| 59 | | - | 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. 2"Intensive Outpatient Services" means comprehensive, individualized, structured, non-residential treatment sessions for an adult with severe mental illness or substance use disorder provided at a licensed outpatient facility for a minimum of nine hours per week.2 "Partial care services" means comprehensive, individualized, structured, non-residential 2[behavioral health care and support] 3[intensive treatment2] behavioral health care and support3 services 3[2, including access to psychiatric, medical, and laboratory services,2]3 for an adult with severe mental illness or substance use disorder 2[in order to facilitate community integration and prevent hospitalization and relapse] provided at a licensed outpatient facility for a minimum of 3[20 hours] two hours3 per week2 3and a maximum of 25 hours per week in order to facilitate community integration and prevent hospitalization and relapse3. 2[Partial care services may include, but are not limited to: psychiatric care, individual and group counseling, case management, and prevocational services.]2 3Partial care services may include, but are not limited to: psychiatric care, individual and group counseling, case management, and prevocational services.3 b. The reimbursement 2[rate] rates2 for in-person partial care 2and intensive outpatient2 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. 2Rates increased under this subsection shall include, but shall not be limited to: per diem and hourly reimbursement rates for partial care and intensive outpatient services, as well as services provided during partial care and intensive outpatient treatment, such as intake evaluation, 3[psychiatric evaluation, family counseling,]3 individual counseling, and group counseling.2 c. The aggregate reimbursement rate for transportation services and mileage to or from a partial care 2or intensive outpatient2 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 1[only]1 apply to services provided to an adult 1[, as of] Medicaid beneficiary on or after1 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.) 1,1 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. |
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| 59 | + | 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. 2"Intensive Outpatient Services" means comprehensive, individualized, structured, non-residential treatment sessions for an adult with severe mental illness or substance use disorder provided at a licensed outpatient facility for a minimum of nine hours per week.2 "Partial care services" means comprehensive, individualized, structured, non-residential 2[behavioral health care and support] intensive treatment2 services2, including access to psychiatric, medical, and laboratory services,2 for an adult with severe mental illness or substance use disorder 2[in order to facilitate community integration and prevent hospitalization and relapse] provided at a licensed outpatient facility for a minimum of 20 hours per week2. 2[Partial care services may include, but are not limited to: psychiatric care, individual and group counseling, case management, and prevocational services.]2 b. The reimbursement 2[rate] rates2 for in-person partial care 2and intensive outpatient2 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. 2Rates increased under this subsection shall include, but shall not be limited to: per diem and hourly reimbursement rates for partial care and intensive outpatient services, as well as services provided during partial care and intensive outpatient treatment, such as intake evaluation, psychiatric evaluation, family counseling, individual counseling, and group counseling.2 c. The aggregate reimbursement rate for transportation services and mileage to or from a partial care 2or intensive outpatient2 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 1[only]1 apply to services provided to an adult 1[, as of] Medicaid beneficiary on or after1 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.) 1,1 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. |
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