Establishes minimum Medicaid reimbursement rate for structured day program services provided to beneficiary eligible for brain injury services.

S438 TR

SENATE, No. 438

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Senator BRIAN P. STACK

District 33 (Hudson)

Senator M. TERESA RUIZ

District 29 (Essex and Hudson)

Co-Sponsored by:

Senators A.M.Bucco, Diegnan, Schepisi, McKeon, Bramnick,
Singer, Pennacchio, Amato, McKnight, Polistina, O'Scanlon, Steinhardt, Testa,
Tiver, Singleton, Space, Johnson and Holzapfel

SYNOPSIS

���� Establishes minimum Medicaid reimbursement rate for
structured day program services provided to beneficiary eligible for brain
injury services.

CURRENT VERSION OF TEXT

���� As reported by the Senate Health, Human Services and
Senior Citizens Committee with technical review.

��

An Act

concerning Medicaid reimbursement for brain
injury services and amending P.L.2022, c.78.

����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:

���� 1.��� Section 2 of P.L.2022,
c. 78 (C.30:4D-7kk) is amended to read as follows:

���� 2.� a.� Notwithstanding the
provisions of any law or regulation to the contrary, the Medicaid per diem or
encounter reimbursement rates for eligible brain injury services, when such
services are provided by an approved brain injury service provider to a Medicaid
beneficiary requiring treatment for a brain injury, shall be, at minimum, as
follows:

���� (1) The reimbursement rate for
Community Residential Services - Low Supervision provided to a Medicaid
beneficiary eligible for brain injury services shall be equal to the
reimbursement rate for Individuals Supports Services - Tier B provided to a
Medicaid beneficiary eligible for services provided by the Division of
Developmental Disabilities in the Department of Human Services;

���� (2) The reimbursement rate for
Community Residential Services - Moderate Supervision provided to a Medicaid
beneficiary eligible for brain injury services shall be equal to the
reimbursement rate for Individuals Supports Services - Tier C provided to a Medicaid
beneficiary eligible for services provided by the Division of Developmental
Disabilities in the Department of Human Services;
[
and
]

���� (3) The reimbursement rate for
Community Residential Services - High Supervision provided to a Medicaid
beneficiary eligible for brain injury services shall be equal to the average of
the reimbursement rates for Individuals Supports Services - Tiers D and E
provided to a Medicaid beneficiary eligible for services provided by the
Division of Developmental Disabilities in the Department of Human Services
;
and

����
(4)�� The reimbursement
rate for Structured Day Program Services provided to a Medicaid beneficiary
eligible for brain injury services shall be equal to the average of the
reimbursement rates for Day Habilitation Services � Tiers D and Tier E provided
to a Medicaid beneficiary eligible for services provided by the Division of
Developmental Disabilities in the Department of Human Services
.

���� b.��� As used in this section:

���� "Brain injury
service" means community-based services, residential services, day care
services, and home care services provided to a Medicaid beneficiary requiring
treatment for traumatic or non-traumatic brain injuries, regardless of whether
such services are provided through the Medicaid fee-for-service delivery system
or the managed care delivery system.

���� "Brain injury service
provider" means a facility licensed by the Division of Disability Services
in the Department of Human Services to provide traumatic or non-traumatic brain
injury services.

���� "Medicaid" means the
Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).

���� "Non-traumatic brain
injury" means an injury to the brain caused by internal factors, such as
stroke, aneurysm, tumor, infectious disease, or anoxia, where continued
impairment can be demonstrated.� This term does not include brain dysfunction caused
by congenital or degenerative disorders, birth trauma, or injuries caused by
other circumstances.

���� "Traumatic brain
injury" means an injury to the brain caused by a blow or jolt to the head
or a penetrating head injury or neuro-trauma that disrupts the normal brain
function, where continued impairment can be demonstrated.� This term does not
include brain dysfunction caused by congenital or degenerative disorders, birth
trauma, or injuries caused by other circumstances.

(cf: P.L.2022, c.78, s.2)

���� 2.��� (New section) The
Commissioner of Human Services, in accordance with the "Administrative
Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt such
rules and regulations as the commissioner deems necessary to carry out the
provisions of this act.

���� 3.��� This act shall take
effect 30 days after

the date of enactment and shall apply to
services provided on or after the effective date of this act and to any
Medicaid managed care contract executed or renewed on or after the effective
date of this act.