ASSEMBLY HEALTH COMMITTEE

STATEMENT TO

ASSEMBLY, No. 4012

STATE OF NEW JERSEY

DATED:  JUNE 17, 2024

      The Assembly Health Committee reports favorably Assembly Bill No. 4012.

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, approximately $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 $9.38 for every 15 minutes of service.