Out-of-Network Labs Could Gain Payment Protections Under New Bill
6/1/2026
On May 4, 2026, the New Jersey State Assembly introduced Bill No. 4877, which would require health plans and Medicaid managed care contracts to pay licensed clinical laboratories for covered lab services even when the laboratory is outside the plan’s network. The payment rate would have to match the rate paid to an in-network clinical laboratory for comparable services, and health plans and Medicaid managed care organizations could still review whether the services were medically necessary. The Bill would also prohibit the Division of Medical Assistance and Health Services from requiring a licensed clinical laboratory to join Medicaid managed care to receive Medicaid payment.
John D. Fanburg
Managing Member
Healthcare Law, Cannabis Industry
973.403.3107 · 973.618.5507 Fax
jfanburg@bracheichler.com
Related Practices: Healthcare Law
Related Attorney: John D. Fanburg, Edward Hilzenrath, Erika R. Marshall
Related Industry: Healthcare
