Senate Commerce Committee Statement to Senate, No. 374 — State of New Jersey (May 18, 2026)

Summary

The Senate Commerce Committee of the State of New Jersey, in a statement dated May 18, 2026, reports favorably and with committee amendments Senate Bill No. 374. As amended, the bill requires health insurers to cover treatment of lipedema, including compression garments, manual lymphatic drainage, medical nutrition therapy, mental health care and lipectomy determined to be medically necessary by the covered person's surgeon. A carrier is to cover the total number of lipectomies the surgeon deems medically necessary and cannot deny coverage solely based on submitted photographs. A carrier that denies coverage must give a detailed explanation. The committee amended the bill to align prior authorization requirements with the "Ensuring Transparency in Prior Authorization Act."

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SENATE COMMERCE COMMITTEE

STATEMENT TO

SENATE, No.
374

with
committee amendments

STATE
OF NEW JERSEY

DATED: MAY 18,
2026

The Senate Commerce Committee reports favorably and
with committee amendments Senate Bill No. 374.

As amended, this bill requires health
insurers (health, hospital and medical service corporations, commercial
individual and group health insurers; health maintenance organizations, health
benefits plans issued pursuant to the New Jersey Individual Health Coverage and
Small Employer Health Benefits Programs, the State Health Benefits Program, and
the School Employees’ Health Benefits Program) to provide coverage for expenses
incurred for the treatment of lipedema. The expenses for which coverage is to be
provided include compression garments for all of the covered person’s affected
extremities, manual lymphatic drainage, medical nutrition therapy, mental
health care, lipectomy that is determined to be medically necessary by the
covered person’s surgeon, and pre-and post-lipectomies appointments with the
covered person’s physician and surgeon.

The bill
requires a covered person to provide a carrier with documentation from the
covered person’s physician diagnosing the covered person with lipedema and, if
applicable, documentation from the covered person’s surgeon that includes
photographs of the covered person that support the diagnosis and information on
the number of lipectomies the covered person’s surgeon deems medically
necessary.

Under the
bill, a carrier is to provide coverage for the total number of lipectomies
deemed medically necessary by the covered person’s surgeon and shall not
require a covered person’s surgeon to remove less fat than the surgeon deems
medically necessary to be removed from the covered person during lipectomy in
order to receive coverage. If a carrier denies coverage for expenses incurred
for the treatment of lipedema, the carrier is to provide the covered person
with a detailed explanation of the reason for the denial. A carrier
cannot deny coverage for expenses incurred for the treatment of lipedema solely
based on photographs of the covered person submitted pursuant to the bill.

Additionally,
the bill provides that prior authorization granted by a carrier for a lipectomy
must be in accordance with prior authorization requirements established
pursuant to the “Ensuring Transparency in Prior Authorization Act.”
Coverage is to be provided consistent with the current standard of care for
lipedema.

Lipedema
is a chronic, progressive condition characterized by abnormal and often painful
fat accumulation in specific areas of the body. The condition does not
have a cure, but lipectomy can help remove fat and reduce the pain associated
with the condition.

This
bill was prefiled for introduction in the 2026-2027 session pending technical
review. As amended and reported, the bill includes the changes required by
technical review, which has been performed.

COMMITTEE AMENDMENTS :

The committee amended the bill to align prior authorization requirements with the “Ensuring
Transparency in Prior Authorization Act.”

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