S 167

SENATE, No. 167
STATE OF NEW JERSEY
222nd LEGISLATURE
�
PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION
Sponsored by:
Senator PATRICK J. DIEGNAN, JR.
District 18 (Middlesex)
Senator JAMES BEACH
District 6 (Burlington and Camden)
SYNOPSIS
���� Establishes pilot program for 24-hour urgent care for
behavioral health.
CURRENT VERSION OF TEXT
���� Introduced Pending Technical Review by Legislative
Counsel.
��
An Act concerning behavioral health and substance use
disorders and supplementing Title 30 of the Revised Statutes.
���� Be It
Enacted by the Senate and General Assembly of
the State of New Jersey:
���� 1.��� As used in this act:
���� �Behavioral health� or
�behavioral health care� means procedures or services rendered by a health care
or mental health care provider for the treatment of a mental illness, a mental
health or emotional disorder, or a substance use disorder.�
���� �Care transition� means the
transfer or transition of a patient from an urgent care facility to a health
care or behavioral health care provider.
���� �Commissioner� means the
Commissioner of Human Services.
���� �Community health center�
means a federally qualified health center (FQHC), an
ambulatory care facility, a certified community behavioral health clinic
(CCBHC), a behavioral health program, and a substance use disorder facility.
���� �Department� means the
Department of Human Services.
���� �Hospital�
means a general acute care hospital licensed pursuant to P.L.1971, c.136
(C.26:2H-1 et seq.).
���� �Managed care organization�
means a Medicaid managed care organization, as that term is defined pursuant to
42 U.S.C. s.1396b (m)(1)(A).
���� �Medicaid� means the Medicaid
program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
���� �Pilot program� means the
Urgent Care Facility Behavioral Health Pilot Program established pursuant to
this act.
���� �Rapid referral� means the
taking of appropriate steps by an urgent care facility as may be necessary to
facilitate:� a patient�s referral or transfer to, prompt access to an
appointment with, and timely receipt of services from, another appropriate health
care or behavioral health care services provider; a patient�s prompt and
voluntary admission to an inpatient psychiatric facility; or a patient�s prompt
evaluation by a screening service or mental health screener to determine
whether involuntary commitment to treatment is warranted pursuant to P.L.1987,
c.116 (C.30:4-27.1 et seq.).�
���� �Supportive contacts� means
brief communications with a patient that occur during care transitions, and
which show support for the patient and are designed to promote a patient�s
feeling of connection to treatment and willingness to collaboratively participate
in treatment.� �Supportive contacts� may include, but shall not be limited to,
sending the patient postcards, letters, email messages, and text messages, as
well as calling the patient on the phone or using video chat.
���� �Warm hand-off� means a safe
care transition that connects a patient directly with a health care or mental
health care provider or interim contact, such as a crisis center worker or peer
specialist, before the patient�s first appointment with the new provider, or
that connects a patient directly with a screening service or mental health
screener for the purposes of determining whether involuntary commitment to
treatment is warranted pursuant to P.L.1987, c.116 (C.30:4-27.1 et seq.).�
���� �Urgent
care facility� means a health care facility that offers episodic, walk-in care
for the treatment of acute, but not life-threatening, health conditions 24
hours per day, seven days per week.
���� 2.��� a.� The Department of
Human Services shall establish a two-year Urgent Care Facility Behavioral
Health Pilot Program, commencing upon the selection of the managed care
organizations pursuant to subsection b. of this section, in accordance with the
provisions of sections 1 through 4 of this act. �The goal of the pilot program
shall be to provide behavioral
health care at certain hospital urgent care facilities to stabilize individuals
experiencing behavioral health crises in a way that reduces unnecessary hospital
emergency department and inpatient admissions.�
���� b.��� Within 180 days after
the effective date of this act or, if the department submits State plan
amendments or waivers pursuant to section 6 of this act, within 30 days of the
receipt of any necessary federal approvals, the department shall issue a
request for proposals and select one or more managed care organizations to
participate in the pilot program.� The managed care organizations selected
pursuant to this subsection shall demonstrate the ability to meet the
requirements of the pilot program and shall operate in each of the northern,
central, and southern regions of the State.
���� c.���� The managed care
organizations selected to participate in the pilot program shall contract with
six hospitals, with two in each of the northern, central, and southern regions
of the State, to provide integrated behavioral health
care within one of the hospital�s urgent care facilities.� To be
eligible to contract with a managed care organization pursuant to this
subsection, a hospital shall demonstrate the ability to coordinate patients with
primary care providers, outpatient behavioral health and substance abuse
providers, community health centers, and social service providers, and shall
not receive funding from the department to provide Early Intervention Support
Services.� In determining which hospitals to contract with, the selected
managed care organizations shall prioritize hospitals that specialize in
pediatric care if feasible.�
���� d.��� Each participating
urgent care facility shall integrate behavioral health care with the facility�s
existing physical health care services, which shall, at a minimum, include:� employing a behavioral health team of at least one licensed
behavioral clinician and one licensed clinical social worker; partnering with
one or more licensed psychiatrists to provide services, as needed, via
telemedicine and telehealth; providing behavioral health awareness and
intervention training to staff; and using warm hand-offs, rapid
referrals, supportive contacts, and other efficient and supportive care
transition methods.
���� 3.��� a.� The pilot program
established pursuant to section 2 of this act shall be funded through the
Medicaid program using a value-based payment system.� The value-based payment
system shall be modeled on, and be consistent with, the population-based
payment methodology that is described under Category 4 of the alternative
payment methodologies (APM) framework developed by the Health Care Payment
Learning and Action Network.� Specifically, the value-based payment system
shall provide for a quarterly advanced bundled payment to be provided to the
managed care organization for the purposes of financing the total cost of
behavioral health care that is provided by participating urgent care
facilities.� The quarterly bundled payment rate shall be established by the
Commissioner of Human Services and shall be based on the commissioner�s
evaluation of the following factors:�
���� (1)�� an assessment of claims
data indicating the cost to provide behavioral health care in hospital
emergency departments and inpatient settings, absent the pilot program;
���� (2)�� the number of patients
who are expected to be served by the pilot program;
���� (3)�� the average anticipated
per-patient cost of care under the pilot program;
���� (4)�� the anticipated costs to
participating urgent care facilities of complying with the provisions of
subsection d. of section 2 of this act; and
���� (5) any other factors that may
affect the cost of care.
���� b.��� The quarterly bundled
payment provided under this section shall be limited to the bundled rate
established by the commissioner under subsection a. of this section, and shall
not be subject to increase, regardless of whether the actual costs of care
received by patients in the pilot program exceed the bundled payment rate
provided hereunder.� If the managed care organization, in cooperation with
participating urgent care facilities, is able to reduce the per-patient costs
of care for patients receiving care and services under the pilot program, the
managed care organization may retain, and shall not be required to repay, any
remaining unexpended bundled payment funds.� Any such savings achieved shall be
shared by the managed care organization with participating urgent care
facilities at a rate that is proportional to the rate of per-patient cost
reduction savings achieved by each such facility.� If the actual per-patient
costs of care for patients receiving care and services under the pilot program
exceed the advanced bundled payment rate established by the commissioner under
this section, the managed care organization shall ensure that all patients
continue to receive appropriate services and care from participating urgent
care facilities without being subject to an increase in out-of-pocket costs.�
Any financial loss incurred by the managed care organization as a result of an
increase in the per-patient cost of care for patients receiving care and
services under the pilot program shall be shared by the managed care
organization with participating urgent care facilities at a rate that is
proportional to the rate of per-patient cost increase attributed to each
facility.�
���� 4.��� a.� Within 90 days after
the two-year pilot program established pursuant to section 2 of this act is
terminated, the department shall prepare and submit a written report of its
findings and recommendations to the Governor and, pursuant to section 2 of P.L.1991,
c.164 (C.52:14-19.1), to the Legislature.�
���� b.��� At a minimum, the report
shall:
���� (1)�� identify the managed
care organizations that were selected to participate in the pilot program;
���� (2)�� identify the hospitals
who were contracted by the managed care organizations pursuant to subsection c.
of section 2 of this act, as well as the urgent care facilities participating
in the pilot program;
���� (3)�� identify the total
number and percentage of patients in each managed care network and the number
and percentage of patients in each of the northern, central, and southern
regions of the State who received behavioral health care from a participating
urgent care facility under the pilot program;
���� (4)�� a summary of patient
outcomes following an urgent care visit under the pilot program, including
follow-up care regarding behavioral health;
���� (5)�� a comparison of costs of
behavioral health care provided in hospital emergency departments and inpatient
settings against costs of behavioral health care provided under the pilot
program; and
���� (6)�� include recommendations
as to whether and how the pilot program should be continued on a permanent
basis.
���� 5.��� The Commissioner of
Health, the Commissioner of Human Services, and the Director of the Division of
Consumer Affairs in the Department of Law and Public Safety shall each adopt
rules and regulations, pursuant to the �Administrative Procedure Act,� P.L.1968,
c.410 (C.52:14B-1 et seq.), as shall be necessary to implement the provisions
of this act.
���� 6.��� The Commissioner of
Human Services shall apply for such State plan amendments or waivers as may be
necessary to implement the provisions of sections 1 through 4 of this act and
secure federal financial participation for State Medicaid expenditures under the
federal Medicaid program.
���� 7.��� This act shall take
effect immediately.
STATEMENT
���� This bill seeks to expand
access to behavioral health care services by requiring the Department of Human
Services (DHS) to establish a two-year Urgent Care Facility Behavioral Health
Pilot Program.
���� The goal of the program will
be to provide behavioral health care at hospital urgent care facilities to
stabilize individuals experiencing behavioral health crises in a way that
reduces unnecessary emergency department and inpatient admissions.� In doing
so, it is the sponsor�s goal to provide quality, timely behavioral health care
in a setting that offers positive patient outcomes, addresses the stigma
associated with behavioral health issues, reduces the burden on hospital
emergency room departments, and minimizes costs.� Under the bill, �behavioral
health� or �behavioral health care� means procedures or services rendered by a
health care or mental health care provider for the treatment of a mental
illness, a mental health or emotional disorder, or a substance use disorder.�
���� Within 180 days after the
effective date of the bill or, if the DHS submits State plan amendments or
waivers to receive federal reimbursement under Medicaid for services provided
under the bill, within 30 days of the receipt of any necessary federal approvals,
the DHS is required to issue a request for proposals and select one or more
Medicaid managed care organizations to participate in the pilot program.� Under
the bill, the two-year pilot program is to commence upon the selection of the
managed care organizations.� The managed care organizations selected are to
demonstrate the ability to meet the requirements of the pilot program and are
required to operate in each of the northern, central, and southern regions of
the State.
���� The selected managed care
organizations are required to contract with six hospitals, with two in each of
the northern, central, and southern regions of the State, to provide integrated
behavioral health care within one of the hospital�s urgent care facilities.� In
determining which hospitals to contract with, the selected managed care
organizations are to prioritize hospitals that specialize in pediatric care if
feasible.� Under the bill, a participating urgent care facility is required to
provide services 24 hours per day, seven days per week.� Furthermore, to be
eligible, a hospital is to demonstrate the ability to coordinate a patient�s
care with primary care providers, outpatient behavioral health and substance
abuse providers, community health centers, and social service providers, and
may not receive funding from the DHS to provide Early Intervention Support
Services.
���� Each participating urgent care
facility is required to integrate behavioral health care with the facility�s
existing physical health services, which will, at a minimum, include:�
employing a behavioral health team of at least one licensed behavioral clinician
and one licensed clinical social worker; partnering with one or more licensed
psychiatrists to provided services, as needed, via telemedicine and telehealth;
providing behavioral health awareness and intervention training to staff; and
using warm hand-offs, rapid referrals, supportive contacts, and other efficient
and supportive care transition methods.
���� The pilot program is to be
funded in part through the Medicaid program using a value-based payment
system.� The value-based payment system is to be modeled on, and be consistent
with, the population-based payment methodology that is described under Category
4 of the alternative payment methodologies (APM) framework developed by the
Health Care Payment Learning and Action Network.� Specifically, the value-based
payment system is required to provide for a quarterly advanced bundled payment
to be provided to the managed care organization for the purposes of financing
the total cost of behavioral health care that is provided by participating
urgent care facilities.�
���� The quarterly bundled payment
rate is to be established by the Commissioner of Human Services and is required
to be based on the commissioner�s evaluation of the following factors:�
���� (1)�� an assessment of claims
data indicating the cost to provide behavioral health care in hospital
emergency departments and inpatient settings, absent the pilot program;
���� (2)�� the number of patients
who are expected to be served by the pilot program;
���� (3)�� the average anticipated
per-patient cost of care under the pilot program;
���� (4)�� the anticipated costs to
participating urgent care facilities of complying with the provisions of the
bill; and
���� (5) any other factors that may
affect the cost of care.
���� Once established, the
quarterly bundled payment may not be increased, regardless of whether the
actual costs of care received by patients under the pilot program exceed the
bundled payment rate provided.� If the managed care organization, in
cooperation with participating urgent care facilities, is able to reduce the
per-patient costs of care for patients receiving care and services under the
pilot program, the managed care organization may retain, and will not be
required to repay, any remaining unexpended bundled payment funds.� The managed
care organization will be required to share any savings achieved with
participating urgent care facilities at a rate that is proportional to the rate
of per-patient cost reduction savings achieved by each such facility.� If the
actual per-patient costs of care for patients receiving care and services under
the pilot program exceed the advanced bundled payment rate established by the
commissioner, the managed care organization is to ensure that all patients
continue to receive appropriate services and care from participating urgent
care facilities without being subject to an increase in out-of-pocket costs.�
Any financial loss incurred by the managed care organization as a result of an
increase in the per-patient cost of care for patients in the pilot program is
to be shared by the managed care organization with participating urgent care
facilities at a rate that is proportional to the rate of per-patient cost
increase attributed to each facility.�
���� The bill requires the DHS,
within 90 days after the two-year pilot program is terminated, to prepare and
submit a written report of its findings and recommendations to the Governor and
Legislature.�
���� The Commissioner of Human
Services will be required to apply for any State plan amendments or waivers as
may be necessary to implement the bill�s provisions and secure federal
financial participation for State Medicaid expenditures under the federal Medicaid
program.