Increases Medicaid reimbursement for in-person partial care and intensive outpatient behavioral health and substance use disorder treatment services, and associated transportation services, for adults.

A1796

ASSEMBLY, No. 1796

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblyman ANTHONY S. VERRELLI

District 15 (Hunterdon and Mercer)

Assemblyman LOUIS D. GREENWALD

District 6 (Burlington and Camden)

Co-Sponsored by:

Assemblywomen Reynolds-Jackson, Dunn and Speight

SYNOPSIS

���� Increases Medicaid reimbursement for in-person
partial care and intensive outpatient behavioral health and substance use
disorder treatment services, and associated transportation services, for
adults.

CURRENT VERSION OF TEXT

���� Introduced Pending Technical Review by Legislative
Counsel.

��

An Act

concerning Medicaid reimbursement for
certain behavioral health and addiction 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.� As used in this
section:

���� �Adult� means an individual
aged 21 years and older.

�����
�Intensive Outpatient Services� means comprehensive,
individualized, structured, non-residential treatment sessions for an adult
with severe mental illness or substance use disorder provided at a licensed
outpatient facility for a minimum of nine hours per week.

���� �Partial care services� means
comprehensive, individualized, structured, non-residential behavioral health
care and support services for an adult with severe mental illness or substance
use disorder
provided at a licensed outpatient
facility for a minimum of two hours per week and a maximum of 25 hours per week

in order to facilitate community integration and prevent hospitalization and
relapse.� Partial care services may include, but are not limited to:
psychiatric care, individual and group counseling, case management, and
prevocational services.

���� b.��� The reimbursement
rates for in-person partial care and intensive
outpatient

services within the Medicaid program, established pursuant to
P.L.1968, c.413 (C.30:4D-1 et seq.), whether such services are provided in the
Medicaid fee-for-service delivery system or through the Medicaid managed care
delivery system, shall be no less than the applicable established State
Medicaid rate as of the effective date of this act, increased by 35 percent.�
Rates increased under this subsection shall include,
but shall not be limited to:� per diem and hourly reimbursement rates for
partial care and intensive outpatient services, as well as services provided
during partial care and intensive outpatient treatment, such as intake
evaluation, individual counseling, and group counseling.

���� c.���� The aggregate
reimbursement rate for transportation services and mileage to or from a partial
care
or intensive outpatient
services
provider within the Medicaid program, established pursuant to P.L.1968, c.413
(C.30:4D-1 et seq.), whether such services are provided in the Medicaid
fee-for-service delivery system or through the Medicaid managed care delivery
system, shall be no less than $10 for each one-way trip.

����� d.�� The Medicaid
reimbursement rates established pursuant to this act shall apply to services
provided to an adult Medicaid beneficiary on or after the effective date of
this act.

���� 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 on the first day of the fourth month next following the date of
enactment, but the Commissioner of Human Services may take such anticipatory
administrative action in advance thereof as may be necessary for the
implementation of this act.

STATEMENT

����� This bill increases Medicaid reimbursement rates for in-person
partial care behavioral health and substance use disorder (SUD) treatment
services and intensive outpatient services by 35 percent, when such services
are provided to an adult Medicaid enrollee on an in-person basis.� The bill
also provides that the aggregate Medicaid reimbursement rate for transportation
services and mileage to or from a partial care services provider and intensive
outpatient services is to be no less than $10 for each one-way trip, an
increase of $3 from the current $7 rate, which is composed of $4.50 for
transportation services and $2.50 for mileage.� These rate increases will apply
to services provided through the fee-for-service or managed care delivery
system on or after the effective date of this bill.�