Overview
New Jersey is active in state market initiatives with a state-based insurance marketplace, Covered NJ, and a state-based reinsurance program that partially reimburses insurers for certain claims. In recent terms, New Jersey lawmakers are also considering legislation that would create a single-payer health plan by expanding Medicare to cover all of the state’s residents, as well as a proposal to create a public option that would compete with private insurers.
To address the rising cost of health care in New Jersey, the Governor signed Executive Order (No. 217 and No. 277) to direct the development of a health care cost growth benchmark program, named the Health Care Affordability, Responsibility and Transparency (HART) Program, which was established in December 2021. The program would collect and analyze data on insurance, hospital, provider and pharmaceutical costs, set the target rate of growth for health care spending, and seek to understand cost drivers and identify strategies to help curb costs.
In price transparency, New Jersey lawmakers imposed limits on surprise medical bills with the enactment of the Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act in 2018. Among other mandates, providers would have to tell their patients before scheduling an appointment whether the provider is in or out of the person’s insurance network, as well as disclose all the financial liability the patient is likely to have for the given procedure. The measure also puts robust reporting and transparency requirements on carriers, requiring insurers to provide up-to-date provider lists and clear information about out-of-network coverage and costs, and creates an arbitration process to resolve disputes. The legislature is also actively exploring ways to create an all-payer claims database. Bills under consideration would require providers reimbursed by state programs to give the state claims data and create a new Center for the Study of Health Care Billing Data to maintain a database and analyze claims data.
While many states have scrambled over the course of the COVID-19 pandemic to require insurers to provide parity for telehealth services, New Jersey established protections back in 2017. The state requires insurers to provide coverage, payment, and reimbursement for telehealth services on the same basis as in-person services and prohibits higher cost-sharing for these services.
With respect to market competition, New Jersey law requires non-profit providers to notify the state’s attorney general regarding proposed mergers and provides review and approval authority of such transactions. New Jersey also has a certificate of need law on the books. It has long prohibited most-favored nation clauses in healthcare contracts for managed care, and lawmakers are considering a bill that would additionally prohibit anti-tiering clauses. Additionally, lawmakers approved legislation that would allow the state’s largest insurer, Horizon Blue Cross Blue Shield, to convert from a nonprofit health services company to a nonprofit mutual holding company—a move that proponents say is needed to allow it to compete with other insurers, while opponents fear could harm enrollees.
On the litigation front, the FTC successfully blocked the proposed merger of the state’s largest healthcare system, Hackensack Meridian Health, and a nonprofit care system. The FTC claims that the acquisition of Englewood Healthcare would lead to higher prices. Another antitrust suit, Shire US, Inc. v. Allergan, Inc., was dismissed by a federal judge in 2019 who held that the plaintiff failed to define a relevant market that defendant was monopolizing, undermining their Sherman Act section 2 claim.
See below for an overview of existing New Jersey state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/10/2023 - 1/8/2024 (2022-2023 term). *Current session bill updates are ongoing. Check back weekly for updates.
A 1012 – New Jersey
Introduced: 2020 Status: Inactive / Dead
This bill establishes a bundled payments pilot program in the Medicaid program, operated by the Division of Medical Assistance and Health Services in the Department of Human Services. The program would be designed to serve …
A 1017 – New Jersey
Introduced: 2022 Status: In Process
This bill allows health insurers licensed in other states to provide individual health benefits plans and small employer health benefits plans to New Jersey residents and to employers in New Jersey under certain conditions and …
A 1034 (see companion bill S 1716) – New Jersey
Introduced: 2020 Status: Inactive / Dead
Requires rate review study of provider reimbursement rates provided by Medicaid and Children’s System of Care for pediatric and adult psychiatry services. The Commissioners of Human Services and Children and Families may require the submission …
A 1190 – New Jersey
Introduced: 2022 Status: In Process
Authorizes provision of comprehensive health care coverage to undocumented immigrant aliens.
A 1235 – New Jersey
Introduced: 2018 Status: Inactive / Dead
ELIMINATES CERTIFICATE OF NEED REQUIREMENT FOR SPECIAL CARE NURSING FACILITIES. This bill would eliminate the requirement for a certificate of need from the Department of Health (DOH) to develop or expand a special care nursing facility.
N.J. Rev. Stat. § 17B:27-50. Reimbursement for service of physician or practicing psychologist: Group Health and Blanket Insurance – New Jersey
Introduced: Status: Enacted
“…whenever such a policy or contract provides for reimbursement for any service which is within the lawful scope of practice of a duly licensed practicing psychologist, a person covered under such group health policy or …
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N.J. Rev. Stat. § 17B:27-51. Reimbursement for optometric service: Group Health and Blanket Insurance – New Jersey
Introduced: Status: Enacted
“…whenever such a policy or contract provides for reimbursement for any optometric service which is within the lawful scope of practice of a duly licensed optometrist, a person covered under such group health policy or …
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N.J. Rev. Stat. § 17B:27-51.1a. Reimbursement for non-salaried services of registered nurse; applicability of chapter to practice of nursing; policies affected: Group Health and Blanket Insurance – New Jersey
Introduced: Status: Enacted
“…whenever such a policy provides for reimbursement for any service which is within the lawful scope of practice of a duly registered professional nurse who is not being paid a salary by a health care …
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N.J. Rev. Stat. § 17B:27-65. Enrollment or continued enrollment; premiums or contributions based on health status-related factors: Group Health Insurance Portability – New Jersey
Introduced: Status: Enacted
A health insurer which offers a group health plan may not require an individual, as a condition of enrollment or continued enrollment under the plan, to pay a premium or contribution which is greater than …
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N.J. Rev. Stat. § 17B:27-74. Filing for Forms: Group Health Insurance Portability – New Jersey
Introduced: Status: Enacted
The commissioner may disapprove the filing of a form if the form contains provisions that are unfair.
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FTC v. RWJBarnabas Health & Saint Peter’s Healthcare System – New Jersey
District Court: District of New Jersey Status: Decided
RWJBH is the largest academic health system in New Jersey with 12 hospitals and collaborates with Rutgers Robert Wood Johnson Medical Schools. Saint Peter’s Healthcare …
Federal Trade Commission v. Hackensack Meridian and Englewood Healthcare – Federal, New Jersey
District Court: District of New Jersey Status: Pending
Hackensack Meridian, the largest healthcare system in New Jersey, and Englewood Healthcare announced their plans to merge in October 2019. While the proposed transaction was …
Shire US, Inc. v. Allergan, Inc. et al. – New Jersey
District Court: District of New Jersey Status: Pending
On October 2, 2017, Shire filed a complaint in New Jersey district court accusing Allergan of violating federal and state antitrust laws by improperly discounting …
Capital Health System, Inc., et al. v. Horizon Healthcare Services, Inc. – New Jersey
District Court: Superior Court of New Jersey, Chancery Division, Bergen County Status: Pending
After Horizon Blue Cross Blue Shield of New Jersey formed the tiered health plan Ominia, which gives discounts on premiums and fees to subscribers opting …
In re: EPIPEN (Epinephrine Injection, USP) Marketing, Sales Practices, and Antitrust Litigtion – Illinois, Kansas, New Jersey, Washington
District Court: District of Kansas Status: Pending
The plaintiffs in the case allege Mylan N.V. created and exploited an EpiPen monopoly by providing aggressive rebates and incentives to pharmacy benefit managers to …
Additional Resources
STATE BUDGET
New Jersey operates on an annual budget cycle. The governor submits a proposed budget in February and the legislature adopts a budget in June. The fiscal year begin July 1.
RESOURCE
- New Jersey Legislature
- New Jersey Office of the Attorney General
- New Jersey Department of Banking & Insurance
- NJ Hospital Price Compare
- New Jersey Prescription Drug Retail Price Registry
- New Jersey Office of Management and Budget