Bill

Bill > S438


NJ S438

NJ S438
Establishes minimum Medicaid reimbursement rate for structured day program services provided to beneficiary eligible for brain injury services.


summary

Introduced
01/13/2026
In Committee
01/13/2026
Crossed Over
Passed
Dead

Introduced Session

2026-2027 Regular Session

Bill Summary

This bill amends existing law, which established minimum Medicaid reimbursement rates for brain injury services, to include structured day program services. Current law is limited to community residential services. Under existing law, "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. Specifically, the bill requires the Medicaid per diem or encounter reimbursement rates for Structured Day Program Services provided to a Medicaid beneficiary requiring treatment for a brain injury, currently at $3.65 for every 15 minutes of services, when such services are provided by an approved brain injury service provider, to 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, currently at $9.09 for every 15 minutes of service.

AI Summary

This bill amends existing law to establish a minimum Medicaid reimbursement rate for structured day program services provided to individuals with brain injuries, expanding upon current law which only covered community residential services. Specifically, it mandates that the reimbursement rate for these structured day program services, currently set at $3.65 per 15 minutes, will be increased to match the average of the reimbursement rates for Day Habilitation Services - Tiers D and E, which is $9.09 per 15 minutes, when provided by an approved brain injury service provider to a Medicaid beneficiary requiring treatment for a brain injury. Medicaid refers to the state's health insurance program for low-income individuals, and brain injury services encompass various community-based, residential, day care, and home care services for those with traumatic or non-traumatic brain injuries. The bill also requires the Commissioner of Human Services to adopt necessary regulations and specifies that these changes will take effect 30 days after enactment, applying to services and contracts thereafter.

Committee Categories

Health and Social Services

Sponsors (18)

Last Action

Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee (on 01/13/2026)

bill text


bill summary

Loading...

bill summary

Loading...

bill summary

Loading...