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Bill

A 2229

"Healthy Smiles Act"; increases NJ FamilyCare fee-for-service reimbursement rates for pediatric dental services; requires NJ FamilyCare managed care rates for identical services be no less than fee-for-service rates.

2026-2027 Regular Session Introduced by Aura Dunn and 5 co-sponsors

The act raises NJ FamilyCare pediatric dental reimbursements by 20% from July 2025, with annual CPI-based increases and requires MCOs to pay at least FFS rates or face penalties.

Introduced, Referred to Assembly Children, Families and Food Security Committee
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Bill Summary · A 2229

Summary: Healthy Smiles Act (A 2229, 2025–2026 Session – New Jersey)

Main purpose

The Healthy Smiles Act aims to improve access to pediatric dental care for NJ FamilyCare enrollees by increasing and stabilizing reimbursement rates for pediatric oral health services and supplies. The bill seeks to ensure that fee-for-service payments to providers are more competitive and that managed care organizations (MCOs) reimburse providers at rates equal to or higher than the state’s fee-for-service (FFS) rates.

Key provisions

  • Name and scope

    • Enacts the “Healthy Smiles Act.”
    • Applies to NJ FamilyCare, including the Medicaid and Children’s Health Insurance Program components, for children under 21 receiving oral health services and supplies.

  • Rate increases (effective date and amount)

    • Starting July 1, 2025 (or 60 days after enactment, whichever is later), FFS reimbursement rates for covered pediatric oral health services and supplies shall increase by 20% over the rates in effect on the act’s effective date.
    • Beginning one year after the initial increase, and annually thereafter, the commissioner must adjust FFS rates in direct proportion to changes in the Northeast CPI for All Urban Consumers (as published by the U.S. Department of Labor) from the previous January over the prior 12 months.

  • Parity requirement for managed care contracts

    • For contracts entered into on or after the act’s effective date, the commissioner must ensure that MCO reimbursement rates to providers for pediatric oral health services and supplies are equal to or greater than the state’s FFS rates for the identical services.
    • If an MCO pays less than the FFS rate, the MCO may be fined a civil penalty of up to $10,000 per day the underpayment occurs. Penalties are collected by the commissioner and governed by the state's Penalty Enforcement Law; decisions are final unless reviewed by the Appellate Division.

  • Compliance and administration

    • The commissioner must pursue necessary State plan amendments or waivers to implement the act and obtain federal participation (Medicaid/CHIP).
    • The commissioner will adopt implementing rules under the Administrative Procedure Act.

  • Effective date

    • The act takes effect immediately upon passage.

Affected entities

  • Providers: Dentists and other licensed oral health professionals rendering pediatric services to NJ FamilyCare enrollees.
  • NJ FamilyCare enrollees: Children under 21 who receive oral health services and supplies.
  • Managed care organizations: Entities contracting with the Division to provide NJ FamilyCare services, including dental care, must comply with parity requirements and could face penalties for noncompliance.

Procedural and timeline notes

  • Effective date provisions: Initial 20% rate increase becomes effective July 1, 2025 (or 60 days after enactment, whichever is later).
  • Annual CPI adjustments: Starting one year after the initial increase, rates adjust annually based on Northeast CPI changes from the prior January.
  • Regulatory framework: DHS Commissioner to implement via regulations and federal-state plan amendments as needed.
  • Enactment status: Introduced January 13, 2026; referred to Assembly committee (Children, Families and Food Security). Co-sponsors include multiple legislators.

Compiled from official sources — confirm details with the bill’s official record.

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