Extends certain provisions relating to involuntary commitment.

A5222 FISCAL ESTIMATE

LEGISLATIVE FISCAL ESTIMATE

ASSEMBLY, No. 5222

STATE OF NEW JERSEY

222nd LEGISLATURE

DATED: JULY 1, 2026

SUMMARY

Synopsis:

Extends certain provisions relating to involuntary
commitment.

Type of Impact:

Potential net expenditure increase for State and local
governments; potential State revenue increase.

Agencies Affected:

Department of Human Services; Department of Health; State
Health Benefits Program; School Employees� Health Benefits Program; the
Judiciary; Office of the Public Defender; University Hospital and Bergen New
Bridge Medical Center; State and County Psychiatric Hospitals; State, County,
and Municipal Law Enforcement Agencies.

Office of
Legislative Services Estimate

Fiscal Impact

Eight-Month Period

Potential Net State Expenditure Increase

Indeterminate

Potential Net State Revenue Increase (Federal Funds)

Indeterminate

Potential Net Local Expenditure Increase

Indeterminate

�

The Office of Legislative Services (OLS) finds that the bill may
increase NJ FamilyCare expenditures and other State and local costs by
indeterminate amounts during its eight-month effective period, due to hospital,
legal, and administrative costs associated with extending initial 72-hour
involuntary holds and placing patients in appropriate psychiatric facilities.

�

Some offsetting savings may result from discharging fewer
non-stabilized patients into the community, thereby reducing other State and
local expenditures on hospital emergency department services, community-based
mental health care, and law enforcement activities.

�

Any net increase in NJ FamilyCare expenditures under the bill for
services rendered to beneficiaries will also increase State revenue
in the form of federal Medicaid and Children�s Health
Insurance Program cost reimbursements, partially offsetting the applicable
State costs.

�

Data from the Department of Human
Services suggest that any State and local fiscal impacts may
be modest
due to the small number of patients receiving extended holds.

BILL DESCRIPTION

����� This bill extends a general hospital�s or emergency
department�s authority, by eight months,
to hold an involuntarily committed person
for
up to 72 hours beyond the initial 72-hour
period typically allowed in civil commitment matters (for a maximum total of
144 hours) provided that the hospital has submitted an emergent application to
the court for a temporary court order and cannot
discharge or admit the
person to another facility
.�
This
authority was originally provided by P.L.2023, c. 139, which took effect on
August 16, 2023 and is set to expire on August 31, 2026.

����� Further, the bill extends, by eight months,
requirements that the Department of Human Services: collect and publish certain
quarterly data related to the continued involuntary holds authorized under the
bill; and establish an educational committee to provide education to short-term
care facilities and individual county assignment judges about the facilities�
legal obligations to accept patients.� The bill also extends, through July 31,
2026, the Department of Health�s authority to issue temporary licenses for
involuntary commitment beds to general acute care hospitals that are already
licensed for acute care hospital psychiatric beds.

FISCAL ANALYSIS

EXECUTIVE BRANCH

����� None received.

OFFICE OF LEGISLATIVE SERVICES

����� The OLS finds that the bill may increase certain State
and local government costs by indeterminate amounts during its eight-month
effective period, due to hospital, legal, and administrative costs associated
with extending initial 72-hour involuntary holds by up to an additional 72
hours.� These extended holds may also increase the likelihood that patients are
placed in appropriate psychiatric facilities, generating additional State and
local costs for those placements.� However, some offsetting savings may result
from discharging fewer non-stabilized patients into the community prior to
placement, thereby reducing other expenditures on hospital emergency department
services, community-based mental health care, and law enforcement activities.

����� The bill may increase expenditures for State and local
health payers that reimburse hospital services during members� extended holds
and that cover any new psychiatric placements (offset to some extent by decreased
expenditures on other emergency department and community-based services).�
Potentially affected payers include: NJ FamilyCare, the State Health Benefits
Program (including participating local governments), school districts that
participate in the School Employees� Health Benefits Program, and local
governments and school districts contracting with private health insurers.� The
bill may also increase expenditures for: the State court system, when
processing extended-hold applications submitted by hospitals; the Office of the
Public Defender, when representing patients in applicable involuntary
commitment cases; University Hospital and Bergen New Bridge Medical Center, as
public hospitals, when providing services to uninsured patients during extended
holds; State and county psychiatric hospitals, if providing additional
placements after extended holds; and the Department of Health and the
Department of Human Services, when fulfilling administrative responsibilities
under the bill.�

����� To the extent that net expenditures on NJ FamilyCare
services increase under the bill, State revenue will increase
in the form of federal Medicaid and Children�s Health
Insurance Program cost reimbursements, partially offsetting the applicable
State costs.� The bill may also reduce operational costs for State and local
law enforcement agencies by decreasing the number of non-stabilized patients
who are discharged into the community and require crisis responses.

����� The OLS has insufficient data regarding the hospital,
legal, and administrative costs associated with extending 72-hour involuntary
holds to estimate the specific State and local expenditure and revenue
increases that are likely under the bill.� However, any fiscal impacts may be
modest due to the small number of patients receiving extended holds.� According
to data from the Department of Human Services, extended holds were granted for
161 patients, on average, over any given eight-month period during the
timeframe between August 16, 2023 (when extended holds were initially
authorized by P.L.2023, c. 139) and March 31, 2026.� During this timeframe, general
hospitals and emergency departments in the State submitted a total of 651 temporary
court order applications
to
extend
initial 72-hour involuntary holds, of which 635 extended holds (98 percent)
were granted.� By comparison, over the same timeframe, these hospitals placed
44,427 patients in appropriate treatment settings within the initial 72-hour
involuntary hold periods.� Of note, University Hospital and Bergen New Bridge
Medical Center did not report any patients with extended holds during this
timeframe, suggesting that the bill may have minimal fiscal impacts on those
public hospitals.

Section:

Human Services

Analyst:

Sarah M. Schmidt

Principal Research Analyst

Approved:

Thomas Koenig

Legislative Budget and Finance Officer

This legislative fiscal estimate has been produced by the
Office of Legislative Services due to the failure of the Executive Branch to
respond to our request for a fiscal note.

This fiscal estimate has been prepared pursuant to P.L.1980,
c.67 (C.52:13B-6 et seq.).