This bill establishes a reference-based pricing system for certain medical services in New Jersey, requiring health carriers to offer this pricing model to covered persons. The Department of Banking and Insurance (DOBI) will determine which medical services will be subject to reference-based pricing, and carriers must provide an annual list to covered persons that includes the medical services, their corresponding reference prices, and the health care providers that have agreements to accept these prices. Additionally, carriers must demonstrate that covered persons have reasonable access to these medical services, adhering to state network adequacy standards.

DOBI is tasked with adopting rules and regulations to implement the reference-based pricing system, which will focus on medical services with the highest unit price variations. The department will gather claims information to identify these services and establish reference prices accordingly. Carriers will also have the option to apply for exemptions from offering reference-based pricing for certain services. Furthermore, the bill mandates the creation of a program to help covered persons select appropriate health care providers and a plan for continuous quality improvement in care provided by those accepting reference-based pricing. The act is set to take effect on January 1, 2028, with provisions for anticipatory administrative actions by the Commissioner of Banking and Insurance.