New Jersey Assembly Bill A5397

New Jersey 2022-2023 Regular Session

• Introduced: 5/8/23
• Refer: 5/8/23

Caption

Establishes minimum Medicaid reimbursement rate for structured day program services provided to beneficiary eligible for brain injury services.

Impact

The enactment of A5397 could significantly improve the financial viability of brain injury service providers, who may be struggling to cover the costs of care under the existing reimbursement rates. As these providers may be incentivized to enhance service quality and accessibility, beneficiaries could experience improved care options. This adjustment seeks to align brain injury services with the reimbursement rates of other critical support services, thus promoting better resource allocation within the state's Medicaid system.

Summary

Assembly Bill A5397 aims to amend the current Medicaid reimbursement framework for certain services provided to beneficiaries requiring treatment for brain injuries. Specifically, the bill establishes minimum reimbursement rates for structured day program services offered by approved brain injury service providers. This move is intended to enhance support for individuals with brain injuries, ensuring that the rates for these services are commensurate with other types of habilitation services available through the Division of Developmental Disabilities (DDD). Currently, reimbursement for structured day program services stands at $3.65 per 15 minutes, whereas the average rate for comparable habilitation services is about $9.09 per 15 minutes.

Contention

Notable points of contention may arise around the fiscal implications of increasing reimbursement rates amidst budget constraints. Critics may argue that elevating rates could lead to higher overall costs to the state, potentially impacting public spending elsewhere. Supporters, however, contend that the long-term benefits derived from enhanced support services for individuals with brain injuries would ultimately offset initial fiscal concerns, by promoting better health outcomes and reducing the need for more expensive emergency and inpatient care in the future.