Fantasia bill increasing Medicaid reimbursement rates for brain injury services advances

TRENTON, N.J. — Legislation sponsored by Assemblywoman Dawn Fantasia aimed at increasing Medicaid reimbursement rates for certain brain injury services advanced Thursday through the Assembly Aging and Human Services Committee.

The bill, A4485, would establish reimbursement parity for providers delivering similar brain injury-related services through different state programs.

According to Fantasia, advocates including the Brain Injury Alliance of New Jersey have raised concerns that providers offering comparable services through separate Department of Human Services programs are reimbursed at significantly different rates.

“Survivors of brain injuries, who are also Medicaid recipients, are among our state’s most vulnerable patients because they rely on state-managed programs to live full and independent lives. Unfortunately, the vital continuity of care these patients deserve is jeopardized by disparities in provider reimbursement rates. It is harder to retain high-quality providers when the rates differ so widely,” Fantasia explained (R-Sussex, Morris, Warren).

Currently, providers participating in the state’s long-term services and supports program receive lower reimbursement rates than providers in other Division of Disability Services programs, according to Fantasia’s office.

The proposed legislation would increase Medicaid reimbursement rates for long-term brain injury services from $3.65 to $9.89 for every 15 minutes of care.

Officials said the increased rate would match reimbursement levels currently provided for day habilitation services for individuals with developmental disabilities.

“Even with the increase, it is more affordable for the state to provide services in the home and in the community, as opposed to a nursing facility,” Fantasia said. “Not only would many patients prefer be at home, but it also makes economic sense to preserve those services.”

According to Fantasia’s office, approximately 10% of the nearly 2 million New Jersey residents enrolled in Medicaid have disabilities, including those resulting from brain injuries.

“Residents with brain injuries have varying needs depending on the severity of their injury and other factors like age, but they shouldn’t have to worry that their access to necessary physical and cognitive services is going to be limited by the type of program they are placed in,” Fantasia added. “This measure gives patients and families navigating life with brain injuries the reassurance that New Jersey offers high-quality services to all survivors equally.”