Requires Medicaid reimbursement rates for certain primary and mental health care services match reimbursement rates under Medicare.

A4265

ASSEMBLY, No. 4265

STATE OF NEW JERSEY

222nd LEGISLATURE

�

INTRODUCED FEBRUARY 19, 2026

Sponsored by:

Assemblywoman� SHANIQUE SPEIGHT

District 29 (Essex and Hudson)

Assemblywoman� MARISA SWEENEY

District 25 (Morris and Passaic)

Co-Sponsored by:

Assemblymen Kearney and Scharfenberger

SYNOPSIS

���� Requires Medicaid reimbursement rates for certain
primary and mental health care services match reimbursement rates under
Medicare.

CURRENT VERSION OF TEXT

���� As introduced.

��

An Act
concerning Medicaid reimbursement for primary care and
mental health services 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:

���� �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 substance use disorder. �

���� �Midwife� means a midwife
licensed by the State Board of Medical Examiners as a certified midwife, a
certified nurse midwife, or a certified professional midwife.

���� �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.

���� b.��� Commencing on July 1,
2023, 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.

���� c.���� Primary care services
as used in subsection b. 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 midwife.

���� d.��� Mental health services as
used in subsection b. of this section shall include those services furnished by
a provider listed in paragraphs (1), (2), or (3) of subsection c. 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, licensed
clinical alcohol and drug counselor, or psychiatrist.�

���� e.���� 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.

���� f.���� 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.

���� g.��� No later than one year
after the effective date of this act, the Commissioner of Human Services shall
submit a report to the Governor and,
pursuant to
section 2 of P.L.1991, c.164 (C.52:14-19.1),
to the Legislature,
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 the 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.�

���� 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 requires the
Medicaid reimbursement rates for primary care and mental health services to
match the reimbursement are for those services under Medicare.�

���� Specifically, commencing July
1, 2023, 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;

���� (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 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, licensed clinical alcohol and drug counselor, or psychiatrist.

���� The provisions of the bill are
not to 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.� The requirements of the bill will
apply to services reimbursed under both the Medicaid fee-for-service delivery
system and the Medicaid managed care delivery system, but will only to services
delivered by an approved Medicaid provider.

���� The bill directs the
Commissioner of Human Services, no later than one year after the effective date
of the bill, to submit a report to the Governor and to the Legislature
concerning implementation of the bill, including data regarding changes in
access to primary care and mental health services, as well as the quality of
care of these services, for Medicaid beneficiaries following any rate increases
implemented under 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.