New Jersey A 4265: Authorizes first responders to obtain, administer, and dispense opioid antidotes, with immunity, pursuant to Statewide standing order issued by State health official; makes clarifying changes to "Overdose Prevention Act."

Bill Text

A4265 

ASSEMBLY, No. 4265 

STATE OF NEW JERSEY

222nd LEGISLATURE

� 

INTRODUCED FEBRUARY 19, 2026

Sponsored by:

Assemblywoman� SHANIQUE SPEIGHT

District 29 (Essex and Hudson)

Assemblywoman� MARISA SWEENEY

District 25 (Morris and Passaic)

Co-Sponsored by:

Assemblymen Kearney and Scharfenberger

SYNOPSIS

���� Requires Medicaid reimbursement rates for certain 
primary and mental health care services match reimbursement rates under 
Medicare. 

CURRENT VERSION OF TEXT 

���� As introduced.

�� 

An Act concerning Medicaid reimbursement for primary care and 
mental health services supplementing Title 30 of the Revised Statutes.

���� Be It 
Enacted by the Senate and General Assembly of 
the State of New Jersey:

���� 1.��� a.� As used in this 
section:

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

���� �Medicare� means the federal 
program established pursuant to Pub.L.89-97 (42 U.S.C. s.1395 et seq.) as 
amended, or its successor plan or plans.

���� �Mental health services� means 
procedures or services rendered by a health care provider, in a traditional 
setting as well in an integrated behavioral health setting or via a 
collaborative care program, for the treatment of mental illness, emotional 
disorders, or substance use disorder. �

���� �Midwife� means a midwife 
licensed by the State Board of Medical Examiners as a certified midwife, a 
certified nurse midwife, or a certified professional midwife.

���� �Primary care services� means 
the same as defined in section 1202 of the 
federal �Health Care and Education 
Reconciliation Act of 2010,� Pub.L. 111-152.

���� b.��� Commencing on July 1, 
2023, and annually thereafter, the Medicaid reimbursement rate for primary care 
and mental health services shall be no less than 100 percent of the payment 
rate that applies to such services under part B of Medicare.

���� c.���� Primary care services 
as used in subsection b. of this section shall include those services furnished 
by:

���� (1)�� a physician with a 
primary specialty designation of family medicine, general internal medicine, general 
pediatric medicine, or obstetrics and gynecology;

���� (2)�� a health care 
professional, including, but not limited to, an advance practice nurse or a 
physician assistant, who is working in the area of family medicine, general 
internal medicine, general pediatric medicine, or obstetrics and gynecology; or

���� (3)�� a midwife.

���� d.��� Mental health services as 
used in subsection b. of this section shall include those services furnished by 
a provider listed in paragraphs (1), (2), or (3) of subsection c. of this 
section or a health care provider with one of the following specialty 
designations:� licensed clinical social worker, psychologist, licensed 
professional counselor, licensed marriage and family therapist, licensed 
clinical alcohol and drug counselor, or psychiatrist.� 

���� e.���� The provisions of this 
section shall not be construed to require any decrease in the Medicaid 
reimbursement rate for a primary care or mental health service from the 
previous fiscal year�s reimbursement level for the same service.

���� f.���� The provisions of this 
section shall apply to primary care and mental health services:

���� (1)�� reimbursed under the 
Medicaid fee-for-service delivery system or through the Medicaid managed care 
delivery system; and 

���� (2)�� delivered by an approved 
Medicaid provider. 

���� g.��� No later than one year 
after the effective date of this act, the Commissioner of Human Services shall 
submit a report to the Governor and, pursuant to 
section 2 of P.L.1991, c.164 (C.52:14-19.1), to the Legislature, providing information on the implementation of this 
section, including data indicating any changes regarding access to primary care 
and mental health services, as well as the quality of care of these services, 
for Medicaid beneficiaries following any rate increases required under this 
section.� The report shall also include any recommendations for further 
enhancements to the Medicaid rates for these services to improve provider access 
and quality of care for Medicaid beneficiaries in underserved areas of the 
State.� 

���� 2.��� The Commissioner of 
Human Services shall apply for such State plan amendments or waivers as may be 
necessary to implement the provisions of this act and to secure federal 
financial participation for State Medicaid expenditures under the federal 
Medicaid program.

���� 3.��� The Commissioner of 
Human Services, pursuant to the "Administrative Procedure Act," 
P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations 
necessary to implement the provisions of this act.

���� 4.��� This act shall take 
effect immediately.

STATEMENT

���� This bill requires the 
Medicaid reimbursement rates for primary care and mental health services to 
match the reimbursement are for those services under Medicare.� 

���� Specific