A 5317 — Allows clinical laboratory and laboratory services providers with opportunity to participate as preferred or contracting provider and allows clinical laboratory services to receive reimbursement.*
Last action — REP/ACS REF AHN
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1Introduced
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2In Committee
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3Passed General Assembly
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4Passed Senate
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5To Executive
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6Enacted
This bill has been introduced in the General Assembly. Introduced June 23, 2026. It must pass committee before a floor vote.
Next likely step: a committee referral and hearing.
Odds of enactment
Low chanceBased on the sponsor, cosponsors, and committee posture, this bill has a low chance of becoming law.
Upgrade to see the exact probability and what's driving it.
A statistical estimate from our own model of past outcomes — an insight, not a guarantee. Policymaking is volatile.
Prognosis
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Introduced
Current position in the legislative process.
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2 sponsors
2 primary, 0 co-sponsors signed on.
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Cleared a recorded vote
Passed 1 recorded vote so far.
Based on stage, sponsorship breadth, committee status, recorded votes, and cross-state momentum — a description of the observable signals, not a prediction.
In plain language
This bill requires health insurance carriers to offer clinical laboratories a chance to join their networks.
The bill mandates that health insurance carriers must provide clinical laboratory and laboratory services providers the opportunity to participate in their provider networks. This aims to ensure more available options for laboratory services within health plans.
What this means for you
- Healthcare: This could lead to increased options for laboratory services within health insurance plans.
Summary
Health insurance carriers-prov opportunity, clinical laboratory & svcs provider
Bill Text
What changed in the latest version
186 added · 166 removedPlain-language change summary
The amendment changes the wording to clarify that clinical laboratories and laboratory services providers are allowed to participate as preferred or contracting providers within health insurance carriers' networks. Additionally, the bill now explicitly mentions that clinical laboratory services can be reimbursed, which may enhance funding for these services. This amendment is significant as it may improve access to clinical laboratory services for subscribers by integrating them more fully into insurance networks.
A5317 ACS ASSEMBLY COMMITTEE SUBSTITUTE FOR ASSEMBLY, No.
5317 STATE OF NEW JERSEY 222nd LEGISLATURE INTRODUCEDADOPTED JUNESEPTEMBER 23,17, 2026 Sponsored by:
District 11 (Monmouth) Assemblyman ROYLOUIS FREIMAND. District 16 (Hunterdon, Mercer, Middlesex and Somerset) SYNOPSIS Requires health insurance carriers to provide opportunity to clinical laboratory and laboratory services provider to participate as preferred or contracting provider in carriers’ provider network.
GREENWALD District 6 (Burlington and Camden) SYNOPSIS Allows clinical laboratory and laboratory services providers with opportunity to participate as preferred or contracting provider and allows clinical laboratory services to receive reimbursement. CURRENT VERSION OF TEXT AsSubstitute introduced.as adopted by the Assembly Financial Institutions and Insurance Committee.
An Act concerning provider networks and clinical laboratories and amending P.L.1993,and c.378.supplementing various parts of the statutory law.
1. a.a. Notwithstanding any other provision of law to the contrary, no group or individual hospital service corporation contract which provides benefits for pharmacy services, prescription drugs, or for participation in a prescription drug plan, shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State [on or after the effective date of this act,] unless the contract:
Notwithstanding any(1) otherPermits provisionthe ofsubscriber, lawat to the contrary,time noof groupissuance, amendment or individualrenewal, hospitalto serviceselect corporationbenefit contractcoverage whichallowing providesthe benefitssubscriber forto pharmacychoose services,a prescriptionpharmacy drugs, or forpharmacist, participationclinical inlaboratory, a prescription drug plan, shall be delivered, issued, executed or renewedlaboratory inservices thisprovider State, or approved for issuancethe orprovision renewalof inprescription thisdrugs State [on or afterpharmacy theservices, effectiveclinical datelaboratory ofservices, thisor act,]laboratory unlessservices, theprovided contract:that:
(1) Permits the subscriber, at the time of issuance, amendment or renewal, to select benefit coverage allowing the subscriber to choose a pharmacy or pharmacist, clinical laboratory, or laboratory services provider for the provision of prescription drugs or pharmacy services, clinical laboratory services, or laboratory services, provided that:
and (b) (b) any clinical laboratory selected by the subscriber is licensed pursuant to the “New Jersey Clinical Laboratory Improvement Act,” P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal “Clinical Laboratory Improvement Amendments of 1988,” Pub.L.100-578 (42 U.S.C.
(2) (2) Provides that no pharmacy or pharmacist, clinical laboratory, or laboratory services provider shall be denied the right to participate as a preferred provider or as a contracting provider, under the same terms and conditions currently applicable to all other preferred or contracting providers, if the contract provides for coverage by contracted or preferred providers for pharmaceutical services, clinical laboratory services, or laboratory services, provided:
and (b) (b) a clinical laboratory is licensed pursuant to the “New Jersey Clinical Laboratory Improvement Act,” P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal “Clinical Laboratory Improvement Amendments of 1988,” Pub.L.100-578 (42 U.S.C.
(3) (3) Provides that no copayment, fee, or other condition shall be imposed upon a subscriber selecting a participating or contracting pharmacist or pharmacy, clinical laboratory, or laboratory services provider that is not also equally imposed upon all subscribers selecting a participating or contracting pharmacist or pharmacy, clinical laboratory, or laboratory services provider;
(4)(4) (a) Provides Provides that no subscriber shall be required to obtain pharmacy services and prescription drugs from a mail service pharmacy;
(b) (b) Provides for no differential in any copayment applicable to any prescription drug of the same strength, quantity and days' supply, whether obtained from a mail service pharmacy or a non-mail service pharmacy, provided that the non-mail service pharmacy agrees to the same terms, conditions, price and services applicable to the mail service pharmacy;
(5) (5) Sets forth the auditing procedures to be used by the hospital service corporation and includes a provision that any audit shall take place at a time mutually agreeable to the pharmacy or pharmacist, clinical laboratory, or laboratory services provider and the auditor. No audit by a hospital service corporation shall include a review of any document relating to any person or prescription plan other than those reimbursable by the hospital service corporation;
and (6) (6) Provides that the hospital service corporation, or any agent or intermediary thereof, including a thirdthird-party party administrator, shall not restrict or prohibit, directly or indirectly, a pharmacy from charging the subscriber for services rendered by the pharmacy that are in addition to charges for the drug, for dispensing the drug or for prescription counseling. Services rendered by the pharmacy for which additional charges are imposed shall be subject to the approval of the Board of Pharmacy. A pharmacy shall disclose to the purchaser the charges for the additional services and the purchaser's out-of-pocket cost for those services prior to dispensing the drug. A pharmacy shall not impose any additional charges for patient counseling or for other services required by the Board of Pharmacy or State or federal law[;
(7) (7) The provisions of P.L.1999, c.395 shall apply to all contracts delivered.
c. c. This section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the subscriber charge.
(1) (1) not discriminate against or exclude a willing pharmacy, pharmacist, clinical laboratory, or laboratory services provider on the basis of corporate structure, size, location, or affiliation, provided that the provider meets the hospital service corporation credentialing standards and agrees to the reimbursement schedule and performance criteria applicable to participating providers;
and (3) (3) issue a written notice of denial, if a pharmacy, pharmacist, clinical laboratory, or laboratory services provider is denied participation in a network, stating the specific criteria that were not satisfied and informing the provider of the process for reconsideration.
e. e. Nothing in this section shall be construed to prohibit a hospital service corporation from establishing quality, safety, utilization, or performance standards for participation in its network, provided that the standards are applied in a uniform and nondiscriminatory manner.
(1) (1) Permits the subscriber, at the time of issuance, amendment or renewal, to select benefit coverage allowing the subscriber to choose a pharmacy or pharmacist, clinical laboratory, or laboratory services provider for the provision of prescription drugs or pharmacy services, clinical laboratory services, or laboratory services, provided that:
or (b) (b) any clinical laboratory selected by the subscriber is licensed pursuant to the “New Jersey Clinical Laboratory Improvement Act,” P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal “Clinical Laboratory Improvement Amendments of 1988,” Pub.L.100-578 (42 U.S.C.
(2) (2) Provides that no pharmacy or pharmacist, clinical laboratory, or laboratory services provider shall be denied the right to participate as a preferred provider or as a contracting provider, under the same terms and conditions currently applicable to all other preferred or contracting providers, if the contract provides for coverage by contracted or preferred providers for pharmaceutical services, clinical laboratory services, or laboratory services, provided:
or (b) (b) a clinical laboratory is licensed pursuant to the “New Jersey Clinical Laboratory Improvement Act,” P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal “Clinical Laboratory Improvement Amendments of 1988,” Pub.L.100-578 (42 U.S.C.
(3) (3) Provides that no copayment, fee, or other condition shall be imposed upon a subscriber selecting a participating or contracting pharmacist or pharmacy, clinical laboratory, or laboratory services provider that is not also equally imposed upon all subscribers selecting a participating or contracting pharmacist or pharmacy, clinical laboratory, or laboratory services provider;
(b) (b) Provides for no differential in any copayment applicable to any prescription drug of the same strength, quantity and days' supply, whether obtained from a mail service pharmacy or a non-mail service pharmacy, provided that the non-mail service pharmacy agrees to the same terms, conditions, price and services applicable to the mail service pharmacy;
(5) (5) Sets forth the auditing procedures to be used by the medical service corporation and includes a provision that any audit shall take place at a time mutually agreeable to the pharmacy or pharmacist, clinical laboratory, or laboratory services provider and the auditor. No audit by a medical service corporation shall include a review of any document relating to any person or prescription plan other than those reimbursable by the medical service corporation;
and (6) (6) Provides that the medical service corporation, or any agent or intermediary thereof, including a thirdthird-party party administrator, shall not restrict or prohibit, directly or indirectly, a pharmacy from charging the subscriber for services rendered by the pharmacy that are in addition to charges for the drug, for dispensing the drug or for prescription counseling. Services rendered by the pharmacy for which additional charges are imposed shall be subject to the approval of the Board of Pharmacy. A pharmacy shall disclose to the purchaser the charges for the additional services and the purchaser's out-of-pocket cost for those services prior to dispensing the drug.
A A pharmacy shall not impose any additional charges for patient counseling or for other services required by the Board of Pharmacy or State or federal law[;
(7) (7) The provisions of P.L.1999, c.395 shall apply to all contracts delivered.
c. c. This section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the subscriber charge.
(1) (1) not discriminate against or exclude a willing pharmacy, pharmacist, clinical laboratory, or laboratory services provider on the basis of corporate structure, size, location, or affiliation, provided that the provider meets the medical service corporation’s credentialing standards and agrees to the reimbursement schedule and performance criteria applicable to participating providers;
and (3) (3) issue a written notice of denial, if a pharmacy, pharmacist, clinical laboratory, or laboratory services provider is denied participation in a network, stating the specific criteria that were not satisfied and informing the provider of the process for reconsideration.
e. e. Nothing in this section shall be construed to prohibit a medical service corporation from establishing quality, safety, utilization, or performance standards for participation in its network, provided that the standards are applied in a uniform and nondiscriminatory manner.
Notwithstanding Notwithstanding any other provisions of law to the contrary, no group or individual health service corporation contract which provides benefits for pharmacy services, prescription drugs, or for participation in a prescription drug plan, shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State [on or after the effective date of this act,] unless the contract:
(1) (1) Permits the subscriber, at the time of issuance, amendment or renewal, to select benefit coverage allowing the subscriber to choose a pharmacy or pharmacist, clinical laboratory, and laboratory services provider for the provision of prescription drugs or pharmacy services, clinical laboratory services, or laboratory services, provided that:
or (b) (b) any clinical laboratory selected by the subscriber is licensed pursuant to the “New Jersey Clinical Laboratory Improvement Act,” P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal “Clinical Laboratory Improvement Amendments of 1988,” Pub.L.100-578 (42 U.S.C.
(2) (2) Provides that no pharmacy or pharmacist, clinical laboratory, or laboratory services provider shall be denied the right to participate as a preferred provider or as a contracting provider, under the same terms and conditions currently applicable to all other preferred or contracting providers, if the contract provides for coverage by contracted or preferred providers for pharmaceutical services, clinical laboratory services, or laboratory services, provided:
or (b) (b) a clinical laboratory is licensed pursuant to the “New Jersey Clinical Laboratory Improvement Act,” P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal “Clinical Laboratory Improvement Amendments of 1988,” Pub.L.100-578 (42 U.S.C.
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(3) (3) Provides that no copayment, fee, or other condition shall be imposed upon a subscriber selecting a participating or contracting pharmacist or pharmacy, clinical laboratory, or laboratory services provider that is not also equally imposed upon all subscribers selecting a participating or contracting pharmacist or pharmacy, clinical laboratory, or laboratory services provider;
(4)(4) (a) Provides Provides that no subscriber shall be required to obtain pharmacy services and prescription drugs from a mail service pharmacy;
(b) (b) Provides for no differential in any copayment applicable to any prescription drug of the same strength, quantity and days' supply, whether obtained from a mail service pharmacy or a non-mail service pharmacy, provided that the non-mail service pharmacy agrees to the same terms, conditions, price and services applicable to the mail service pharmacy;
(5) (5) Sets forth the auditing procedures to be used by the health service corporation and includes a provision that any audit shall take place at a time mutually agreeable to the pharmacy or pharmacist, clinical laboratory, or laboratory services provider and the auditor. No audit by a health service corporation shall include a review of any document relating to any person or prescription plan other than those reimbursable by the health service corporation;
and (6) (6) Provides that the health service corporation, or any agent or intermediary thereof, including a thirdthird-party party administrator, shall not restrict or prohibit, directly or indirectly, a pharmacy from charging the subscriber for services rendered by the pharmacy that are in addition to charges for the drug, for dispensing the drug or for prescription counseling. Services rendered by the pharmacy for which additional charges are imposed shall be subject to the approval of the Board of Pharmacy. A pharmacy shall disclose to the purchaser the charges for the additional services and the purchaser's out-of-pocket cost for those services prior to dispensing the drug.
A A pharmacy shall not impose any additional charges for patient counseling or for other services required by the Board of Pharmacy or State or federal law[;
(7) (7) The provisions of P.L.1999, c.395 shall apply to all contracts delivered.
c. c. This section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the subscriber charge.
(1) (1) not discriminate against or exclude a willing pharmacy, pharmacist, clinical laboratory, or laboratory services provider on the basis of corporate structure, size, location, or affiliation, provided that the provider meets the health service corporation’s credentialing standards and agrees to the reimbursement schedule and performance criteria applicable to participating providers;
and (3) (3) issue a written notice of denial, if a pharmacy, pharmacist, clinical laboratory, or laboratory services provider is denied participation in a network, stating the specific criteria that were not satisfied and informing the provider of the process for reconsideration.
e. e. Nothing in this section shall be construed to prohibit a health service corporation from establishing quality, safety, utilization, or performance standards for participation in its network, provided that the standards are applied in a uniform and nondiscriminatory manner.
Notwithstanding Notwithstanding any other provision of law to the contrary, no individual health insurance policy which provides benefits for pharmacy services, prescription drugs, or for participation in a prescription drug plan, shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State [on or after the effective date of this act,] unless the policy:
(1) (1) Permits the insured, at the time of issuance, amendment or renewal, to select benefit coverage allowing the insured to choose a pharmacy or pharmacist, clinical laboratory, and laboratory services provider for the provision of prescription drugs or pharmacy services, clinical laboratory services, or laboratory services, provided that:
or (b) (b) any clinical laboratory selected by the insured is licensed pursuant to the “New Jersey Clinical Laboratory Improvement Act,” P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal “Clinical Laboratory Improvement Amendments of 1988,” Pub.L.100-578 (42 U.S.C.
(2) (2) Provides that no pharmacy or pharmacist, clinical laboratory, or laboratory services provider shall be denied the right to participate as a preferred provider or as a contracting provider, under the same terms and conditions currently applicable to all other preferred or contracting providers, if the policy provides for coverage by contracted or preferred providers for pharmaceutical services, clinical laboratory services, or laboratory services, provided:
or (b) (b) a clinical laboratory is licensed pursuant to the “New Jersey Clinical Laboratory Improvement Act,” P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal “Clinical Laboratory Improvement Amendments of 1988,” Pub.L.100-578 (42 U.S.C.
(3) (3) Provides that no copayment, fee, or other condition shall be imposed upon an insured selecting a participating or contracting pharmacist or pharmacy, clinical laboratory, or laboratory services provider that is not also equally imposed upon all insureds selecting a participating or contracting pharmacist or pharmacy, clinical laboratory, or laboratory services provider;
(4)(4) (a) Provides Provides that no insured shall be required to obtain pharmacy services and prescription drugs from a mail service pharmacy;
(b) (b) Provides for no differential in any copayment applicable to any prescription drug of the same strength, quantity and days' supply, whether obtained from a mail service pharmacy or a non-mail service pharmacy, provided that the non-mail service pharmacy agrees to the same terms, conditions, price and services applicable to the mail service pharmacy;
(5) (5) Sets forth the auditing procedures to be used by the insurer and includes a provision that any audit shall take place at a time mutually agreeable to the pharmacy or pharmacist, clinical laboratory, or laboratory services provider and the auditor. No audit by an insurer shall include a review of any document relating to any person or prescription plan other than those reimbursable by the insurer;
and (6) (6) Provides that the insurer, or any agent or intermediary thereof, including a thirdthird-party party administrator, shall not restrict or prohibit, directly or indirectly, a pharmacy from charging the insured for services rendered by the pharmacy that are in addition to charges for the drug, for dispensing the drug or for prescription counseling. Services rendered by the pharmacy for which additional charges are imposed shall be subject to the approval of the Board of Pharmacy.
A A pharmacy shall disclose to the purchaser the charges for the additional services and the purchaser's out-of-pocket cost for those services prior to dispensing the drug.
A A pharmacy shall not impose any additional charges for patient counseling or for other services required by the Board of Pharmacy or State or federal law[;
(7) (7) The provisions of P.L.1999, c.395 shall apply to all policies delivered.
c. c. This section shall apply to all individual health insurance policies in which the insurer has reserved the right to change the premium.
(1) (1) not discriminate against or exclude a willing pharmacy, pharmacist, clinical laboratory, or laboratory services provider on the basis of corporate structure, size, location, or affiliation, provided that the provider meets the insurer’s credentialing standards and agrees to the reimbursement schedule and performance criteria applicable to participating providers;
(2)(2) upon request, provide written notice of participation requirements, credentialing criteria, reimbursement terms, and application procedures to a pharmacy, pharmacist, clinical laboratory, or laboratory services provider. An insurer shall respond to a completed application for participation within 60 days of receipt;
and (3) (3) issue a written notice of denial, if a pharmacy, pharmacist, clinical laboratory, or laboratory services provider is denied participation in a network, stating the specific criteria that were not satisfied and informing the provider of the process for reconsideration.
e. e. Nothing in this section shall be construed to prohibit an insurer from establishing quality, safety, utilization, or performance standards for participation in its network, provided that the standards are applied in a uniform and nondiscriminatory manner.
(1) (1) Permits the insured, at the time of issuance, amendment or renewal, to select benefit coverage allowing the insured to choose a pharmacy or pharmacist, clinical laboratory, and laboratory services provider for the provision of prescription drugs or pharmacy services, clinical laboratory services, or laboratory services, provided that:
or (b) (b) any clinical laboratory selected by the insured is licensed pursuant to the “New Jersey Clinical Laboratory Improvement Act,” P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal “Clinical Laboratory Improvement Amendments of 1988,” Pub.L.100-578 (42 U.S.C.
(2) (2) Provides that no pharmacy or pharmacist, clinical laboratory, or laboratory services provider shall be denied the right to participate as a preferred provider or as a contracting provider, under the same terms and conditions currently applicable to all other preferred or contracting providers, if the policy provides for coverage by contracted or preferred providers for pharmaceutical services, clinical laboratory services, or laboratory services, provided:
(a)(a) the pharmacy or pharmacist is registered pursuant to R.S.45:14-1 et seq., and accepts the terms and conditions of the policy;
or (b) (b) a clinical laboratory is licensed pursuant to the “New Jersey Clinical Laboratory Improvement Act,” P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal “Clinical Laboratory Improvement Amendments of 1988,” Pub.L.100-578 (42 U.S.C.
(3) (3) Provides that no copayment, fee, or other condition shall be imposed upon an insured selecting a participating or contracting pharmacist or pharmacy, clinical laboratory, or laboratory services provider that is not also equally imposed upon all insureds selecting a participating or contracting pharmacist or pharmacy, clinical laboratory, or laboratory services provider;
(4)(4) (a) Provides Provides that no insured shall be required to obtain pharmacy services and prescription drugs from a mail service pharmacy;
(b) (b) Provides for no differential in any copayment applicable to any prescription drug of the same strength, quantity and days' supply, whether obtained from a mail service pharmacy or a non-mail service pharmacy, provided that the non-mail service pharmacy agrees to the same terms, conditions, price and services applicable to the mail service pharmacy;
(5) (5) Sets forth the auditing procedures to be used by the insurer and includes a provision that any audit shall take place at a time mutually agreeable to the pharmacy or pharmacist, clinical laboratory, or laboratory services provider and the auditor. No audit by an insurer shall include a review of any document relating to any person or prescription plan other than those reimbursable by the insurer;
and (6) (6) Provides that the insurer, or any agent or intermediary thereof, including a thirdthird-party party administrator, shall not restrict or prohibit, directly or indirectly, a pharmacy from charging the insured for services rendered by the pharmacy that are in addition to charges for the drug, for dispensing the drug or for prescription counseling. Services rendered by the pharmacy for which additional charges are imposed shall be subject to the approval of the Board of Pharmacy.
A A pharmacy shall disclose to the purchaser the charges for the additional services and the purchaser's out-of-pocket cost for those services prior to dispensing the drug.
A A pharmacy shall not impose any additional charges for patient counseling or for other services required by the Board of Pharmacy or State or federal law[;
(7) (7) The provisions of P.L.1999, c.395 shall apply to all policies delivered.
c. c. This section shall apply to all group health insurance policies in which the insurer has reserved the right to change the premium.
(1) (1) not discriminate against or exclude a willing pharmacy, pharmacist, clinical laboratory, or laboratory services provider on the basis of corporate structure, size, location, or affiliation, provided that the provider meets the insurer’s credentialing standards and agrees to the reimbursement schedule and performance criteria applicable to participating providers;
and (3) (3) issue a written notice of denial, if a pharmacy, pharmacist, clinical laboratory, or laboratory services provider is denied participation in a network, stating the specific criteria that were not satisfied and informing the provider of the process for reconsideration.
e. e. Nothing in this section shall be construed to prohibit an insurer from establishing quality, safety, utilization, or performance standards for participation in its network, provided that the standards are applied in a uniform and nondiscriminatory manner.
Notwithstanding Notwithstanding any provision of law to the contrary, a certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued [on or after the effective date of this act] for a health maintenance organization which provides pharmacy services, prescription drugs, or a prescription drug plan, unless the coverage for health care services:
(1) (1) Permits the enrollee, at the time of enrollment, to select benefit coverage allowing the enrollee to choose a pharmacy or pharmacist, clinical laboratory, or laboratory services provider for the provision of prescription drugs or pharmacy services, clinical laboratory services, or laboratory services, provided that:
or (b) (b) any clinical laboratory selected by the enrollee is licensed pursuant to the “New Jersey Clinical Laboratory Improvement Act,” P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal “Clinical Laboratory Improvement Amendments of 1988,” Pub.L.100-578 (42 U.S.C.
(2) (2) Provides that no pharmacy or pharmacist, clinical laboratory, or laboratory services provider shall be denied the right to participate as a preferred provider or as a contracting provider, under the same terms and conditions currently applicable to all other preferred or contracting providers, if the health maintenance organization provides for coverage by contracted or preferred providers for pharmaceutical services, clinical laboratory services, or laboratory services, provided:
or (b) (b) a clinical laboratory is licensed pursuant to the “New Jersey Clinical Laboratory Improvement Act,” P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal “Clinical Laboratory Improvement Amendments of 1988,” Pub.L.100-578 (42 U.S.C.
(3) (3) Provides that no copayment, fee, or other condition shall be imposed upon an enrollee selecting a participating or contracting pharmacist or pharmacy, clinical laboratory, or laboratory services provider that is not also equally imposed upon all enrollees selecting a participating or contracting pharmacist or pharmacy, clinical laboratory, or laboratory services provider;
(b) (b) Provides for no differential in any copayment applicable to any prescription drug of the same strength, quantity and days' supply, whether obtained from a mail service pharmacy or a non-mail service pharmacy, provided that the non-mail service pharmacy agrees to the same terms, conditions, price and services applicable to the mail service pharmacy;
(5) (5) Sets forth the auditing procedures to be used by the health maintenance organization and includes a provision that any audit shall take place at a time mutually agreeable to the pharmacy or pharmacist, clinical laboratory, or laboratory services provider and the auditor, unless authorized by the Division of Medical Assistance and Health Services in the Department of Human Services with regard to any health care-related programs funded in whole or in part with State funds, including, but not limited to, the Medicaid program and "Children's Health Care Coverage Program". No audit by a health maintenance organization shall include a review of any document relating to any person or prescription plan other than those reimbursable by the health maintenance organization, unless authorized by the Division of Medical Assistance and Health Services in the Department of Human Services with regard to any health care-related programs funded in whole or in part with State funds, including, but not limited to, the Medicaid program and "Children's Health Care Coverage Program";
and (6) (6) Provides that the health maintenance organization, or any agent or intermediary thereof, including a third party administrator, shall not restrict or prohibit, directly or indirectly, a pharmacy from charging the enrollee for services rendered by the pharmacy that are in addition to charges for the drug, for dispensing the drug or for prescription counseling.
(7) (7) The provisions of P.L.1999, c.395 shall apply to all health maintenance organization contracts delivered.
c. c. This section shall apply to health maintenance organization plans in which the right to change the enrollee charge has been reserved.
(1) (1) not discriminate against or exclude a willing pharmacy, pharmacist, clinical laboratory, or laboratory services provider on the basis of corporate structure, size, location, or affiliation, provided that the provider meets the health maintenance organization’s credentialing standards and agrees to the reimbursement schedule and performance criteria applicable to participating providers;
(2)(2) uponupon request, provide written notice of participation requirements, credentialing criteria, reimbursement terms, and application procedures to a pharmacy, pharmacist, clinical laboratory, or laboratory services provider. A health maintenance organization shall respond to a completed application for participation within days of receipt;
and (3) (3) issue a written notice of denial, if a pharmacy, pharmacist, clinical laboratory, or laboratory services provider is denied participation in a network, stating the specific criteria that were not satisfied and informing the provider of the process for reconsideration.
e. e. Nothing in this section shall be construed to prohibit a health maintenance organization from establishing quality, safety, utilization, or performance standards for participation in its network, provided that the standards are applied in a uniform and nondiscriminatory manner.
P.L.1999, c.395, s.6) 7. The(New Commissionersection) ofa. BankingNotwithstanding andany Insurancelaw to the contrary, a carrier that offers a managed care plan shall adoptprovide rulespayment andfor regulations,laboratory services to a clinical laboratory licensed pursuant to the “Administrative"New ProcedureJersey Act,”Clinical P.L.1968,Laboratory c.140Improvement (C.52:14B-1Act," P.L.1975, c.166 (C.45:9-42.26 et seq.), asregardless mayof bewhether necessarythe toclinical effectuatelaboratory theis provisionsa ofparticipating thisprovider act.in the managed care plan.
8. b. This(1) actThe carrier shall takepay effect on the firstclinical daylaboratory offor thelaboratory seventhservices monthat next after the datesame ofrate enactmentit andwould shallpay applya toparticipating policiesclinical andlaboratory contracts issued or renewed on or after that date, except that the commissioner may take any anticipatory administrative action in advance as shall be necessary for thecomparable implementationservices. of this act.
STATEMENT This(2) billThe amends current law by requiring a health insurance carrier (ashall hospitalretain service corporation, medical service corporation, group and individual insurers, and a health maintenance organization) to extend the sameright opportunity currently allowed pharmacies and pharmacists to participatereview asall aservices preferredprovided providerpursuant or as a contracting provider in a health benefits plan to clinicalthis laboratoriessection andfor laboratorymedical servicesnecessity. providers.
Underc. theAs bill,used ain carrierthis thatsection, offers“carrier” ameans managed care plan, or an organizedinsurance deliverycompany, systemhealth contractingservice withcorporation, ahospital carrier,service iscorporation, tomedical notservice discriminatecorporation, against or excludehealth amaintenance willingorganization pharmacyauthorized practice site, pharmacist, clinical laboratory, or laboratory services provider on the basis of corporate structure, size, location, or affiliation, provided that the provider meets the carrier’s credentialing standards and agrees to theissue reimbursementhealth schedulebenefits andplans performancein criteriathis applicableState to participating providers. A carrier, upon request, is to provide written notice of provider participation requirements, credentialing criteria, reimbursement terms, and application procedures to a pharmacy practice site, pharmacist, clinical laboratory, or laboratoryany servicesentity provider. contracted A carrier is to respondadminister tohealth abenefits completedin applicationconnection forwith participation within 60 days of receipt. A carrier that denies participation to a provider is to issue a written notice of denial stating the specificState criteriaHealth thatBenefits wereProgram notor satisfiedSchool andEmployees' informingHealth theBenefits providerProgram. of the process for reconsideration.
Nothing8. in(New thesection) billa. isAny tocontract beor construedother asarrangement prohibitingentered ainto carrierby froma establishingmanaged quality,care safety,organization utilization, or performance standards for participationthe inprovision itsof network,laboratory providedservices thatunder the standardsMedicaid areprogram appliedshall inprovide: a uniform and nondiscriminatory manner.
(1) payment for laboratory services to a clinical laboratory licensed pursuant to the "New Jersey Clinical Laboratory Improvement Act," P.L.1975, c.166 (C.45:9-42.26 et seq.), regardless of whether the clinical laboratory is a participating provider in the managed care plan;
and (2) reimbursement of the clinical laboratory for laboratory services at the same rate it would provide to a participating clinical laboratory for comparable services.
b. Services provided pursuant to this section may be reviewed for medical necessity.
c. The Division of Medical Assistance and Health Services in the Department of Humans Services shall be prohibited from requiring a clinical laboratory licensed pursuant to the "New Jersey Clinical Laboratory Improvement Act," P.L.1975, c.166 (C.45:9-42.26 et seq.), to participate in the managed care delivery system in order to receive reimbursement under Medicaid or to transition from the fee-for-service delivery system to the managed care delivery system in order to receive reimbursement under Medicaid.
d. As used in this section, “Medicaid” means the program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
9. (New section) The Commissioner of Banking and Insurance shall adopt rules and regulations, pursuant to the “Administrative Procedure Act,” P.L.1968, c.140 (C.52:14B-1 et seq.), as may be necessary to effectuate the provisions of sections 1 through 6 of this act.
10. This act shall take effect on the first day of the seventh month next after the date of enactment and shall apply to policies, contracts, plans, and arrangements issued or renewed on or after that date, except that the commissioner may take any anticipatory administrative action in advance as shall be necessary for the implementation of this act.
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AI-generated reading aid from the bill's amendatory text — verify against the official bill.
This bill amends 6 section(s) of the New Jersey statutes: N.J.S.A. 17:48-6j; N.J.S.A. 17:48A-7i; N.J.S.A. 17:48E-35.7; N.J.S.A. 17B:26-2.1i; N.J.S.A. 17B:27-46.1i; N.J.S.A. 26:2J-4.7.
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N.J.S.A. 17:48-6j
on or after the effective date of this act, ; (7) The provisions of P.L.1999, c.395 shall apply to all contracts delivered. issued or renewed on or after the effective date of P.L.1999, c.395→ , clinical laboratory, or laboratory services provider clinical laboratory services, or laboratory services, : (a) ; and (b) any clinical laboratory selected by the subscriber is licensed pursuant to the "New Jersey Clinical Laboratory Improvement Act," P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal "Clinical Laboratory Improvement Amendments of 1988," Pub.L.100-578 (42 U.S.C. s.263a) , clinical laboratory, or laboratory services provider clinical laboratory services, or laboratory services, : (a) and (b) a clinical laboratory is licensed pursuant to the "New Jersey Clinical Laboratory Improvement Act," P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal "Clinical Laboratory Improvement Amendments of 1988," Pub.L.100-578 (42 U.S.C. s.263a), and accepts the terms and conditions of the contract; , clinical laboratory, or laboratory services provider , clinical laboratory, or laboratory services provider , clinical laboratory, or laboratory services provider and d. A hospital service corporation that offers a managed care plan, or an organized delivery system contracting with the hospital service corporation, shall: (1) not discriminate against or exclude a willing pharmacy, pharmacist, clinical laboratory, or laboratory services provider on the basis of corporate structure, size, location, or affiliation, provided that the provider meets the hospital service corporation credentialing standards and agrees to the reimbursement schedule and performance criteria applicable to participating providers; (2) upon request, provide written notice of participation requirements, credentialing criteria, reimbursement terms, and application procedures to a pharmacy, pharmacist, clinical laboratory, or laboratory services provider. A hospital service corporation shall respond to a completed application for participation within 60 days of receipt; and (3) issue a written notice of denial, if a pharmacy, pharmacist, clinical laboratory, or laboratory services provider is denied participation in a network, stating the specific criteria that were not satisfied and informing the provider of the process for reconsideration. e. Nothing in this section shall be construed to prohibit a hospital service corporation from establishing quality, safety, utilization, or performance standards for participation in its network, provided that the standards are applied in a uniform and nondiscriminatory manner. f. As used in this section: "Laboratory services provider" means any person or entity that performs, directs, supervises, or provides clinical laboratory services.amended
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N.J.S.A. 17:48A-7i
on or after the effective date of this act, ; (7) The provisions of P.L.1999, c.395 shall apply to all contracts delivered. issued or renewed on or after the effective date of P.L.1999, c.395→ , clinical laboratory, or laboratory services provider clinical laboratory services, or laboratory services, : (a) ; or (b) any clinical laboratory selected by the subscriber is licensed pursuant to the "New Jersey Clinical Laboratory Improvement Act," P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal "Clinical Laboratory Improvement Amendments of 1988," Pub.L.100-578 (42 U.S.C. s.263a) , clinical laboratory, or laboratory services provider clinical laboratory services, or laboratory services, : (a) or (b) a clinical laboratory is licensed pursuant to the "New Jersey Clinical Laboratory Improvement Act," P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal "Clinical Laboratory Improvement Amendments of 1988," Pub.L.100-578 (42 U.S.C. s.263a), and accepts the terms and conditions of the contract; , clinical laboratory, or laboratory services provider , clinical laboratory, or laboratory services provider , clinical laboratory, or laboratory services provider and d. A medical service corporation that offers a managed care plan, or an organized delivery system contracting with the medical service corporation, shall: (1) not discriminate against or exclude a willing pharmacy, pharmacist, clinical laboratory, or laboratory services provider on the basis of corporate structure, size, location, or affiliation, provided that the provider meets the medical service corporation's credentialing standards and agrees to the reimbursement schedule and performance criteria applicable to participating providers; (2) upon request, provide written notice of participation requirements, credentialing criteria, reimbursement terms, and application procedures to a pharmacy, pharmacist, clinical laboratory, or laboratory services provider. A medical service corporation shall respond to a completed application for participation within 60 days of receipt; and (3) issue a written notice of denial, if a pharmacy, pharmacist, clinical laboratory, or laboratory services provider is denied participation in a network, stating the specific criteria that were not satisfied and informing the provider of the process for reconsideration. e. Nothing in this section shall be construed to prohibit a medical service corporation from establishing quality, safety, utilization, or performance standards for participation in its network, provided that the standards are applied in a uniform and nondiscriminatory manner. f. As used in this section: "Laboratory services provider" means any person or entity that performs, directs, supervises, or provides clinical laboratory services.amended
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N.J.S.A. 17:48E-35.7
on or after the effective date of this act, ; (7) The provisions of P.L.1999, c.395 shall apply to all contracts delivered. issued or renewed on or after the effective date of P.L.1999, c.395→ , clinical laboratory, and laboratory services provider clinical laboratory services, or laboratory services, : (a) ; or (b) any clinical laboratory selected by the subscriber is licensed pursuant to the "New Jersey Clinical Laboratory Improvement Act," P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal "Clinical Laboratory Improvement Amendments of 1988," Pub.L.100-578 (42 U.S.C. s.263a) , clinical laboratory, or laboratory services provider clinical laboratory services, or laboratory services, : (a) or (b) a clinical laboratory is licensed pursuant to the "New Jersey Clinical Laboratory Improvement Act," P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal "Clinical Laboratory Improvement Amendments of 1988," Pub.L.100-578 (42 U.S.C. s.263a), and accepts the terms and conditions of the contract; , clinical laboratory, or laboratory services provider , clinical laboratory, or laboratory services provider , clinical laboratory, or laboratory services provider and d. A health service corporation that offers a managed care plan, or an organized delivery system contracting with the health service corporation, shall: (1) not discriminate against or exclude a willing pharmacy, pharmacist, clinical laboratory, or laboratory services provider on the basis of corporate structure, size, location, or affiliation, provided that the provider meets the health service corporation's credentialing standards and agrees to the reimbursement schedule and performance criteria applicable to participating providers; (2) upon request, provide written notice of participation requirements, credentialing criteria, reimbursement terms, and application procedures to a pharmacy, pharmacist, clinical laboratory, or laboratory services provider. A health service corporation shall respond to a completed application for participation within 60 days of receipt; and (3) issue a written notice of denial, if a pharmacy, pharmacist, clinical laboratory, or laboratory services provider is denied participation in a network, stating the specific criteria that were not satisfied and informing the provider of the process for reconsideration. e. Nothing in this section shall be construed to prohibit a health service corporation from establishing quality, safety, utilization, or performance standards for participation in its network, provided that the standards are applied in a uniform and nondiscriminatory manner. f. As used in this section: "Laboratory services provider" means any person or entity that performs, directs, supervises, or provides clinical laboratory services.amended
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N.J.S.A. 17B:26-2.1i
on or after the effective date of this act, ; (7) The provisions of P.L.1999, c.395 shall apply to all policies delivered. issued or renewed on or after the effective date of P.L.1999, c.395→ , clinical laboratory, and laboratory services provider clinical laboratory services, or laboratory services, : (a) ; or (b) any clinical laboratory selected by the insured is licensed pursuant to the "New Jersey Clinical Laboratory Improvement Act," P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal "Clinical Laboratory Improvement Amendments of 1988," Pub.L.100-578 (42 U.S.C. s.263a) , clinical laboratory, or laboratory services provider clinical laboratory services, or laboratory services, : (a) or (b) a clinical laboratory is licensed pursuant to the "New Jersey Clinical Laboratory Improvement Act," P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal "Clinical Laboratory Improvement Amendments of 1988," Pub.L.100-578 (42 U.S.C. s.263a), and accepts the terms and conditions of the contract; , clinical laboratory, or laboratory services provider , clinical laboratory, or laboratory services provider , clinical laboratory, or laboratory services provider and d. An insurer that offers a managed care plan, or an organized delivery system contracting with the insurer, shall: (1) not discriminate against or exclude a willing pharmacy, pharmacist, clinical laboratory, or laboratory services provider on the basis of corporate structure, size, location, or affiliation, provided that the provider meets the insurer's credentialing standards and agrees to the reimbursement schedule and performance criteria applicable to participating providers; (2) upon request, provide written notice of participation requirements, credentialing criteria, reimbursement terms, and application procedures to a pharmacy, pharmacist, clinical laboratory, or laboratory services provider. An insurer shall respond to a completed application for participation within 60 days of receipt; and (3) issue a written notice of denial, if a pharmacy, pharmacist, clinical laboratory, or laboratory services provider is denied participation in a network, stating the specific criteria that were not satisfied and informing the provider of the process for reconsideration. e. Nothing in this section shall be construed to prohibit an insurer from establishing quality, safety, utilization, or performance standards for participation in its network, provided that the standards are applied in a uniform and nondiscriminatory manner. f. As used in this section: "Laboratory services provider" means any person or entity that performs, directs, supervises, or provides clinical laboratory services.amended
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N.J.S.A. 17B:27-46.1i
, on or after the effective date of this act, ; (7) The provisions of P.L.1999, c.395 shall apply to all policies delivered. issued or renewed on or after the effective date of P.L.1999, c.395→ , clinical laboratory, and laboratory services provider clinical laboratory services, or laboratory services, : (a) ; or (b) any clinical laboratory selected by the insured is licensed pursuant to the "New Jersey Clinical Laboratory Improvement Act," P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal "Clinical Laboratory Improvement Amendments of 1988," Pub.L.100-578 (42 U.S.C. s.263a) , clinical laboratory, or laboratory services provider clinical laboratory services, or laboratory services, : (a) or (b) a clinical laboratory is licensed pursuant to the "New Jersey Clinical Laboratory Improvement Act," P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal "Clinical Laboratory Improvement Amendments of 1988," Pub.L.100-578 (42 U.S.C. s.263a), and accepts the terms and conditions of the policy; , clinical laboratory, or laboratory services provider , clinical laboratory, or laboratory services provider , clinical laboratory, or laboratory services provider and d. An insurer that offers a managed care plan, or an organized delivery system contracting with the insurer, shall: (1) not discriminate against or exclude a willing pharmacy, pharmacist, clinical laboratory, or laboratory services provider on the basis of corporate structure, size, location, or affiliation, provided that the provider meets the insurer's credentialing standards and agrees to the reimbursement schedule and performance criteria applicable to participating providers; (2) upon request, provide written notice of participation requirements, credentialing criteria, reimbursement terms, and application procedures to a pharmacy, pharmacist, clinical laboratory, or laboratory services provider. An insurer shall respond to a completed application for participation within 60 days of receipt; and (3) issue a written notice of denial, if a pharmacy, pharmacist, clinical laboratory, or laboratory services provider is denied participation in a network, stating the specific criteria that were not satisfied and informing the provider of the process for reconsideration. e. Nothing in this section shall be construed to prohibit an insurer from establishing quality, safety, utilization, or performance standards for participation in its network, provided that the standards are applied in a uniform and nondiscriminatory manner. f. As used in this section: "Laboratory services provider" means any person or entity that performs, directs, supervises, or provides clinical laboratory services.amended
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N.J.S.A. 26:2J-4.7
on or after the effective date of this act ; (7) The provisions of P.L.1999, c.395 shall apply to all health maintenance organization contracts delivered. issued or renewed on or after the effective date of P.L.1999, c.395→ , clinical laboratory, or laboratory services provider clinical laboratory services, or laboratory services, : (a) or (b) any clinical laboratory selected by the enrollee is licensed pursuant to the "New Jersey Clinical Laboratory Improvement Act," P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal "Clinical Laboratory Improvement Amendments of 1988," Pub.L.100-578 (42 U.S.C. s.263a) , clinical laboratory, or laboratory services provider clinical laboratory services, or laboratory services, : (a) (b) a clinical laboratory is licensed pursuant to the "New Jersey Clinical Laboratory Improvement Act," P.L.1975, c.166 (C.45:9-42.26) or certified pursuant to the federal "Clinical Laboratory Improvement Amendments of 1988," Pub.L.100-578 (42 U.S.C. s.263a), and accepts the terms and conditions of the health maintenance organization; , clinical laboratory, or laboratory services provider , clinical laboratory, or laboratory services provider , clinical laboratory, or laboratory services provider and d. A health maintenance organization that offers a managed care plan, or an organized delivery system contracting with the health maintenance organization, shall: (1) not discriminate against or exclude a willing pharmacy, pharmacist, clinical laboratory, or laboratory services provider on the basis of corporate structure, size, location, or affiliation, provided that the provider meets the health maintenance organization's credentialing standards and agrees to the reimbursement schedule and performance criteria applicable to participating providers; (2) upon request, provide written notice of participation requirements, credentialing criteria, reimbursement terms, and application procedures to a pharmacy, pharmacist, clinical laboratory, or laboratory services provider. A health maintenance organization shall respond to a completed application for participation within 60 days of receipt; and (3) issue a written notice of denial, if a pharmacy, pharmacist, clinical laboratory, or laboratory services provider is denied participation in a network, stating the specific criteria that were not satisfied and informing the provider of the process for reconsideration. e. Nothing in this section shall be construed to prohibit a health maintenance organization from establishing quality, safety, utilization, or performance standards for participation in its network, provided that the standards are applied in a uniform and nondiscriminatory manner. f. As used in this section: "Laboratory services provider" means any person or entity that performs, directs, supervises, or provides clinical laboratory services.amended
Action History
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REP/ACS REF AHN
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INT 1RA REF AFI
Sponsors
- Louis D. Greenwald · Primary
- Margie Donlon · Primary
Sponsorship breakdown
Export CSV (upgrade) →2 sponsors · 0 co-sponsors · 118 not signed on
Sponsors (2)
- Greenwald, Louis D.
- Donlon, Margie
Co-sponsors (0)
None.
Not signed on (118)
118 members have not signed on to this bill.
Show all 118 →"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.
Votes
| Party | Yea | Nay | Present | Not Voting |
|---|---|---|---|---|
| Democrat | 9 | 0 | 0 | 1 |
| Republican | 0 | 0 | 0 | 4 |
| Total | 9 | 0 | 0 | 5 |
| % of votes cast | 64% | 0% | 0% | 36% |
How each member voted (14)
| Member | Party | Vote |
|---|---|---|
| Bagolie, Rosaura | Democrat | Yea |
| Freiman, Roy | Democrat | Yea |
| Hutchison, Dan | Democrat | Yea |
| Peterpaul Esq., Luanne M. | Democrat | Not Voting |
| Rodriguez, Ed | Democrat | Yea |
| Schnall, Alexander | Democrat | Yea |
| Simmons, Heather | Democrat | Yea |
| Singh, Balvir | Democrat | Yea |
| Stanley, Sterley S. | Democrat | Yea |
| Venezia, Michael | Democrat | Yea |
| Auth, Robert | Republican | Not Voting |
| Clifton, Robert D. | Republican | Not Voting |
| Flynn, Victoria A. | Republican | Not Voting |
| Myhre, Gregory E. | Republican | Not Voting |
Subjects
Frequently asked questions
- What does A 5317 do?
- Health insurance carriers-prov opportunity, clinical laboratory & svcs provider
- Who sponsors A 5317?
- A 5317 is sponsored by Greenwald, Louis D. and Donlon, Margie.
- What is the current status of A 5317?
- This bill has been introduced in the General Assembly. Introduced June 23, 2026. It must pass committee before a floor vote.
- Where can I track A 5317?
- Track A 5317 free on One Click Politics — get push/email alerts when it moves.
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