NJ S1399

Clinical laboratories may offer discounted charges to patients experiencing financial hardship (household income at or below 200% federal poverty level or exceptional unforeseen expenses) without reducing their NJ FamilyCare reimbursement rates

Reimbursement for laboratory services under NJ FamilyCare will be the lesser of the maximum fee schedule amount or the laboratory's usual charge to the general public, eliminating the current requirement to match the lowest price offered to any patient

Discounts to vulnerable populations are explicitly excluded from the state's anti-rebate prohibitions, which previously classified patient discounts as prohibited rebates under N.J.A.C.10:61-2.4

All pending audits, investigations, recoupments, and enforcement actions against laboratories for previously offering discounts to vulnerable patients will be dismissed, and past judgments or certificates of debt will be vacated and expunged

Laboratories must document patient financial hardship through proof of income from the preceding 1-12 months or documentation of exceptional circumstances that impair ability to pay