S2792

An Act concerning primary care and mental health services reimbursed under Medicaid 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. Commencing on July 1, 2022, and annually thereafter, the Medicaid reimbursement rate for primary care and mental health services shall be no less than 100 percent of the payment rate that applies to such services under part B of Medicare.

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 certified nurse-midwife.

c. Mental health services as used in subsection a. of this section shall include those services furnished by a provider listed in paragraphs (1), (2), or (3) of subsection b. of this section or 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.

d. The provisions of this section shall not 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.

e. The provisions of this section shall apply to primary care and mental health 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.

f. No later than July 1, 2024, 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 and mental health services, as well as quality of care of these services, for Medicaid beneficiaries following any rate increases required 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.

“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.

“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. 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. It is the sponsor’s goal to leverage higher reimbursement rates for Medicaid primary care and mental health services to improve beneficiaries’ access to essential services and quality of health care.

Specifically, under the bill, commencing on July 1, 2022, 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;

(3) a certified nurse-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 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 to the 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 quality of care of these services, for Medicaid beneficiaries following any rate increases associated with the bill. The report is also to 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. Furthermore, the commissioner is to apply for such State plan amendments or waivers as may be necessary to implement the provisions of the bill and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program. The commissioner is also to adopt rules and regulations necessary to implement the provisions of the bill.

Historically, the Medicaid program has reimbursed providers at lower rates than either private insurance or the Medicare program for the same services. For example, a study by the Urban Institute indicated that New Jersey’s 2016 Medicaid primary care reimbursement rates were only 42 percent of the Medicare rates for the same services. As a result, too few physicians in New Jersey choose to accept Medicaid, which creates barriers to healthcare accessibility and equity for the 2 million beneficiaries of the program. Furthermore, closing the provider pay gap that makes Medicaid less attractive to providers will help reduce health care disparities in the State, as 66.6 percent of non-elderly Medicaid enrollees identify as Black, Latino, Asian, or mixed race .

Additionally, as a population prone to chronic health conditions, the availability of primary and mental health care is particularly important to Medicaid recipients. Health care providers offer services critical to an individual’s overall health, such as preventative care and screenings to avoid costly illnesses and emergency room admissions and care coordination with medical specialists to ensure that the patient receives the most effective and appropriate treatment. Increasing Medicaid service rates will have beneficial outcomes on the quality and efficiency of care under program, leading to long-term improved health care outcomes for beneficiaries and cost savings for the State.