Sponsored by:
Senator RICHARD J. CODEY
District 27 (Essex and Morris)
Senator BRIAN P. STACK
District 33 (Hudson)
Co-Sponsored by:
Senators Singer, Thompson, Ruiz, Diegnan, Bramnick, A.M.Bucco and Schepisi
SYNOPSIS
Establishes minimum Medicaid reimbursement rate for structured day program services provided to beneficiary eligible for brain injury services.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning Medicaid reimbursement for brain injury services and amending P.L.2022, c.78.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 2 of P.L.2022, c. 78 (C.30:4D-7kk) is amended to read as follows:
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 service 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 - Tier B provided to a Medicaid beneficiary eligible for services provided by the Division of Developmental Disabilities in the Department of Human Services;
(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 - Tier C provided to a Medicaid beneficiary eligible for services provided by the Division of Developmental Disabilities in the Department of Human Services; [and]
(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 average of the reimbursement rates for Individuals Supports Services - Tiers D and E provided to a Medicaid beneficiary eligible for services provided by the Division of Developmental Disabilities in the Department of Human Services; 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 average of the reimbursement rates for Day Habilitation Services – Tiers D and Tier E provided to a Medicaid beneficiary eligible for services provided by the Division of Developmental Disabilities in the Department of Human Services.
b. As used in this section:
"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, regardless of 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.
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Non-traumatic brain injury" means an injury to the brain caused by internal factors, such as stroke, aneurysm, tumor, infectious disease, or 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.
(cf: P.L.2022, c.78, s.2)
2. (New section) 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.
3. This act shall take effect 30 days after 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.
STATEMENT
This bill amends existing law, which established minimum Medicaid reimbursement rates for brain injury services, to include structured day program services. Current law is limited to community residential services. Under existing law, “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, regardless of whether such services are provided through the Medicaid fee-for-service delivery system or the managed care delivery system.
Specifically, the bill requires the Medicaid per diem or encounter reimbursement rates for Structured Day Program Services provided to a Medicaid beneficiary requiring treatment for a brain injury, currently at $3.65 for every 15 minutes of services, when such services are provided by an approved brain injury service provider, to be equal to the average of the reimbursement rates for Day Habilitation Services – Tiers D and Tier E provided to a Medicaid beneficiary eligible for services provided by the Division of Developmental Disabilities in the Department of Human Services, currently at $9.09 for every 15 minutes of service.