New Jersey Assembly Bill A5515

New Jersey 2022-2023 Regular Session

• Introduced: 5/25/23
• Refer: 5/25/23

Caption

Establishes minimum NJ FamilyCare reimbursement rate for certain out-of-state hospitals that provide services to NJ FamilyCare pediatric beneficiaries.

Impact

The introduction of A5515 is anticipated to have significant implications for the healthcare landscape in New Jersey. By ensuring higher reimbursement rates for out-of-state hospitals, this bill aims to create a more robust safety net for pediatric beneficiaries, particularly those living in areas with limited access to medical specialists. The adjustment in reimbursement rates is poised to incentivize out-of-state providers to continue serving New Jersey children, enhancing patient care access and potentially reducing the burden on local hospitals.

Summary

Assembly Bill A5515 is designed to amend the existing statutory framework governing the NJ FamilyCare program, particularly concerning reimbursement rates for certain out-of-state hospitals that serve NJ FamilyCare pediatric beneficiaries. The bill mandates that out-of-state hospitals, which cater to a significant number of NJ FamilyCare pediatric patients annually, shall receive reimbursement rates that are at least 125% of the Medicaid fee-for-service rates applicable in their respective states. This is intended to improve access to quality pediatric care for New Jersey children who may require services from hospitals outside the state's borders.

Contention

Despite the positives, there are concerns regarding the financial implications of A5515. Critics may argue that increasing reimbursement rates for out-of-state facilities could drain resources from in-state entities, potentially impacting local healthcare providers' sustainability. Additionally, the proposed changes could lead to disparities in how pediatric services are funded and accessed across different counties, especially between urban and non-urban areas. Stakeholders are likely to debate the balance between providing comprehensive coverage for families while ensuring that New Jersey's healthcare infrastructure remains strong and financially viable.