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  • NJ A4776
  • Establishes certain requirements and conditions concerning changes to DHS reimbursement system for mental health and substance use disorder treatment services; appropriates $10 million.
In Committee
Crossed OverPassedSignedDead/Failed/VetoedVeto Overridden
2016-2017 Regular Session
This bill places certain requirements and conditions on the implementation of the Department of Human Services (DHS) plan to reform its system for providing State reimbursement to providers of mental health and substance use disorder treatment services to low-income New Jersey residents. The bill would apply to any such services funded through the Division of Mental Health and Addiction Services or the Division of Medical Assistance and Health Services (Medicaid) in the Department of Human Services. The DHS is in process of transitioning its contracted providers of community-based mental health and substance use disorder treatment services from a cost-based reimbursement model to a fee-for-service model. Under the current plan, providers will be required to transition their contracts no later than July 1, 2017. The bill requires a fee-for-service provider contract to include provisions allowing for the provider to be reimbursed for the following services and activities: · providing an initial intake assessment of a patient, and separately for providing an initial psychiatric evaluation, even if both services are performed on the same day; · outreach services after a consumer fails to appear for a scheduled appointment to determine the cause of the missed appointment; · transportation for staff traveling to visit a consumer at the consumer's residence or another appropriate remote location; · transitional planning and other engagement for a consumer who is preparing to transition, or who has recently transitioned, between an institutional setting and a community setting; and · assistance with applications for public benefits for which a consumer may be eligible, including, but not limited to, medical assistance, nutrition assistance, and home energy assistance programs. The bill also prohibits the department from requiring prior authorization for partial care services for treatment of a substance use disorder. This provision of the bill is intended to preempt a proposed change to Medicaid regulations (noticed in the New Jersey Register at 48 N.J.R.2737(a), but not yet adopted as of March 2017) that would extend current prior authorization requirements to substance use disorder services. According to providers, the proposed $6,000 limit on services that may be provided without prior authorization would cover approximately 85 days of care, while more severe cases may require as much as 240 days to provide necessary treatment. The bill requires the DHS to provide in-person technical support to any provider that is planning to transition or in process of transitioning from a cost-based reimbursement system to a fee-for-service reimbursement system, upon the provider's request. This provision would be effective until June 30, 2018. Finally, the bill establishes a grant program for licensed providers transitioning from the cost-based reimbursement system to the fee-for-service system. Grants would be awarded on a competitive basis to those providers that can demonstrate the need for specific equipment or business or technical assistance in order to establish financial stability and continued services to consumers under the fee-for-service system. No applicant would be eligible to receive more than one grant under this section. The bill appropriates from the General Fund $10 million in FY 2018 to effectuate this grant program.
Human Services
Introduced, Referred to Assembly Human Services Committee  (on 5/11/2017)
Date Chamber Action Description
5/11/2017 A Introduced, Referred to Assembly Human Services Committee
Date Motion Yea Nay Other
None specified