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NJ S4298

NJ S4298
"Healthy Smiles Act"; increases NJ FamilyCare fee-for-service reimbursement rates for pediatric dental services; requires NJ FamilyCare managed care rates for identical services be no less than fee-for-service rates.

summary

Introduced
03/24/2025
In Committee
03/24/2025
Crossed Over
Passed
Dead
01/12/2026

Introduced Session

2024-2025 Regular Session

Bill Summary

This bill makes certain adjustments to the NJ FamilyCare reimbursement rates for oral health services and supplies. The bill requires that, commencing upon July 1, 2025 or 60 days following the enactment of this bill, whichever is later, the NJ FamilyCare fee-for-service reimbursement rates for covered pediatric oral health services and supplies will be increased by 20 percent from the reimbursement rates in use for identical services at the time of the bill's adoption. Commencing one year after the implementation of the increased reimbursement rates, and annually thereafter, the bill directs the Commissioner of Human Services (commissioner) to adjust the existing fee-for-service reimbursement rates according to changes in the Consumer Price Index (CPI) for All Urban Consumers as published by the United States Department of Labor for the Northeast region of the country in the previous January over the immediately preceding 12-month period. For reference, in November 2024, the most recent time this data was assessed over a 12-month period, the CPI increased by 3.5 percent. Finally, the commissioner is required to ensure that every contract entered into on and after the effective date of this bill between the State and a managed care organization (MCO) for the provision of NJ FamilyCare services provides that the reimbursement rates for pediatric oral health services and supplies are equal to or greater than the NJ FamilyCare fee-for-service reimbursement rates for the identical services and supplies. Under the bill, an MCO in violation of this provision would be liable for a civil penalty of not more than $10,000 for each day that the non-compliant reimbursement rate was issued. Any penalties assessed are to be collected by the commissioner in the name of the State in a summary proceeding in accordance with State law. The commissioner's determination regarding violations is the final agency decision, subject to review by the Appellate Division of the Superior Court.

AI Summary

This bill, known as the "Healthy Smiles Act," addresses dental healthcare access for children in New Jersey's Medicaid program (NJ FamilyCare) by significantly increasing reimbursement rates for pediatric dental services. Starting July 1, 2025, or 60 days after enactment, the bill mandates a 20% increase in fee-for-service reimbursement rates for oral health services for children under 21. Annually thereafter, these rates will be adjusted according to the Consumer Price Index for the Northeast region. The bill also requires that managed care organizations (MCOs) participating in NJ FamilyCare pay providers at least the same rates as the fee-for-service schedule, with a potential penalty of up to $10,000 per day for non-compliance. The legislation is motivated by data showing poor dental health among New Jersey children, particularly low-income and minority populations, with higher rates of untreated tooth decay compared to national averages. By increasing reimbursement rates, the bill aims to improve dental care access, encourage more providers to participate in the program, and ultimately support better oral health outcomes for children enrolled in NJ FamilyCare.

Committee Categories

Health and Social Services

Sponsors (4)

Last Action

Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee (on 03/24/2025)
(1 Companion Bills)

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Document Type Source Location
State Bill Page https://www.njleg.state.nj.us/bill-search/2024/S4298
BillText https://pub.njleg.gov/Bills/2024/S4500/4298_I1.HTM
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