ASSEMBLY, No. 1034

STATE OF NEW JERSEY

219th LEGISLATURE

 

PRE-FILED FOR INTRODUCTION IN THE 2020 SESSION

 


 

Sponsored by:

Assemblywoman  JOANN DOWNEY

District 11 (Monmouth)

 

Co-Sponsored by:

Assemblyman Dancer

 

 

 

 

SYNOPSIS

     Requires rate review study of provider reimbursement rates provided by Medicaid and Children's System of Care for pediatric and adult psychiatry services.

 

CURRENT VERSION OF TEXT

     Introduced Pending Technical Review by Legislative Counsel.

  


An Act concerning pediatric and adult psychiatry reimbursement rates.

 

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

 

     1.    a.  The Commissioner of Human Services, in collaboration with the Commissioner of Children and Families, shall implement, or contract with a third party to implement, a rate review study of the provider reimbursement rates provided by Medicaid and the Children's System of Care for pediatric and adult psychiatry services.  The purpose of this study shall be to conduct an analysis of the access, service, quality, and utilization of pediatric and adult psychiatry services provided within these programs.

     The rate review study, at a minimum, shall:

     (1)   evaluate current reimbursement practices within Medicaid and the Children’s System of Care utilizing cost data from existing providers;  

     (2)   compare provider reimbursement rates paid by Medicaid and the Children’s System of Care with those rates paid by other payers, such as Medicare and private insurance, for identical services;

     (3)   analyze the availability and access to pediatric and adult psychiatry services within Medicaid and the Children’s System of Care in each geographic region of the State;

     (4)   Assess whether existing reimbursement rates are sufficient to allow for provider retention, access to care, and appropriate payment for high-quality services within Medicaid and the Children’s System of Care

     (5)   establish a means to receive and incorporate provider and stakeholder input; and

     (6)   suggest a rate setting methodology for pediatric and adult psychiatry services within Medicaid and the Children’s System of Care in response to the findings of the study.

     b.    The Commissioners of Human Services and Children and Families may require the submission of cost reports, provider surveys, and other materials and data in order to complete the rate review study as required pursuant to this section.

     c.     The Commissioner of Human Services, in collaboration with the Commissioner of Children and Families, shall report the findings and conclusions of the rate review study, as well as any recommendation for legislation, to the Legislature within 1 year of the effective date of this act. 

     d.    As used in this section:

     "Children's System of Care" means the Division of Children's System of Care in the Department of Children and Families.

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

     2.    This act shall take effect immediately and shall expire upon the submission of the report by the Commissioner of Human Services pursuant to subsection c. of section 1 of this act.

 

 

STATEMENT

 

     This bill requires the Commissioner of Human Services, in collaboration with the Commissioner of Children and Families, to implement, or contract with a third party to implement, a rate review study of the provider reimbursement rates provided by Medicaid and the Children's System of Care for pediatric and adult psychiatry services.  As used in the bill, "Children's System of Care" means the Division of Children's System of Care in the Department of Children and Families; and “Medicaid" means the program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).  The purpose of this study is to conduct an analysis of the access, service, quality, and utilization of pediatric and adult psychiatry services provided within these programs.

     The rate review study, at a minimum, is require to:

     (1)   evaluate current reimbursement practices within Medicaid and the Children’s System of Care utilizing cost data from existing providers;  

     (2)   compare provider reimbursement rates paid by Medicaid and the Children’s System of Care with those rates paid by other payers, such as Medicare and private insurance, for identical services;

     (3)   analyze the availability and access to pediatric and adult psychiatry services within Medicaid and the Children’s System of Care in each geographic region of the State;

     (4)   assess whether existing reimbursement rates are sufficient to allow for provider retention, access to care, and appropriate payment for high-quality services within Medicaid and the Children’s System of Care

     (5)   establish a means to receive and incorporate provider and stakeholder input; and

     (6)   suggest a rate setting methodology for pediatric and adult psychiatry services within Medicaid and the Children’s System of Care in response to the findings of the study.

     The Commissioners of Human Services and Children and Families may require the submission of cost reports, provider surveys, and other materials and data in order to complete the rate review study as required pursuant to this section.  Furthermore, the Commissioner of Human Services, in collaboration with the Commissioner of Children and Families, is directed to report the findings and conclusions of the rate review study, as well as any recommendation for legislation, to the Legislature within 1 year of the effective date of this act, at which point the provisions of the bill will expire.