Sponsor: Assembly member Lou Greenwald (co-sponsor)

Core Purpose and Intent

A4877 aims to ensure that health insurance plans and Medicaid reimburse clinical laboratories for their services regardless of whether the laboratory participates in the health plan’s managed care network. In other words, it seeks to standardize reimbursement to clinical laboratories across both in-network and non-network arrangements, promoting uniform payment for laboratory testing under both private insurance and Medicaid programs.

Key Provisions (as described by the bill’s title and typical structure)

While the full text of the bill is not provided here, the title indicates the principal reform:
- Mandatory reimbursement parity: Health insurance plans and Medicaid must reimburse clinical laboratories irrespective of managed care plan participation status.
- Scope of reimbursement: Applies to clinical laboratory services, likely including billing for laboratory tests, specimen processing, and related laboratory services performed for insured individuals and Medicaid beneficiaries.
- Non-discrimination in payment: Aims to prevent lower reimbursement rates for out-of-network or non-participating labs compared to participating networks, thereby reducing access barriers for labs and patients relying on non-network providers.

Who Would Be Affected

  • Clinical laboratories: Particularly those not participating in certain health insurer or Medicaid managed care networks. The bill would ensure they receive payment for covered services regardless of network status.
  • Health insurers and managed care plans: They would be required to reimburse labs at parity with in-network rates even if the lab is not part of their network.
  • Medicaid program: If applicable under the bill's provisions, Medicaid would reimburse labs for covered services without regard to plan participation status.
  • Patients/beneficiaries: Beneficiaries seeking laboratory testing could experience more consistent access to a broader range of labs without concerns about out-of-network reimbursement disparities.

Procedural and Timeline Aspects

  • Introduction and referral: The bill was introduced and immediately referred to the Assembly Financial Institutions and Insurance Committee on May 4, 2026.
  • Next steps in process: The committee may hold hearings, request amendments, and vote to advance the bill to the full Assembly. If passed, it would move to the Senate (and, subsequently, to the Governor for signature) in the legislative process.

Potential Impact and Considerations

  • Access and competition: By extending reimbursement parity, the bill could increase access to a wider network of laboratories and potentially increase competition on quality and efficiency.
  • Cost implications: Insurers and Medicaid might experience changes in costs due to broader reimbursement obligations. The bill may include specific rate-setting or reference pricing mechanisms in the full text, which would influence overall expenditures.
  • Administrative considerations: Payers would need to align claim adjudication systems to ensure parity-based reimbursement for non-network labs, possibly requiring new verification and auditing processes.

Note

The summary reflects the information available from the bill’s title and introductory action. For precise language, definitions (e.g., what constitutes “clinical laboratory” services, whether self-insured plans are covered, and any carve-outs), and detailed terms (rates, timelines, enforcement mechanisms), the full bill text and any fiscal impact statements should be consulted.

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

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