Bill > S3837

Introduced Session

This bill requires that NJ FamilyCare reimbursement for long-acting injectable antipsychotic drugs administered in an inpatient setting be separate and distinct from any reimbursement issued to an inpatient provider based on a Diagnostic Related Group reimbursement system. Additionally, under the bill, the inpatient reimbursement rate of these drugs is mandated to be equal to the identical drug's NJ FamilyCare reimbursement rate when administered in an outpatient setting. Long-acting injectable antipsychotic drugs can treat and manage symptoms of major psychiatric disorders, such as schizophrenia and bipolar disorder, for up to 24 weeks with a single dose. While expensive medications, these drugs have significant benefits for the patient and health care system, including: improved medication adherence, reduced hospitalizations and need for medical intervention, and improved clinical outcomes. Currently, NJ Family Care uses Diagnosis Related Groups (DRGs) to reimburse inpatient providers, such as general acute care hospitals, a fixed amount for inpatient services. DRGs are a classification system that group hospital services based on similar diagnoses and procedures, as well as age, sex, and discharge status, in order to determine a reimbursement rate. Reimbursement for the administration of a long-acting injectable antipsychotic drug in an inpatient setting is included within this payment; however, the high cost of these drugs is not considered in the methodology that establishes the DRG payment amount. Alternatively, the reimbursement rate for long-acting injectable antipsychotic drugs in an outpatient setting is largely based on the ingredient cost of the drug. Therefore, the provisions of the bill ensure that inpatient providers receive a reimbursement payment for long-acting injectable antipsychotic drugs that is more closely reflective of the cost of the drug. In doing so, it is the sponsor's goal that the bill will increase access to these drugs, when clinically appropriate, within inpatient settings and improve health care outcomes, while simultaneously reducing inpatient readmission rates, for individuals with serious mental illness.

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Nick Scutari (D)*, 

Referred to Senate Budget and Appropriations Committee (on 03/03/2025)

Official Document