Sponsored by:
Senator TROY SINGLETON
District 7 (Burlington)
Co-Sponsored by:
Senators Diegnan, A.R.Bucco and Gopal
SYNOPSIS
Requires Department of Human Services to review Medicaid reimbursement to nursing homes under Managed Long-Term Services and Supports Program.
CURRENT VERSION OF TEXT
As reported by the Senate Health, Human Services and Senior Citizens Committee on January 17, 2019, with amendments.
An Act concerning Medicaid reimbursement and supplementing Title 30 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. The Commissioner of Human Services shall conduct a study of the State’s Medicaid program reimbursement to nursing homes under the Managed Long-Term Services and Supports Program. The study shall include:
a. a study of the current costs of providing long term care services in State nursing homes;
b. an analysis of the adequacy of the current Medicaid nursing home reimbursement rates given the current costs of providing long term care services in nursing homes; and
c. a recommendation of alternative reimbursement methodologies for Medicaid recipients described in section 2 of this act, including consideration of:
(1) a reinstatement of the methodology provided for in N.J.A.C.8:85-3.1 et seq. to establish prospective per diem rates for the provision of nursing home services to residents under the State's Medicaid program;
(2) implementation of a case mix adjusted price model for nursing home reimbursement;
(3) implementation of a rate floor for nursing home rates negotiated by a managed care organization under contract with the State’s Medicaid program;
(4) an allowance for regional cost variation in the State; and
(5) a provision for inflationary increases in the cost of care by means of periodic cost reporting and rebasing of rates or the implementation of an inflationary rate adjustment based on actual health care cost increases.
2. Within 180 days following the enactment of this act, the Commissioner of Human Services shall adopt rules and regulations establishing reimbursement methodologies for all long-term care recipients:
a. that have been receiving State Medicaid nursing home services since June 30, 2014 and who continue to have eligible services paid for by the State through a fee-for-service reimbursement model;
b. that receive Medicaid Managed Long Term Services and Supports from a nursing home that is a participating provider in a Medicaid managed care organization network;
c. hat receive Medicaid Managed Long Term Services and Supports from a nursing home that is not a participating provider in a Medicaid managed care organization network; and
d. that receive State Medicaid nursing home services paid for by the State through a fee-for-service reimbursement model covering any period of Medicaid eligibility prior to a managed care organization enrollment period or a period of time between managed care organization enrollment periods.
3. a. One year after the effective date of this act, the Commissioner of Human Services shall conduct a review 1[for] of1 payment for continuity of care for long term care services during the transition period of long term care service recipients into the Medicaid Managed Long Term Services and Supports program. The Department of Human Services shall cooperate with and consider input from nursing homes to the extent that it is possible. The review shall include evaluation of the efficiency of services and promptness of payment for:
(1) the period of time pending Medicaid eligibility;
(2) the process of authorization of the Medicaid Managed Long Term Services and Supports program;
(3) interruptions of Medicaid eligibility or Medicaid Managed Long Term Services and Supports enrollment; and
(4) all routine Medicaid Managed Long Term Services and Supports program services.
b. Within 180 days following the enactment of this act, the Commissioner of Human Services shall issue a report of findings made pursuant to section 1 of this act and shall adopt changes in policies, procedures, regulations, and contract terms, where permissible under law, to guarantee the maximization of care and payment for Medicaid Managed Long Term Services and Supports recipients.
4. Pending the establishment of a reimbursement methodology for long term care recipients pursuant to section 2 of this act, the State and Medicaid managed care organizations shall continue to reimburse nursing homes at the rates established pursuant to the annual appropriation act or negotiated between the managed care organization and the nursing home.
5. The Commissioner of Human Services shall apply for 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.
6. Pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), the Commissioner of Human Services shall adopt rules and regulations to effectuate the purposes of this act.
7. This act shall take effect immediately.