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S3802
SENATE, No. 3802
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED MARCH 5, 2026
Sponsored by:
Senator� M. TERESA RUIZ
District 29 (Essex and Hudson)
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,
2026
, 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 rates
for those services under Medicare.� Specifically, commencing July 1, 2026, 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, and 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.�
�