Bill
A 2500
Medicaid must pay at least Medicare rates for qualifying outpatient evidence-based behavioral health counseling, expanding access for adults and children.
Note: The bill description provided here centers on the introduced version named the Mental Health Access Act, which discusses Medicaid reimbursement rates for certain behavioral health services. The title in the user prompt mentions “resource exemptions for applicants for public assistance programs,” but the text and policy summary below reflect the introduced Mental Health Access Act provisions.
1) Medicaid Reimbursement Rate
- Reimbursement rate for an evidence-based behavioral health care service billed to New Jersey Medicaid shall be no less than the Medicare rate for that service.
- Applicable only if:
- The service is limited to individual or group counseling provided in an outpatient setting; and
- The billing provider is either:
- A licensed behavioral health treatment facility (licensed by the Department of Health), or
- A person licensed or authorized under Title 45 of the Revised Statutes to practice a health care profession.
2) Definitions
- Behavioral health care service: A treatment procedure for mental illness, emotional disorders, or drug/alcohol abuse provided by a licensed or authorized health care professional.
- Evidence-based: Treatment provided by licensed mental health professionals that meets criteria established by the Commissioner of Human Services, in consultation with the Commissioner of Children and Families.
- Medicaid: New Jersey’s Medicaid program.
- Medicare: Federal Medicare program.
3) Administrative and Regulatory Action
- The Commissioner of Human Services must seek state plan amendments or waivers necessary to implement the act and secure federal participation for Medicaid expenditures.
- The Commissioners of Human Services and Children and Families must adopt rules under the Administrative Procedure Act to effectuate the act.
4) Effective Date
- Effective on the first day of the fourth month after enactment.
- Applies to all services provided on or after that date; anticipatory administrative action may be taken in advance as needed for implementation.
A 2500 seeks to strengthen access to evidence-based behavioral health care by ensuring Medicaid pays at least Medicare rates for qualifying outpatient counseling services, contingent on provider licensing and evidence-based criteria. It requires administrative readiness through state plan amendments and rulemaking, with a defined effective date and clear patient/provider eligibility parameters.
Compiled from official sources — confirm details with the bill’s official record.
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