NJ S3011

NJ FamilyCare fee-for-service reimbursement rates for pediatric dental services (children under 21) would increase by 20% starting July 1, 2025 or 60 days after enactment, whichever is later.

Annual adjustments to pediatric dental reimbursement rates would be tied to the Consumer Price Index for All Urban Consumers for the Northeast region, beginning one year after the initial rate increase.

Managed care organizations contracting with NJ FamilyCare must pay providers at least the fee-for-service rate for identical pediatric dental services.

MCOs violating the rate floor requirement face civil penalties up to $10,000 per day of non-compliance.

Current NJ FamilyCare dental reimbursement rates for children rank in the bottom 10% nationally and have not been comprehensively updated since 2007, contributing to 36% of New Jersey third-graders experiencing tooth decay compared to 20% nationally.