Requires NJ FamilyCare to reimburse inpatient providers for long-acting injectable antipsychotic drugs at outpatient reimbursement rate.

A2120

ASSEMBLY, No. 2120

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblywoman LINDA S. CARTER

District 22 (Somerset and Union)

Assemblyman MICHAEL VENEZIA

District 34 (Essex)

Assemblywoman VERLINA REYNOLDS-JACKSON

District 15 (Hunterdon and Mercer)

Co-Sponsored by:

Assemblywoman Speight

SYNOPSIS

���� Requires NJ FamilyCare to reimburse inpatient
providers for long-acting injectable antipsychotic drugs at outpatient
reimbursement rate.

CURRENT VERSION OF TEXT

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

��

An Act
concerning NJ FamilyCare reimbursement of
long-acting
injectable antipsychotic drugs 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. Notwithstanding any
law, rule, or regulation to the contrary,
reimbursement under NJ FamilyCare, whether under the fee-for service� or managed
care delivery system, for long-acting injectable antipsychotic drugs
administered in an inpatient setting shall be :

���� (1)��
separate and distinct from any
reimbursement issued to an inpatient provider based on a Diagnostic Related
Group reimbursement system; and

���� (2)��
at a rate equal to the NJ FamilyCare reimbursement rate of
the identical long-acting injectable antipsychotic drug when administered in an
outpatient setting.

���� b.��� The provisions of this section shall not be
construed to alter any coverage requirements for long-acting injectable
antipsychotic drugs under NJ FamilyCare, when administered in an inpatient
setting.

���� c.���� As used in this section:

���� �Diagnostic Related Group reimbursement
system� means an inpatient provider payment system that classifies patients
into groups based on the patient�s principal procedure, diagnosis, or other
significant characteristics to determine the provider�s reimbursement
payment.��

���� �Long-acting injectable
antipsychotic drugs� mean

medications approved by the United States Food and Drug Administration that can
treat and manage symptoms of major psychiatric
disorders, such as schizophrenia and bipolar disorder
, for up to
24 weeks with a single dose.

���� �NJ FamilyCare� means
the
program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), which
includes the Medicaid program and the Children�s Health Insurance Program.

���� 2.� Notwithstanding any law,
order, rule, or regulation to the contrary, a pharmacist may administer a
long-acting injectable antipsychotic drug to the patient pursuant to a
prescription issued by an authorized prescriber, provided that the pharmacist
is appropriately educated and qualified to administer the drug, as determined
by the New Jersey State Board of Pharmacy, and in accordance with requirements
set forth in rules jointly promulgated by the New Jersey State Board of
Pharmacy and the State Board of Medical Examiners.

����
3.��� 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.

���� 4.
��� 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.

���� 5.
��� 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

����
T
his bill requires that NJ FamilyCare
reimbursement for long-acting injectable
antipsychotic drugs administered in an inpatient setting be
separate and
distinct from any reimbursement issued to an inpatient provider based on a
Diagnostic Related Group reimbursement system.� Additionally, under the bill,
the inpatient reimbursement rate of these drugs is mandated to be
equal to the identical drug�s NJ FamilyCare
reimbursement rate when administered in an outpatient setting
.�
Long-acting injectable antipsychotic drugs
can
treat
and manage symptoms of
major psychiatric disorders, such as schizophrenia and bipolar disorder
, for up to
24 weeks with a single dose.� While
expensive medications, these drugs have significant benefits for the patient
and health care system, including:� improved medication adherence, reduced
hospitalizations and need for medical intervention, and improved clinical
outcomes.

���� Currently, NJ FamilyCare
uses Diagnosis Related Groups (DRGs) to reimburse
inpatient providers, such as general acute care hospitals, a fixed amount for
inpatient services.� DRGs are a classification system that group hospital
services based on similar diagnoses and procedures, as well as age, sex, and
discharge status, in order to determine a reimbursement rate.� Reimbursement
for the administration of a
long-acting injectable antipsychotic drug in
an inpatient setting is included within this payment; however, the high cost of
these drugs is not considered in the methodology that establishes the DRG
payment amount
.�

���� Alternatively,
the reimbursement rate for
long-acting injectable antipsychotic drugs
in an outpatient setting is largely based on the
ingredient cost of the drug.
� Therefore, the provisions of the bill
ensure that inpatient providers receive a reimbursement payment for long-acting
injectable antipsychotic drugs that is more closely reflective of the cost of
the drug.�

����� The bill also
allows pharmacists to administer a
long-acting antipsychotic injectable drug, pursuant to a prescription issued by
an authorized prescriber, provided the pharmacist is appropriately educated and
qualified to administer the drug, as determined by the State Board of Pharmacy.