SENATE, No. 1895 STATE OF NEW JERSEY 220th LEGISLATURE INTRODUCED MARCH 3, 2022
SENATE, No. 1895
STATE OF NEW JERSEY
220th LEGISLATURE
INTRODUCED MARCH 3, 2022
Sponsored by: Senator ROBERT W. SINGER District 30 (Monmouth and Ocean) SYNOPSIS Increases Medicaid reimbursement for in-person partial care behavioral health and substance use disorder treatment services, and associated transportation services, for adults. CURRENT VERSION OF TEXT As introduced.
Sponsored by:
Senator ROBERT W. SINGER
District 30 (Monmouth and Ocean)
SYNOPSIS
Increases Medicaid reimbursement for in-person partial care behavioral health and substance use disorder treatment services, and associated transportation services, for adults.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning Medicaid reimbursement for certain behavioral health and addiction services and supplementing Title 30 of the Revised Statutes. Be It Enacted by the Senate and General Assembly of the State of New Jersey: 1. a. As used in this section: "Adult" means an individual aged 21 years and older. "Partial care services" means comprehensive, individualized, structured, non-residential behavioral health care and support services for an adult with severe mental illness or substance use disorder in order to facilitate community integration and prevent hospitalization and relapse. Partial care services may include, but are not limited to: psychiatric care, individual and group counseling, case management, and prevocational services. b. The reimbursement rate for in-person partial care services within the Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), whether such services are provided in the Medicaid fee-for-service delivery system or through the Medicaid managed care delivery system, shall be no less than the applicable established State Medicaid rate as of the effective date of this act, increased by 35 percent. c. The aggregate reimbursement rate for transportation services and mileage to or from a partial care services provider within the Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), whether such services are provided in the Medicaid fee-for-service delivery system or through the Medicaid managed care delivery system, shall be no less than $10 for each one-way trip. d. The Medicaid reimbursement rates established pursuant to this act shall only apply to services provided to an adult, as of the effective date of this act. 2. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program. 3. The Commissioner of Human Services, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) shall adopt rules and regulations necessary to implement the provisions of this act. 4. This act shall take effect on the first day of the fourth month next following the date of enactment, but the Commissioner of Human Services may take such anticipatory administrative action in advance thereof as may be necessary for the implementation of this act. STATEMENT 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, an increase of $3 from the current $7 rate, which is composed of $4.50 for transportation services and $2.50 for mileage. These rate increases apply to services provided through the fee-for-service or managed care delivery system. It is the intent of the bill's sponsor to improve Medicaid reimbursement for the critical supports and services that partial care programs provide to some of New Jersey's most vulnerable residents. Under current law, NJ Medicaid covers partial care behavioral health and SUD treatment services for most adults through the fee-for-service delivery system. The reimbursement rate for in-person partial care behavioral health services is $17.92 per hour, with service providers required to deliver a minimum of two hours and a maximum of five hours of services per day, limited to 25 hours per week. Medicaid additionally pays a per diem rate of $78.31 for in-person partial care SUD treatment services; providers are required to deliver a minimum of four hours of services per day, or no less than 20 service hours per week. By contrast, the State provides partial care behavioral health and SUD treatment services through the managed care delivery system for clients of the Division of Developmental Disabilities (DDD), individuals enrolled in a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP), and enrollees in the Medicaid Managed Long Term Services and Supports (MLTSS) program. Therefore, Medicaid reimbursement for partial care services provided for these beneficiary groups is proprietary and embedded in the State's contracted capitation payments to the Medicaid managed care organizations. Partial care services encompass a variety of medical and psychological interventions and supportive services for individuals diagnosed with severe mental illness or addiction. The goal of partial care programs is to integrate the individual into the community, thereby preventing relapse and inpatient hospitalization. Partial care programs offer individualized, structured, non-residential services including, but not limited to: individual and group counseling, psychiatric care, psychoeducation, social and recreational services, pre-vocational services, and case management services.
An Act concerning Medicaid reimbursement for certain behavioral health and addiction services and supplementing Title 30 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. As used in this section:
"Adult" means an individual aged 21 years and older.
"Partial care services" means comprehensive, individualized, structured, non-residential behavioral health care and support services for an adult with severe mental illness or substance use disorder in order to facilitate community integration and prevent hospitalization and relapse. Partial care services may include, but are not limited to: psychiatric care, individual and group counseling, case management, and prevocational services.
b. The reimbursement rate for in-person partial care services within the Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), whether such services are provided in the Medicaid fee-for-service delivery system or through the Medicaid managed care delivery system, shall be no less than the applicable established State Medicaid rate as of the effective date of this act, increased by 35 percent.
c. The aggregate reimbursement rate for transportation services and mileage to or from a partial care services provider within the Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), whether such services are provided in the Medicaid fee-for-service delivery system or through the Medicaid managed care delivery system, shall be no less than $10 for each one-way trip.
d. The Medicaid reimbursement rates established pursuant to this act shall only apply to services provided to an adult, as of the effective date of this act.
2. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
3. The Commissioner of Human Services, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) shall adopt rules and regulations necessary to implement the provisions of this act.
4. This act shall take effect on the first day of the fourth month next following the date of enactment, but the Commissioner of Human Services may take such anticipatory administrative action in advance thereof as may be necessary for the implementation of this act.
STATEMENT
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, an increase of $3 from the current $7 rate, which is composed of $4.50 for transportation services and $2.50 for mileage. These rate increases apply to services provided through the fee-for-service or managed care delivery system. It is the intent of the bill's sponsor to improve Medicaid reimbursement for the critical supports and services that partial care programs provide to some of New Jersey's most vulnerable residents.
Under current law, NJ Medicaid covers partial care behavioral health and SUD treatment services for most adults through the fee-for-service delivery system. The reimbursement rate for in-person partial care behavioral health services is $17.92 per hour, with service providers required to deliver a minimum of two hours and a maximum of five hours of services per day, limited to 25 hours per week. Medicaid additionally pays a per diem rate of $78.31 for in-person partial care SUD treatment services; providers are required to deliver a minimum of four hours of services per day, or no less than 20 service hours per week.
By contrast, the State provides partial care behavioral health and SUD treatment services through the managed care delivery system for clients of the Division of Developmental Disabilities (DDD), individuals enrolled in a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP), and enrollees in the Medicaid Managed Long Term Services and Supports (MLTSS) program. Therefore, Medicaid reimbursement for partial care services provided for these beneficiary groups is proprietary and embedded in the State's contracted capitation payments to the Medicaid managed care organizations.
Partial care services encompass a variety of medical and psychological interventions and supportive services for individuals diagnosed with severe mental illness or addiction. The goal of partial care programs is to integrate the individual into the community, thereby preventing relapse and inpatient hospitalization. Partial care programs offer individualized, structured, non-residential services including, but not limited to: individual and group counseling, psychiatric care, psychoeducation, social and recreational services, pre-vocational services, and case management services.