[Second Reprint]
ASSEMBLY, No. 3110
STATE OF NEW JERSEY
220th LEGISLATURE
INTRODUCED MARCH 7, 2022
Sponsored by:
Assemblywoman MILA M. JASEY
District 27 (Essex and Morris)
Assemblyman DANIEL R. BENSON
District 14 (Mercer and Middlesex)
Assemblywoman VERLINA REYNOLDS-JACKSON
District 15 (Hunterdon and Mercer)
Senator RICHARD J. CODEY
District 27 (Essex and Morris)
Senator HOLLY T. SCHEPISI
District 39 (Bergen and Passaic)
Co-Sponsored by:
Assemblywomen Piperno, Eulner, Assemblymen Caputo, Verrelli, Assemblywomen Jimenez, Dunn, Assemblymen Barranco, DiMaio, Umba, Bergen, Conaway, Rooney, Assemblywoman Speight, Assemblyman Stanley, Assemblywomen Murphy, McKnight, Senators Durr, Singer, Madden, A.M.Bucco, Thompson, Turner, Ruiz and O'Scanlon
SYNOPSIS
Establishes minimum Medicaid reimbursement rates for brain injury services.
CURRENT VERSION OF TEXT
As amended by the Senate on June 29, 2022.
An Act concerning Medicaid reimbursement for brain injury 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. The Legislature funds and declares:
a. An acquired brain injury is an injury caused by an event, either internal or external to the injured individual, and does not include congenital or degenerative disorders, or those injuries induced by birth trauma. An acquired brain injury can either be categorized as a traumatic brain injury or non-traumatic brain injury. A traumatic brain injury is an alteration in brain function caused by an external force and may be caused by falls, assaults, motor vehicle accidents, or sports injuries. A non-traumatic brain injury is damage to the brain caused by internal factors, such as stroke, aneurysm, tumor, infectious disease, 1[and] or1 anoxia.
b. A severe acquired brain injury can produce an altered or diminished state of consciousness and result in an impairment of cognitive abilities or physical functioning. It can also effect behavioral or emotional functioning. These impairments may be permanent and cause partial or total functional disability, leading to the injured individual requiring long-term care supports.
c. The State’s Medicaid program provides brain injury services under the Managed Long-Term Supports and Services program, with the goal of providing community alternatives for individuals with brain injuries residing in nursing facilities or who are in the community and at risk for placement in nursing facilities.
d. Unlike other Medicaid community-based services, reimbursement rates for brain injury services have remained static in recent years despite growing costs, which threatens the ability of providers to meet the complex health needs of individuals with brain injuries and provide services within a safe and fulfilling community environment.
e. Despite the similar model of care, reimbursement rates for services provided to Medicaid beneficiaries with intellectual and developmental disabilities have not only increased, but have been restructured to account for adequate consideration for acuity, increased minimum wage requirements, and other inflationary trends that assert pressure on providers’ cost structures.
f.
By failing to receive reimbursement rates that adequately support services,
brain injury providers are being forced to return this fragile population to
more costly institutional care in nursing home facilities.
g. It is imperative that the Legislature take action and increase Medicaid rates for these essential services and ensure that individuals with brain injuries can continue to thrive and reach their optimal recoveries in community settings.
2. a. Notwithstanding the provisions of any law or regulation to the contrary, the Medicaid per diem or encounter reimbursement rates for eligible brain injury services, when such services are provided by an approved brain injury 1[services] service1 provider to a Medicaid beneficiary requiring treatment for a brain injury, shall be, at minimum, as follows:
(1) The reimbursement rate for Community Residential Services – Low Supervision provided to a Medicaid beneficiary eligible for brain injury services shall be equal to the reimbursement rate for Individuals Supports Services - 2[Tier C] Tier B2 provided to a Medicaid beneficiary eligible for services provided by the Division of Developmental Disabilities 1in the Department of Human Services1 ;
(2) The reimbursement rate for Community Residential Services – Moderate Supervision provided to a Medicaid beneficiary eligible for brain injury services shall be equal to the reimbursement rate for Individuals Supports Services - 2[Tier D] Tier C2 provided to a Medicaid beneficiary eligible for services provided by the Division of Developmental Disabilities 1in the Department of Human Services1 ; 2and2
(3) The reimbursement rate for Community Residential Services – High Supervision provided to a Medicaid beneficiary eligible for brain injury services shall be equal to the 2average of the2 reimbursement 2[rate] rates2 for Individuals Supports Services - 2[Tier E] Tiers D and E2 provided to a Medicaid beneficiary eligible for services provided by the Division of Developmental Disabilities 1in the Department of Human Services1 2[; and
(4) The reimbursement rate for Structured Day Program Services provided to a Medicaid beneficiary eligible for brain injury services shall be equal to the reimbursement rate for Day Habilitation Services - Tier D provided to a Medicaid beneficiary eligible for services provided by the Division of Developmental Disabilities 1in the Department of Human Services1]2 .
b. As used in this section:
1[“Medicaid” means the program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).]1
“Brain injury service” means community-based services, residential services, day care services, and home care services provided to a Medicaid beneficiary requiring treatment for traumatic or non-traumatic brain injuries, 1regardless of1 whether such services are provided through the Medicaid fee-for-service delivery system or the managed care delivery system.
“Brain injury service provider” means a facility licensed by the Division of Disability Services in the Department of Human Services to provide traumatic or non-traumatic brain injury services.
1“Medicaid” means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).1
“Non-traumatic brain injury” means an injury to the brain caused by internal factors, such as stroke, aneurysm, tumor, infectious disease, 1[and] or1 anoxia, where continued impairment can be demonstrated. This term does not include brain dysfunction caused by congenital or degenerative disorders, birth trauma, or injuries caused by other circumstances.
“Traumatic brain injury” means an injury to the brain caused by a blow or jolt to the head or a penetrating head injury or neuro-trauma that disrupts the normal brain function, where continued impairment can be demonstrated. This term does not include brain dysfunction caused by congenital or degenerative disorders, birth trauma, or injuries caused by other circumstances.
3. The Commissioner of Human Services shall apply for such State plan amendments or waivers specific to brain injury services, that currently exist or may arise in the future which affect reimbursement rates, 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.
4. The Commissioner of Human Services, in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt such rules and regulations as the commissioner deems necessary to carry out the provisions of this act.
5. This act shall take effect 2[on July 1 next following] 30 days after2 the date of enactment and shall apply to services provided on or after the effective date of this act and to any Medicaid managed care contract executed or renewed on or after the effective date of this act.