Office of Legislative Services
State House Annex
P.O. Box 068
Trenton, New Jersey 08625
Legislative Budget and Finance Office
Phone (609) 847-3105
Fax (609) 777-2442
www.njleg.state.nj.us
LEGISLATIVE FISCAL ESTIMATE
[First Reprint]
ASSEMBLY, No. 3792
STATE OF NEW JERSEY
220th LEGISLATURE
DATED: DECEMBER 9, 2022
SUMMARY
Synopsis: Increases Medicaid reimbursement for in-person partial care
behavioral health and substance use disorder treatment services, and
associated transportation services, for adults.
Type of Impact: Annual increases in State expenditures and revenue; General Fund.
Agencies Affected: Department of Human Services.
Office of Legislative Services Estimate
Fiscal Impact Annual
State Cost Increase Indeterminate
State Revenue Increase Indeterminate
The OLS estimates that this bill will increase, by an indeterminate amount, the annual State
Medicaid expenditures incurred by the Department of Human Services (DHS). As eligible
State Medicaid expenditures are matched 50 percent by federal Medicaid funds, this bill will
also increase annual State revenue from federal reimbursements by an indeterminate amount.
BILL DESCRIPTION
This bill increases Medicaid reimbursement rates for partial care behavioral health and
substance use disorder (SUD) treatment services by 35 percent, when such services are provided
to an adult Medicaid enrollee on an in-person basis. The bill also provides that the aggregate
Medicaid reimbursement rate for transportation services and mileage to or from a partial care
services provider is to be no less than $10 for each one-way trip. These rate increases under this
bill apply to services provided through the fee-for-service (FFS) or managed care delivery system.
FE to A3792 [1R]
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FISCAL ANALYSIS
EXECUTIVE BRANCH
None received.
OFFICE OF LEGISLATIVE SERVICES
The OLS estimates that this bill will increase, by an indeterminate amount, the annual State
Medicaid expenditures incurred by the DHS. As eligible State Medicaid expenditures are matched
50 percent by federal Medicaid funds, this bill will also increase annual State revenue from federal
reimbursements by an indeterminate amount.
This bill increases the Medicaid rate for in-person partial care behavioral health and SUD
treatment services delivered to adults under both the FFS and managed care delivery system by 35
percent. Under current law, Medicaid covers these services for most adults through the FFS
delivery system. The OLS does not have access to data regarding the current expenditures for
these services under FFS, nor the number of beneficiaries who receive these services under FFS,
and therefore cannot quantify the fiscal impact of the bill on the State. For context, however, the
existing FFS rates would increase to the following under the bill:
Type of Partial Care Existing FFS Rate FFS Rate Under the Bill
Behavioral Health $18.82 per hour $25.41 per hour
Substance Use Disorder $78.31 per diem $105.72 per diem
Service providers are required to deliver a minimum of two hours and a maximum of five hours
of services per day, limited to 25 hours per week for partial care behavioral health treatment
services. Assuming services are provided 5 days a week, for 6 weeks, the cost per beneficiary
would increase between $395.22 (2 hours per day) and $988.05 (five hours per day) for partial
care behavioral health treatment services.
Service providers are required to deliver a minimum of four hours of service per day, or no
less than 20 hours of service per week for partial care SUD treatment services. Assuming services
are provided 5 days a week, for 6 weeks, the cost per beneficiary would increase by $822.26 for
partial care SUD treatment services under the bill.
The bill also provides that the aggregate Medicaid reimbursement rate for transportation
services and mileage to or from a partial care services provider is to be no less than $10 for each
one-way trip, an increase of $3 from the current rate. Under the bill, the cost per each beneficiary
who utilizes transportation services to access partial care behavioral health or SUD treatment
services, as described above (5 days a week for 6 weeks), would increase by $180.
Outside of FFS, the State provides partial care behavioral health and SUD treatment services
through the managed care delivery system to an unknown number of Medicaid beneficiaries as
follows: clients of the Division of Developmental Disabilities; individuals enrolled in a Fully
Integrated Dual Eligible Special Needs Plan; and enrollees in the Medicaid Managed Long Term
Services and Supports program. Medicaid reimbursement rates provided under managed care are
proprietary and embedded in the State’s contracted capitation payments to the Medicaid managed
care organizations; and therefore the costs incurred by the State for these beneficiaries under the
bill are not quantifiable. The OLS notes, however, that the majority of partial care services
described under this bill are provided under FFS. FE to A3792 [1R]
3
Section: Human Services
Analyst: Sarah Schmidt
Lead Research 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.).