Sponsored by:
Senator NILSA I. CRUZ-PEREZ
District 5 (Camden and Gloucester)
SYNOPSIS
Requires adult day health care facilities to establish hybrid model for provision of adult day health care services under certain circumstances.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning adult day health 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 require every adult day health care services facility in the State licensed by the department to establish a hybrid model which allows for the provision of services to an adult day health care beneficiary when the beneficiary is unable to receive such services in person.
b. An adult day health care services facility shall allow for the provision of services to an adult day health care beneficiary under the following circumstances:
(1) as a result of a hospitalization or an illness or injury to the beneficiary, or a hospitalization, an illness or injury, or a personal issue involving the beneficiary’s caregiver that would prevent the beneficiary from receiving in person adult day health care services;
(2) in order to prevent an infectious disease outbreak or reduce the risk of spread of disease to beneficiaries receiving in person adult day health care services; or
(3) any other reason that may prevent a beneficiary from receiving in person adult day health care services.
c. The services offered by an adult day health care facility to an adult day health care beneficiary pursuant to subsection b. of this section shall:
(1) be provided through the use of telehealth;
(2) include, but not be limited to, clinical assessment, preventive, diagnostic, nursing, dietary, meal delivery, pharmaceutical, social work, therapeutic, rehabilitative, and habilitative services;
(3) be documented in the beneficiary’s plan of care; and
(4) not be provided to any beneficiary in excess of the facility’s licensed capacity.
d. As used in this section:
“Telehealth” means the use of information and communications technologies, including telephones, remote patient monitoring, or other electronic means, to support the provision of adult day health care services to an adult day health care beneficiary when the beneficiary is unable to receive such services in person.
2. a. An adult day health care facility seeking reimbursement for the provision of services under the hybrid model established pursuant to section 1 of this act shall include information on the scope and type of services provided to an adult day health care beneficiary on the prior authorization request form submitted by the facility to the Department of Human Services in accordance with N.J.A.C.10:164-1.3 for each beneficiary to whom the facility provides such services.
b. An adult day health care facility shall be reimbursed for services provided under the hybrid model at the same contracted rate charged by the facility for all other adult day health care services a beneficiary receives from the facility.
3. The Commissioner of Human Services shall adopt rules and regulations, pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), as may be necessary to effectuate the provisions of this act.
4. This act shall take effect on the first day of the sixth month next following the date of enactment, except that the commissioner may take any administrative action in advance as shall be necessary for the implementation of this act.
STATEMENT
This bill stipulates that the Department of Human Services (DHS) is to require every adult day health care services facility in the State licensed by the DHS to establish a hybrid model which allows for the provision of services to an adult day health care beneficiary when the beneficiary is unable to receive such services in person.
Specifically, the bill mandates that an adult day health care services facility is to allow for the provision of services to an adult day health care beneficiary under the following circumstances:
(1) as a result of a hospitalization or an illness or injury to the beneficiary, or a hospitalization, an illness or injury, or a personal issue involving the beneficiary’s caregiver that would prevent the beneficiary from receiving in person adult day health care services; (2) in order to prevent an infectious disease outbreak or to reduce the risk of spread of disease to beneficiaries receiving in person adult day health care services; or (3) any other reason that may prevent a beneficiary from receiving in person adult day health care services.
The bill further requires that the services offered by an adult day health care facility to an adult day health care beneficiary is: (1) to be provided through the use of telehealth; (2) to include, but not be limited to, clinical assessment, preventive, diagnostic, nursing, dietary, meal delivery, pharmaceutical, social work, therapeutic, rehabilitative, and habilitative services; (3) to be documented in the beneficiary’s plan of care; and (4) not to be provided to any beneficiary in excess of the facility’s licensed capacity.
As used in the bill, “telehealth” means the use of information and communications technologies, including telephones, remote patient monitoring, or other electronic means, to support the provision of adult day health care services to an adult day health care beneficiary when the beneficiary is unable to receive such services in person.
The bill’s provisions specify that an adult day health care facility seeking reimbursement for the provision of services under the hybrid model is to: (1) include information on the scope and type of services provided to an adult day health care beneficiary on the prior authorization request form submitted by the facility to the DHS in accordance with N.J.A.C.10:164-1.3 for each beneficiary to whom the facility provides such services; and (2) be reimbursed for remote services provided under the hybrid model at the same contracted rate charged by the facility for all other adult day health care services a beneficiary receives from the facility.