Sponsored by:
Assemblywoman SHANIQUE SPEIGHT
District 29 (Essex and Hudson)
Assemblyman REGINALD W. ATKINS
District 20 (Union)
Assemblyman BENJIE E. WIMBERLY
District 35 (Bergen and Passaic)
Co-Sponsored by:
Assemblywomen Hall and Reynolds-Jackson
SYNOPSIS
Increases cap on personal care assistant services from 40 hours to 91 hours per week for Medicaid beneficiary determined clinically eligible for nursing facility level of care.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning personal care assistant services provided under Medicaid and supplementing Title 30 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Notwithstanding any regulation to the contrary, the Department of Human Services shall approve, as medically necessary, up to 91 hours of personal care assistant services per calendar week for any eligible Medicaid beneficiary who is clinically eligible for nursing facility level of care. The department shall modify the existing assessment tool for personal care assistant services in accordance with the provisions of this section.
As used in this section,
“Medicaid” means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Personal care assistant services" means health related tasks associated with the cueing, supervision, or the completion of activities of daily living, as well as related tasks, performed by a qualified individual in a beneficiary's home, or at a place of employment or post-secondary educational or training program, under the supervision of a registered professional nurse, certified as medically necessary, and in accordance with a beneficiary's written plan of care.
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 secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
3. The Commissioner of Human Services, in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt such rules and regulations as the commissioner deems necessary to carry out the provisions of this act.
4. This act shall take effect immediately.
STATEMENT
This bill increases the cap on personal care assistant (PCA) services from 40 hours to 91 hours per week for a Medicaid beneficiary determined clinically eligible for nursing facility level of care. The bill defines “personal care assistant services” to mean health related tasks associated with the cueing, supervision, or the completion of activities of daily living, as well as related tasks. PCA services are certified as medically necessary; delivered in accordance with a beneficiary's written plan of care; and performed by a qualified individual, typically in a beneficiary's home, and under the supervision of a registered professional nurse.
Currently, pursuant to State regulation, the Medicaid program limits PCA services to a maximum of 40 hours per week per beneficiary. Additional hours of service may be approved by the Department of Human Services on a case-by-case basis and based on exceptional circumstances.
The sponsor believes that the existing policy puts pressure on seniors who need nursing facility level of care to leave their homes and seek care in long-term care facilities, a policy that is more expensive for the State and unfair to seniors who have worked all their lives to maintain the independence and dignity of living in their own home. In addition, 40 hours per week of PCA services is insufficient to supplement care from a beneficiary’s family and friends. Since New Jersey’s cost of living is one of the highest in the country, these caregivers often need more hours of PCA services for their loved one in order to maintain their own employment. Increasing the service cap for the State’s most vulnerable Medicaid beneficiaries will ensure that they can thrive within the community for additional years.
Specifically, the bill directs the Department of Human Services to approve, as medically necessary, up to 91 hours of PCA services per calendar week for any eligible Medicaid beneficiary who is clinically eligible for nursing facility level of care. The department is also required to modify the existing assessment tool for PCA services to reflect the provisions of this bill.