Sponsored by:
Assemblyman NICHOLAS CHIARAVALLOTI
District 31 (Hudson)
Assemblyman GARY S. SCHAER
District 36 (Bergen and Passaic)
Assemblyman DANIEL R. BENSON
District 14 (Mercer and Middlesex)
Co-Sponsored by:
Assemblywomen Murphy and Downey
SYNOPSIS
Establishes minimum Medicaid reimbursement rate for adult medical day care services.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning Medicaid reimbursement for providers of adult medical day 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. Notwithstanding the provisions of any law or regulation to the contrary, the per diem reimbursement rate for providers of adult medical day care services within the Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), whether the services are provided in the Medicaid fee-for-service delivery system or through a managed care delivery system, shall be no less than the established State Medicaid fee-for-service rate.
b. As used in this section:
“Provider of adult medical day care services” means an adult day health services facility licensed by the Department of Health, which provides preventive, diagnostic, therapeutic, and rehabilitative services under medical and nursing supervision to meet the needs of functionally impaired adult participants for a period of time that does not exceed 12 hours during any calendar day.
2. A managed care organization contracted with the Division of Medical Assistance and Health Services within the Department of Human Services to provide benefits under the Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), shall not terminate or modify an existing provider network contract solely due to a change of provider ownership or ownership structure.
3. This act shall take effect on July 1, 2020 and shall apply to services provided on or after the effective date of this act and to any Medicaid managed care contract executed or renewed on or after the effective date of this act, except that the provisions of section 2. of this act shall take effect immediately.
STATEMENT
This bill establishes a minimum Medicaid reimbursement rate for a provider of adult medical day care services. As defined under the bill, “provider of adult medical day care services” means an adult day health services facility licensed by the Department of Health, which provides preventive, diagnostic, therapeutic, and rehabilitative services under medical and nursing supervision to meet the needs of functionally impaired adult participants for a period of time that does not exceed 12 hours during any calendar day.
Under the bill, whether the services are provided in the Medicaid fee-for-service (FFS) delivery system or through a managed care delivery system, the per diem reimbursement rate is required to be no less than the established State Medicaid FFS rate. Currently, the FY 2020 annual Appropriations Act (P.L.2019, c.150) sets forth the FFS rate at $78.50 per day.
The bill also prohibits a managed care organization contracted to provide benefits under the Medicaid program from terminating or modifying an existing provider network contract solely due to a change of provider ownership or ownership structure.
The bill would take effect on July 1, 2020 and apply to services provided on or after the effective date of bill and to any Medicaid managed care contract executed or renewed on or after the effective date of the bill, except that the provisions of the bill prohibiting a Medicaid managed care organization from terminating or modifying an existing provider network contract under certain circumstances would take effect immediately.