The Clinical Laboratory Services Reimbursement and Vulnerable Patient Discount Act seeks to enable clinical laboratories in New Jersey to provide discounts to uninsured, underinsured, or vulnerable patients without risking their reimbursement rates under the NJ FamilyCare program or breaching existing rebate prohibitions. The bill defines terms such as "financial hardship" and establishes criteria for offering discounts, particularly for individuals affected by substance use disorders. It modifies current regulations to clarify that laboratories can charge or accept lower amounts from non-NJ FamilyCare enrollees based on demonstrated financial hardship, ensuring that these actions do not impact their NJ FamilyCare reimbursement.

Additionally, the bill includes provisions to dismiss any pending audits or actions against laboratories that would now be permissible under the new guidelines, effectively expunging related administrative records. It amends existing laws to confirm that discounts provided in compliance with the act are not classified as illegal rebates. By modifying the reimbursement policy under N.J.A.C.10:61-1.7, the bill ensures that reimbursement for clinical laboratory services under NJ FamilyCare will be the lesser of the maximum fee schedule or the laboratory's usual charge to the public, thereby enhancing access to care for vulnerable populations while adhering to state and federal regulations.

Statutes affected:
Introduced: 30:4D-17