SENATE HEALTH, HUMAN SERVICES AND SENIOR CITIZENS COMMITTEE

STATEMENT TO

SENATE, No. 3873

STATE OF NEW JERSEY

DATED:  MARCH 3, 2025

      The Senate Health, Human Services and Senior Citizens Committee reports favorably Senate Bill No. 3873.

      This bill provides for NJ FamilyCare reimbursement for multiple medical encounters with federally qualified health center (FQHC) specialists on a single day for an enrollee, provided:

      1.   the referring provider documents the reason for referring the patient to each specialty provider;

      2.   each of the enrollee’s medical encounters is with a different specialty provider; and

      3.   NJ FamilyCare reimbursement for multiple medical encounters per day at a FQHC does not violate federal statute.

      The bill defines a “federally qualified health center” as a community-based health care provider that delivers integrated primary care services in medically underserved areas, and meets the criteria established under section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. s.1396(d)). 

      The bill defines a “specialty provider” as a licensed physician who:

      (1)  is a diplomate of a specialty board approved by the American Board of Medical Specialties or the Bureau of Osteopathic Specialists of the American Osteopathic Association (AOA);

      (2)  is a fellow of the appropriate American specialty college or a member of an osteopathic specialty college;

      (3)  is currently admissible to take the examination administered by a specialty board approved by the American Board of Medical Specialties or the Bureau of Osteopathic Specialists of the AOA, or has evidence of completion of an appropriate qualifying residency approved by the American Medical Association or the AOA;

      (4)  holds an active staff appointment with specialty privileges in a hospital which is licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) and which is approved for training in the specialty in which the physician has privileges; or

      (5)  is recognized in the community as a specialist by his or her peers.

      Nothing in this bill should be construed to authorize the Commissioner of Human Services to waive or limit any provisions of federal statute or any other State reimbursement methodologies governing NJ FamilyCare reimbursement to federally qualified health centers.