Bill
Bill > S2995
summary
Introduced
01/13/2026
01/13/2026
In Committee
01/13/2026
01/13/2026
Crossed Over
Passed
Dead
Introduced Session
2026-2027 Regular Session
Bill Summary
This bill requires the State Health Benefits Commission and School Employees' Health Benefits Commission to conduct comprehensive reviews of reference-based pricing health benefits models and the fiscal impact of implementing reference-based pricing for the State Health Benefits Program and the School Employees' Health Benefits Program. The review must be conducted in consultation with the actuary of each program and the carriers under contract with each program. The review must identify areas of health care benefits and services where reference-based pricing can be implemented. The bill specifies the areas and issues to be evaluated by each commission and requires each commission to issue a final report on its findings and recommendations within 180 days after the effective date of the bill. Within one year following the effective date of this bill, each commission must implement reference-based pricing for each contract entered into with a carrier after the effective date in a manner that places limitations on reimbursement rates using Medicare rates as the reference point. Each commission, prior to implementation, must adopt a written report detailing how the reference percentages have been set by each commission, the expected cost savings, and the existing negotiated cost ranges by procedure that each carrier under contract with each commission has in place prior to implementation of the reference-based price limitation.
AI Summary
This bill mandates that the State Health Benefits Commission and the School Employees' Health Benefits Commission (which manage health insurance for state employees and school employees, respectively) must study and then implement a system called "reference-based pricing" for their health insurance plans. Reference-based pricing means that the amount insurance will pay for a medical service is capped, using Medicare's rates as a benchmark, rather than the provider's billed amount or a previously negotiated rate. The commissions are required to consult with their actuaries and insurance carriers to review how this pricing model works, its potential financial impact, and identify which healthcare services are suitable for this approach. They must also consider factors like anticipated costs and savings, the effect on high-cost services, optimal reimbursement percentages based on Medicare rates, outcomes from other states, changes in patient choice and provider prices, and legal requirements like the Affordable Care Act (often abbreviated as PPACA). After this review, they must submit a report with their findings and recommendations within 180 days. Within one year, they must then implement reference-based pricing for new contracts with insurance carriers, detailing in a public report how the reference percentages were determined, expected savings, and current negotiated costs before the new pricing takes effect.
Committee Categories
Health and Social Services
Sponsors (1)
Last Action
Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee (on 01/13/2026)
Official Document
bill text
bill summary
Loading...
bill summary
Loading...
bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.njleg.state.nj.us/bill-search/2026/S2995 |
| BillText | https://pub.njleg.gov/Bills/2026/S3000/2995_I1.HTM |
Loading...