Bill Text: NJ A1860 | 2024-2025 | Regular Session | Introduced
Bill Title: Increases Medicaid reimbursement rates for primary care services; appropriates $20 million.
Spectrum: Partisan Bill (Democrat 8-0)
Status: (Introduced) 2024-01-09 - Introduced, Referred to Assembly Aging and Human Services Committee [A1860 Detail]
Download: New_Jersey-2024-A1860-Introduced.html
STATE OF NEW JERSEY
221st LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2024 SESSION
Sponsored by:
Assemblyman HERB CONAWAY, JR.
District 7 (Burlington)
Assemblywoman CAROL A. MURPHY
District 7 (Burlington)
Co-Sponsored by:
Assemblywomen Haider, Reynolds-Jackson, Speight and Lampitt
SYNOPSIS
Increases Medicaid reimbursement rates for primary care services; appropriates $20 million.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning primary care services reimbursed under Medicaid, supplementing Title 30 of the Revised Statutes, and making an appropriation.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. Commencing on July 1, 2023, or upon the effective date of this act, whichever occurs first, the Commissioner of Human Services shall increase the Medicaid reimbursement rates for primary care services. The Commissioner of Human Services shall determine the amount of the increases as follows: The primary care services reimbursement rates associated with the most frequently used medical billing codes under Medicaid in calendar year 2022 shall be increased so that each rate is no less than 100 percent of the payment rate that applies to the same service under part B of Medicare. The Commissioner of Human Services shall determine the number of primary care services rates increased under this subsection such that the annual aggregate amount of the rate increases is equal to $20,000,000, as appropriated pursuant to section 4 of this act, combined with the anticipated receipt of increased federal Medicaid matching funds.
b. Primary care services as used in subsection a. of this section shall include those services furnished by:
(1) a physician with a primary specialty designation of family medicine, general internal medicine, general pediatric medicine, or obstetrics and gynecology;
(2) a health care professional, including but not limited to an advance practice nurse or a physician assistant, who is working in the area of family medicine, general internal medicine, general pediatric medicine, or obstetrics and gynecology; or
(3) a midwife .
c. The provisions of this section shall not be construed to require any decrease in the Medicaid reimbursement rate for a primary care service from the previous fiscal year's reimbursement level for the same service.
d. The provisions of this section shall apply to primary
care services:
(1) reimbursed under the Medicaid fee-for-service delivery system or through the Medicaid managed care delivery system, and
(2) delivered by an approved Medicaid provider.
e. No later than one year after the effective date of this act, the Commissioner of Human Services shall submit a report to the Governor and to the Legislature, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), providing information on the implementation of this section, including data indicating any changes regarding access to primary care services, as well as the quality of care of these services, for Medicaid beneficiaries following rate increases implemented under this section. The report shall also include any recommendations for further enhancements to the Medicaid rates for these services to improve provider access and quality of care for Medicaid beneficiaries in underserved areas of the State.
g. As used in this section:
"Medicaid" means the program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Medicare" means the federal program established pursuant to Pub.L.89-97 (42 U.S.C. s.1395 et seq.) as amended, or its successor plan or plans.
"Midwife" means a midwife licensed by the State Board of Medical Examiners as a certified midwife, a certified nurse midwife, or a certified professional midwife.
"Primary care services" means the same as defined in section 1202 of the federal "Health Care and Education Reconciliation Act of 2010," Pub.L. 111-152.
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. There is appropriated from the General Fund to the Department of Human Services the sum of $20,000,000 to effectuate the provisions of this act.
5. This act shall take effect immediately.
STATEMENT
This bill increases the Medicaid reimbursement rates for primary care and mental health services according to the Medicare payment rate for the same services. Under the bill, primary care services means the same as defined under section 1202 of the federal "Health Care and Education Reconciliation Act of 2010," and includes evaluation and management services, which cover the non-procedural services patients receive from a provider, and services related to immunization administration. Mental health services means procedures or services rendered by a health care provider, in a traditional setting as well in an integrated behavioral health setting or via a collaborative care program, for the treatment of mental illness, emotional disorders, or drug or alcohol abuse.
Under the bill, commencing on July 1, 2023, and annually thereafter, the Medicaid reimbursement rate for primary care and mental health services is required to be no less than 100 percent of the payment rate that applies to such services under part B of the federal Medicare program. Primary care and mental health services include those services furnished by:
(1) a physician with a primary specialty designation of family medicine, general internal medicine, general pediatric medicine, or obstetrics and gynecology;
(2) a health care professional, including but not limited to an advance practice nurse or a physician assistant, who is working in the area of family medicine, general internal medicine, general pediatric medicine, or obstetrics and gynecology; or
(3) a midwife.
Mental health services additionally include those services furnished by a health care provider with one of the following specialty designations: licensed clinical social worker, psychologist, licensed professional counselor, licensed marriage and family therapist, or psychiatrist.
The provisions of the bill are not to be construed to require any decrease in the Medicaid reimbursement rate for a primary care or mental health service from the previous fiscal year's reimbursement level for the same service. Moreover, the requirements established under the bill apply whether the services are reimbursed under the Medicaid fee-for-service delivery system or the Medicaid managed care delivery system, and only to services delivered by approved Medicaid providers.
The bill directs the Commissioner of Human Services, no later than July 1, 2024, to submit a report to the Governor and Legislature providing information on the implementation of the bill, including data indicating any changes regarding access to primary care and mental health services, as well as the quality of care of these services, for Medicaid beneficiaries following any rate increases associated with the bill.
