P.L. 1997, CHAPTER 156, approved July 3, 1997
Senate, No. 1000 (Second Reprint)
An Act concerning clinical laboratories and amending and supplementing P.L.1975, c.166.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. (New section) A clinical laboratory shall present or cause to be presented a claim, bill or demand for payment for clinical laboratory services directly to the recipient of the services 2[unless the recipient of the services or the recipient's responsible party authorizes 1, under the terms and conditions of the recipient's third party payer contract,1] , except2 that the claim, bill or demand for payment 2may2 be presented to any of the following:
a. An immediate family member of the recipient of the services or other person legally responsible for the debts or care of the recipient of the services;
b. A third party payer including a health insurer, 1a health, hospital or medical services corporation,1 a State approved or federally qualified health maintenance organization in which the recipient of the services is enrolled, a governmental agency or its specified agent which provides health care benefits on behalf of the recipient of the services, and an employer of the recipient of the services who is responsible for payment of the services2, provided that billing these payers is consistent with the terms of any applicable contract between the payer and the recipient of the services2;
c. A hospital or skilled nursing facility in which the recipient of the services is or has been an inpatient or outpatient;
d. A substance abuse program in which the recipient of the services is or has been a participant; and
e. A nonprofit clinic or other health care provider whose purpose is the promotion of public health, from which the recipient of the
services has received health care.
2[1A] Upon the request of the health care provider who requested the clinical laboratory services, a2 clinical laboratory shall notify the health care provider 2[who requested the clinical laboratory services on behalf of the recipient]2 of the amount of the claim, bill or demand for payment that was presented to the recipient or the recipient's responsible third party pursuant to this section.1
Notwithstanding the provisions of this section to the contrary, in the case of a clinical laboratory which performs services at the request of another clinical laboratory, the clinical laboratory may present the claim, bill or demand for payment to the requesting clinical laboratory.
1Notwithstanding the provisions of this section to the contrary, nothing in this section shall affect a contractual agreement between a clinical laboratory and a third party payer regarding presentation of a claim, bill or demand for payment directly to that third party payer.1
2. Section 17 of P.L.1975, c.166 (C.45:9-42.42) is amended to read as follows:
17. No person shall:
a. Operate, maintain, direct, or engage in the business of operating a clinical laboratory, as herein defined, unless he has obtained a clinical laboratory license from the department, or is exempt under the provisions of this act.
b. Collect or receive specimens for analysis by an unlicensed laboratory.
c. Accept specimens for tests from and make reports to persons who are not legally qualified or authorized to submit specimens to clinical laboratories and to receive such reports, but this shall not prohibit the referral of specimens from one licensed clinical laboratory to another similarly licensed under the laws of the state in which it is located, providing the report indicates clearly the clinical laboratory performing the test and the name of the director of such clinical laboratory.
d. Either personally, or through an agent, solicit referral of specimens to his or any other clinical laboratory or contract to perform clinical laboratory examinations of specimens in a manner which offers or implies an offer of rebates to a person or persons submitting specimens, other fee-splitting inducements, participation in any fee-splitting arrangements or other unearned remuneration.
e. Obstruct or interfere with the department or any officer or employee thereof in the performance of any duty imposed by this act.
f. Collect any amounts that were billed in violation of section 1 of
P.L. , c. (C. )(pending before the Legislature as this bill).
(cf: P.L.1975, c.166, s.17)
3. Section 18 of P.L.1975, c.166 (C.45:9-42.43) is amended to read as follows:
18. a. Any person convicted of violating any provision of this act or of any rule or regulation adopted hereunder shall be subject to a penalty of not less than $100.00 nor more than $1,000.00 for each violation. The penalty shall be collected, and enforced in summary proceedings under the Penalty Enforcement Law (N.J.S.2A:58-1 et seq.).
b. A person who collects any amounts that were billed in violation of section 1 of P.L. , c. (C. )(pending before the Legislature as this bill), is liable for, and shall refund on a timely basis to the person who was billed, any amounts so collected.
(cf: P.L.1975, c.166, s.18)
14. (New section) A clinical laboratory shall annually provide a health care provider with a list of its schedule of fees and charges for laboratory services rendered to the health care provider's patients. The clinical laboratory shall promptly provide the health care provider with an updated list of its schedule of fees and charges whenever any changes are made to the list.1 2The clinical laboratory shall include with the list a form to be used by the health care provider to request billing information pursuant to section 1 of this act.2
15. (New section) Nothing in this act shall be construed to prevent a health care provider from including a charge for the interpretation of a laboratory test as part of the health care provider's office visit fee.1
[4.] 6.1 This act shall take effect immediately.
Requires clinical laboratories to bill recipients of services directly.