N.J. Stat. § 30:4D-7kk

Current through L. 2024, c. 80.

Section 30:4D-7kk - Medicaid per diem, encounter reimbursement rates, eligible brain injury services, minimum requirements

a. Notwithstanding the provisions of any law or regulation to the contrary, the Medicaid per diem or encounter reimbursement rates for eligible brain injury services, when such services are provided by an approved brain injury service provider to a Medicaid beneficiary requiring treatment for a brain injury, shall be, at minimum, as follows:

(1) The reimbursement rate for Community Residential Services - Low Supervision provided to a Medicaid beneficiary eligible for brain injury services shall be equal to the reimbursement rate for Individuals Supports Services - Tier B provided to a Medicaid beneficiary eligible for services provided by the Division of Developmental Disabilities in the Department of Human Services;

(2) The reimbursement rate for Community Residential Services - Moderate Supervision provided to a Medicaid beneficiary eligible for brain injury services shall be equal to the reimbursement rate for Individuals Supports Services - Tier C provided to a Medicaid beneficiary eligible for services provided by the Division of Developmental Disabilities in the Department of Human Services; and

(3) The reimbursement rate for Community Residential Services - High Supervision provided to a Medicaid beneficiary eligible for brain injury services shall be equal to the average of the reimbursement rates for Individuals Supports Services - Tiers D and E provided to a Medicaid beneficiary eligible for services provided by the Division of Developmental Disabilities in the Department of Human Services.

b. As used in this section:

"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.

"Brain injury service provider" means a facility licensed by the Division of Disability Services in the Department of Human Services to provide traumatic or non-traumatic brain injury services.

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

"Non-traumatic brain injury" means an injury to the brain caused by internal factors, such as stroke, aneurysm, tumor, infectious disease, or anoxia, where continued impairment can be demonstrated. This term does not include brain dysfunction caused by congenital or degenerative disorders, birth trauma, or injuries caused by other circumstances.

"Traumatic brain injury" means an injury to the brain caused by a blow or jolt to the head or a penetrating head injury or neuro-trauma that disrupts the normal brain function, where continued impairment can be demonstrated. This term does not include brain dysfunction caused by congenital or degenerative disorders, birth trauma, or injuries caused by other circumstances.

N.J.S. § 30:4D-7kk

Added by L. 2022, c. 78, s. 2, eff. 8/28/2022, app. to services provided on or after the effective date of this act and to any Medicaid managed care contract executed or renewed on or after the effective date of this act.