Bill > A2149

This bill requires the State Health Benefits Commission (SHBC) and the School Employees' Health Benefit Commission (SEHBC) to implement two new programs: a bundled payment program and a referenced-based pricing program for certain elective medical procedures. The bundled payment program will involve contracting with a healthcare marketplace vendor to negotiate a single, predetermined payment for all services provided during a specific "episode of care" (which includes all related medical services for a condition) by a group of providers, including hospital and post-acute care. The referenced-based pricing program will establish a "metric based allowable amount," which is a maximum, uniformly applied payment for elective medical procedures, determined by factors like Medicare pricing or provider costs. "Elective medical procedures" are defined as non-emergency care that can be scheduled at least 24 hours in advance without posing a health risk. The bill also outlines an expedited procurement process for contracting with healthcare marketplace vendors for these programs and allows for immediate adoption of necessary regulations.

Government Affairs

https://www.njleg.state.nj.us/bill-search/2026/A2149