The Clinical Laboratory Services Reimbursement and Vulnerable Patient Discount Act is designed to enable clinical laboratories in New Jersey to provide discounts to certain patients, specifically those who are uninsured, underinsured, or facing financial hardship, without risking their reimbursement rates from NJ FamilyCare or breaching existing rebate prohibitions. The bill defines key terms related to financial hardship and establishes criteria for discount eligibility, particularly focusing on vulnerable populations, including those affected by substance use disorders. It modifies current regulations to allow laboratories to charge or accept lower amounts from non-NJ FamilyCare enrollees based on demonstrated financial hardship, ensuring that these actions do not impact their reimbursement from NJ FamilyCare.

Furthermore, the bill stipulates that any ongoing audits or actions against laboratories for prior violations of reimbursement policies will be dismissed upon the bill's enactment. It clarifies that discounts provided in accordance with the new provisions will not be classified as illegal rebates, thus offering legal protection to laboratories assisting vulnerable patients. The act also amends existing laws to ensure that reimbursement for NJ FamilyCare services is based on the lesser of the maximum fee schedule or the laboratory's usual charge to the public. The Department of Human Services is responsible for implementing the necessary rules and regulations, and the act will take effect immediately upon passage.

Statutes affected:
Introduced: 30:4D-17