LEGISLATIVE FISCAL ESTIMATE
ASSEMBLY, No. 2448
STATE OF NEW JERSEY
221st LEGISLATURE
DATED: JANUARY 8, 2026
SUMMARY
|
Synopsis: |
Requires health care professionals to order bi-lateral ultrasounds concurrently when ordering mammograms; requires insurers to cover concurrent mammograms and bi-lateral ultrasounds. |
|
Type of Impact: |
Potential annual State and local expenditure increases. |
|
Agencies Affected: |
Division of Pensions and Benefits in the Department of the Treasury; affected counties, municipalities, and school districts. |
|
Office of Legislative Services Estimate |
||||
|
Fiscal Impact |
|
Annual |
|
|
|
Potential State Expenditure Increase |
|
Indeterminate |
|
|
|
Potential Local Expenditure Increase |
|
Indeterminate |
|
|
· The Office of Legislative Services (OLS) concludes that by requiring health care professionals to concurrently order bi-lateral ultrasounds when ordering a mammogram if determined necessary for the patient by the provider and requiring health insurers, including the State Health Benefits Program and the School Employees’ Health Benefits Program, to cover such testing may result in an annual indeterminate expenditure increase for the State and units of local government that participate in the health benefits programs.
· The OLS notes that local government units and school districts who purchase health insurance on the private market may also experience an annual indeterminate expenditure increase.
BILL DESCRIPTION
This bill requires health care professionals to concurrently order an ultrasound evaluation, a magnetic resonance imaging scan, three-dimensional mammography, or other additional testing of an entire breast or breasts when ordering a mammogram if the patient has additional risk factors for breast cancer or other indications as determined by the provider.
This bill also requires health insurers, including the State Health Benefits Program and the School Employees’ Health Benefits Program, to cover the additional testing when concurrently ordered with a mammogram.
FISCAL ANALYSIS
EXECUTIVE BRANCH
None received.
OFFICE OF LEGISLATIVE SERVICES
The OLS concludes that by requiring health care professionals to concurrently order bi-lateral ultrasounds, and other additional testing, when ordering a mammogram if determined necessary for the patient by the provider and requiring health insurers, including the State Health Benefits Program and the School Employees’ Health Benefits Program, to cover such testing may result in an annual indeterminate expenditure increase for the State and participating units of local government. Local government units and school districts who purchase health insurance on the private market may also experience an annual indeterminate expenditure increase.
Current law requires health insurers to cover an annual mammogram examination for certain patients, as well as an ultrasound evaluation, a magnetic resonance imaging scan, a three-dimensional mammography, or other additional testing of an entire breast or breasts if the patient has dense breast tissue, additional risk factors for breast cancer, or is otherwise indicated as necessary by the provider. Such additional tests are subject to utilization review.
The bill requires the additional tests to be ordered concurrently with the mammogram and does not subject the additional tests to utilization review. Both of these factors may lead to an increased number of additional tests being ordered by health care providers, increasing the costs resulting from the provision and coverage of such tests.
|
Section: |
State Government |
|
Analyst: |
Associate Fiscal Analyst |
|
Approved: |
Thomas Koenig Legislative Budget and Finance Officer |
This legislative fiscal estimate has been produced by the Office of Legislative Services due to the failure of the Executive Branch to respond to our request for a fiscal note.
This fiscal estimate has been prepared pursuant to P.L.1980, c.67 (C.52:13B-6 et seq.).