Sponsored by:
Assemblyman JOSEPH A. LAGANA
District 38 (Bergen and Passaic)
Assemblyman VINCENT MAZZEO
District 2 (Atlantic)
Assemblyman TIMOTHY J. EUSTACE
District 38 (Bergen and Passaic)
Assemblyman BOB ANDRZEJCZAK
District 1 (Atlantic, Cape May and Cumberland)
Assemblywoman VALERIE VAINIERI HUTTLE
District 37 (Bergen)
Co-Sponsored by:
Assemblyman Singleton, Assemblywoman Mosquera and Assemblyman Garcia
SYNOPSIS
Requires DHS to monitor utilization and billing of services for Medicaid home and community-based long-term care.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning monitoring of long-term care services and supplementing Title 30 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. The Department of Human Services shall monitor the services provided to an individual receiving services under the Medicaid Managed Long Term Services and Supports section 1115 demonstration waiver program or any other Medicaid home and community-based services long-term care program, in accordance with this section.
b. In the case of an individual who receives services under one of these programs through a managed care organization, the department shall perform a monthly review of the number of encounters the individual has had with the managed care organization, as compared with the services authorized for the individual by the program, to help ensure efficient utilization of services from the managed care organization.
c. In the case of an individual who receives services under one of these programs through a provider whose claims are processed by a third-party billing agent, the department shall require the third party-billing agent to perform a monthly review of the provider's billing limits and of the services provided to the individual, to help ensure that: services are provided if those services are authorized for the individual by the program; and claims are processed if those claims do not exceed the billing limits authorized for the individual by the program.
2. This act shall take effect on the first day of the fourth month next following the date of enactment, except the Commissioner of Human Services may take any anticipatory administrative action in advance as shall be necessary for the implementation of this act.
STATEMENT
This bill provides for the monitoring of services provided to an individual receiving services under the Medicaid Managed Long Term Services and Supports section 1115 demonstration waiver program or any other Medicaid home and community-based services long-term care program.
In the case of an individual who receives services under one of these programs through a managed care organization, the Department of Human Services (DHS) is to perform a monthly review of the number of encounters the individual has had with the managed care organization, as compared with the services authorized for the individual by the program, to help ensure efficient utilization of services from the managed care organization. If services are received through a provider whose claims are processed by a third-party billing agent, DHS is to require the third party-billing agent to perform a monthly review of the provider's billing limits and of the services provided to the individual, to help ensure that services are provided and claims are processed if those services and claims are authorized for the individual.