Sponsored by:
Senator PAUL A. SARLO
District 36 (Bergen and Passaic)
SYNOPSIS
Establishes Medicaid emergency room triage reimbursement fee for low acuity emergency room encounters.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning Medicaid reimbursement of certain emergency 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. A hospital licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) providing emergency services to patients enrolled in the State Medicaid fee-for-service program shall accept as final payment an emergency room triage reimbursement fee of $140.00 when the emergency services provided are for low acuity emergency room encounters. The Commissioner of Human Services shall publish a list of diagnostic codes that would be considered low acuity emergency room encounters for the purpose of applying this fee.
b. As used in this section:
“Acuity” means the measurement of the intensity of nursing care required by a patient.
“Medicaid” means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
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 shall adopt rules and regulations pursuant to the "Administrative Procedure Act" P.L.1968, c.410 (C.52:14B-1 et seq.) to effectuate the purposes of this act.
4. This act shall take effect on the first day of the fourth month next following the date of enactment, and shall apply to all services provided on or after the effective date, except that the Commissioner of Human Services may take any anticipatory administrative action in advance as shall be necessary for the implementation of this act.
STATEMENT
This bill establishes a Medicaid emergency room triage reimbursement fee for low acuity emergency room encounters of patients enrolled in the State Medicaid fee-for-service program. Under the bill, a hospital in the State providing emergency services to patients enrolled in the State Medicaid fee-for-service program must accept as final payment an emergency room triage reimbursement fee of $140.00 when the emergency services provided are for low acuity emergency room encounters. As defined by the bill, acuity means the measurement of the intensity of nursing care required by a patient. The bill requires the Commissioner of Human Services to publish a list of diagnostic codes that would be considered low acuity emergency room encounters for the purpose of applying this fee.