S4189

An Act concerning healthy foods, amending the title and body of P.L.2019, c.15, and supplementing P.L.1968, c.413 (C.30:4D-1 et seq.).

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. The title of P.L.2019, c.15 is amended to read as follows:

An Act concerning food retailers and retail pharmacies, and supplementing Title 24 of the Revised Statutes.

(cf: P.L.2019, c.15, title)

2. Section 1 of P.L.2019, c.15 (C.24:4A-6) is amended to read as follows:

1. This act shall be known and may be cited as the "Healthy Small Food Retailer and Retail Pharmacy Act."

(cf: P.L.2019, c.15, s.1)

3. Section 2 of P.L.2019, c.15 (C.24:4A-7) is amended to read as follows:

2. The Legislature finds and declares:

a. Overweight children and adults are at greater risk for numerous adverse health consequences, including type 2 diabetes, heart disease, stroke, high blood pressure, high cholesterol, certain cancers, asthma, low self-esteem, depression, and other debilitating diseases;

b. In the United States, the medical costs of obesity are rising rapidly with Medicare and Medicaid paying roughly half of these obesity-related costs, estimated to be over $100 billion per year;

c. Many Americans, particularly those in low income neighborhoods, rural areas, and communities of color, live in communities that lack adequate access to full-service grocery stores, and low income areas have more than twice as many convenience stores and four times as many small grocery stores as high income areas;

d. Small food stores, which tend to charge higher prices for food compared to grocery stores and supermarkets, have limited supplies of fresh produce, whole grains, and low-fat dairy products and frequently sell highly processed foods that are high in fat and low in nutrients;

e. Providing assistance to existing small food retailers and retail pharmacies to stock fresh produce and other healthy foods that promote good nutrition will better provide people with access to healthier foods, and community programs that work with these small food retailers have shown promise in increasing healthy food sales, improving the quality of store offerings, and promoting good nutrition; and

f. It is therefore the intent of the Legislature to provide support to small food retailers and retail pharmacies operating in New Jersey, in both urban and rural areas, to sell more fresh fruits and vegetables and other healthy foods at affordable prices to neighborhood residents in an effort to improve the health and wellness of all New Jerseyans.

(cf: P.L.2019, c.15, s.2)

4. Section 3 of P.L.2019, c.15 (C.24:4A-8) is amended to read as follows:

3. As used P.L.2019, c.15 (C.24:4A-6 et seq.):

"Department" means the Department of Health.

“Division” means the Division of Medical Assistance and Health Services in the Department of Human Services.

“Food prescription” means a prescription, written by a health care provider, for certain foods as a treatment for diet-related health conditions.

"Fund" means the "Healthy Small Food Retailer and Retail Pharmacy Fund" established pursuant to section 5 of [this act] P.L.2019, c.15 (C.24:4A-10) and section 6 of P.L. , c. (pending before the Legislature as this bill).

"Healthy Corner Store and Retail Pharmacy Program" means the program established pursuant to section 4 of [this act] P.L.2019, c.15 (C.24:4A-9) and section 5 of P.L. , c. (pending before the Legislature as this bill).

"Low income area" means a census tract, as reported in the most recently completed decennial census published by the United States Census Bureau, that has a poverty rate of at least 20 percent or in which the median family income does not exceed 80 percent of the Statewide or metropolitan median family income, whichever is greater.

"Moderate income area" means a census tract, as reported in the most recently completed decennial census published by the United States Census Bureau, in which the median family income is between 81 and 95 percent of the median family income for the area.

“NJ FamilyCare” means the program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), which includes the State’s Medicaid Program and the Children’s Health Insurance Program.

“Retail pharmacy” means any establishment, including a community pharmacy, licensed by the State to dispense prescription medications directly to patients.

"Small food retailer" means a small retail outlet, with less than 2,500 square feet, which sells a limited selection of foods and other

products, such as a bodega, convenience store, corner store, neighborhood store, small grocery, or small-scale store.

(cf: P.L.2019, c.15, s.3)

5. Section 4 of P.L.2019, c.15 (C.24:4A-9) is amended to read as follows:

4. a. The department, in collaboration with the division, shall develop and implement a "Healthy Corner Store and Retail Pharmacy Program" to:

(1) increase the availability and sales of fresh produce and nutritious, healthy food by small food retailers and retail pharmacies in rural and urban low income and moderate income areas; and

(2) enable a NJ FamilyCare enrollee, for whom a licensed health care provider has written a food prescription, to fill the prescription at a retail pharmacy pursuant to subsection a. of section 9 of P.L. , c. (C. ) (pending before the Legislature as this bill).

The department in collaboration with the division shall select at least one grantee in each community participating in the program to administer the program and distribute program funding to small food retailers and retail pharmacies in the community.

b. To support the program, the department shall promote the availability of program funding Statewide, establish eligibility guidelines for funding, evaluate applicants, raise matching funds, and disburse funding through the "Healthy Small Food Retailer and Retail Pharmacy Fund," established pursuant to section 5 of [this act] P.L.2019, c.15 (C.24:4A-10).

c. The department shall develop an application and applicant selection process and create eligibility guidelines for any organization applying to be selected as a grantee. To qualify for funding, an applicant shall:

(1) provide proof satisfactory to the department that it is a nonprofit entity;

(2) have a well-defined public health goal with standards based on the best available science;

(3) agree to provide assistance to small food retailers and retail pharmacies located in low income or moderate income areas that:

(a) accept, or agree to accept as a condition of receiving assistance, Supplemental Nutrition Assistance Program benefits;

(b) agree to apply to accept Special Supplemental Nutrition Program for Women, Infants, and Children benefits, and accept those benefits if eligible; [and]

(c) in the case of a retail pharmacy, are or agree to apply to become an approved NJ FamilyCare provider as a condition of receiving assistance; and;

(d) agree to abide by the [department's] conditions , established by the department and the division, for receiving assistance;

(4) collect and provide data and other information required by the department and the division for program monitoring, accountability, and evaluation purposes; [and]

(5) establish defined goals, standards, and accountability mechanisms to ensure that expenditures from the fund are appropriate and consistent with the purpose of [this act] P.L.2019, c.115 (C.24:4A-6 et seq.), including:

(a) identifying the basis for selecting each particular small food retailer, retail pharmacy, or geographic area for assistance;

(b) submitting and implementing a plan which includes specific targets and goals for increasing the sales of produce and other healthy foods by a small food retailer or retail pharmacy in the designated area, engaging the community to support the participating small food retailers and retail pharmacies, and establishing standards to assess performance and whether goals within the plan are met; [and]

(c) engaging an advisory group of members of county or municipal agencies, such as planning or economic development entities, private or public universities, cooperative extensions, community-based organizations, and community members, to provide expertise and support and to coordinate other efforts to support the program and participating small food retailers and retail pharmacies; and

(d) ensure that small food retailers and retail pharmacies selected for assistance are accessible for community members; and

(6) present a plan to engage in public awareness and community outreach concerning the availability of healthy foods at participating small food retailers and retail pharmacies.

d. The department, in collaboration with the division, shall develop specific standards for selecting a small food retailer or a retail pharmacy to participate as a designated healthy corner store or retail pharmacy. In determining whether a small food retailer or a retail pharmacy is qualified, consideration shall be given to the level of need in the area served. As a condition of participation, a small food retailer or a retail pharmacy shall sign a written agreement prior to receiving assistance. A grantee shall be authorized to monitor the participating small food retailers and retail pharmacies, and enforce the agreements if necessary. A grantee shall establish monitoring and accountability mechanisms for participating small food retailers and retail pharmacies.

(cf: P.L.2019, c.15, s.4)

6. Section 5 of P.L.2019, c.15 (C.24:4A-10) is amended to read as follows:

5. a. There is established in the Department of Health the "Healthy Small Food Retailer and Retail Pharmacy Fund," to support the "Healthy Corner Store and Retail Pharmacy Program" created pursuant to section 4 of [this act] P.L.2019, c.15 (C.24:4A-9) and section 5 of P.L. , c. (pending before the Legislature as this bill). All monies received in the fund shall be expended by the Commissioner of Health and distributed through grantees to provide assistance to participating small food retailers and retail pharmacies in rural and urban low income and moderate income areas.

b. The fund shall be credited annually with any monies made available to it from the General Fund or any public, or private source other than the State. The commissioner shall include with the annual budget request for the department a request for funds sufficient to carry out the purposes and intent of [this act] P.L.2019, c.15 (C.24:4A-6 et seq.) and P.L. , c. (C. ) (pending before the Legislature as this bill .

c. Monies from the fund shall be used only for the following purposes:

(1) salary and associated administrative costs incurred to provide education, advice, or other assistance to small food retailers and retail pharmacists or pharmacy staff on food safety and handling, nutrition education, business operations, and promotion;

(2) refrigeration, display shelving, storage, transportation, or other equipment necessary for a small food retailer or a retail pharmacy to [keep] stock [of] or distribute perishable healthy foods and fresh produce, up to [$5,000] $6,000 per retailer or retail pharmacy;

(3) materials and supplies for nutrition education and healthy food promotion; and

(4) mini-grants to small food retailers and retail pharmacies, of up to $100 per retailer or pharmacy, to meet initial expenses incurred with participation in the program.

d. At least 10 percent, but not more than 25 percent of the fund shall be reserved for each grantee's administrative and operational costs to allocate funds to small food retailers and retail pharmacies and evaluate and report on the program, unless those costs are provided for from other funding sources or in-kind resources.

(cf: P.L.2019, c.15, s.5)

7. Section 6 of P.L.2019, c.15 (C.24:4A-11) is amended to read as follows:

6. a. Each grantee shall submit a report to the department and the division on or before March 1 of each year, which includes information concerning the overall geographic distribution of the funding, the amount of funding allocated to each small food retailer and retail pharmacy, the health impact associated with the program and its funding, the number and amount of any Medicaid claims for food prescriptions filled pursuant to section 4 of P.L. , c. (C. ) (pending before the Legislature as this bill), and any other data or information required by the department or the division for program monitoring, accountability, and evaluation pursuant to subsection c. of section 4 of [this act] P.L.2019, c.15 (C.24:4A-9) and section 5 of P.L. , c. . The report shall also evaluate any data collected from participating small food retailers and retail pharmacies and assess other effects and outcomes of the program.

b. Pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), the department , in collaboration with the division, shall prepare and submit to the Legislature and to the Governor an annual report summarizing the expenditures of the fund, assessing the program and the performance of any grantee, and including all reports submitted by a grantee pursuant to subsection a. of this section. The department, in collaboration with the division, shall provide recommendations about the program as necessary.

(cf: P.L.2019, c.15, s.6)

8. Section 7 of P.L.2019, c.15 (C.24:4A-12) is amended to read as follows:

7. The Department of Agriculture shall expand the "Jersey Fresh" website to provide opportunities for the establishment of purchasing networks between farmers, distributors, grantees, and small food retailers and retail pharmacies participating in the "Healthy Corner Store and Retail Pharmacy Program." The department shall post, in a prominent location on the homepage of its Internet website, a hyperlink that provides visitors with direct access to the "Healthy Corner Store and Retail Pharmacy Program" on the expanded website.

(cf: P.L.2019, c.15, s.7)

9. (New section) a. (1) Conditional upon the receipt of all necessary federal approvals and the securing of federal financial participation for NJ FamilyCare expenditures under the federal Medicaid program, the Commissioner of Human Services, in collaboration with the Commissioner of Health, shall establish a three-year pilot program to provide NJ FamilyCare coverage for food prescriptions written by licensed health care providers for NJ FamilyCare enrollees who are diagnosed with a diet-related medical condition. The pilot program shall be designed to reduce overall Medicaid expenditures through improved management of diet-related conditions.

(2) Food prescriptions written pursuant to P.L. , c. (C. ) (pending before the Legislature as this bill) may be filled at a Medicaid-approved retail pharmacy that participates in the “Healthy Corner Store and Retail Pharmacy Program," as amended by section 4 of P.L. c. (C. ) (pending before the Legislature as this bill).

b. (1) Foods that may be prescribed to NJ FamilyCare enrollees, pursuant to the pilot program established in subsection a. of this section, shall include:

(a) fresh fruits;

(b) fresh vegetables;

(d) other medically-appropriate grocery items as identified by the Commissioner of Human Services in consultation with the Commissioner of Health.

(2) In implementing the pilot program established in subsection a. of this section, the Department of Human Services shall, to the extent practicable, prioritize partnerships with local farmers and food suppliers in filling food prescriptions for pilot program participants.

c. (1) The Department of Human Services, in consultation with the Department of Health, shall engage with stakeholders, including health care providers, Medicaid managed care organizations, food retailers, retail pharmacies, and community based organizations in the implementation of the pilot program established in subsection a. of this section.

(2) Where practicable and permissible under federal and State law, the Department of Human Services shall engage with community-based organizations and community health workers to provide program participants with educational resources, encourage compliance, and facilitate participants’ access to prescribed foods.

d. The Department of Human Services shall monitor:

(1) the number of food prescriptions written for, and filled by, NJ FamilyCare enrollees who have a diet-related medical condition and who elect to participate in the pilot program established pursuant to subsection a. of this section;

(2) any improvements in access to healthy foods for NJ FamilyCare enrollees who participate in the pilot program; and

(3) health outcomes for NJ FamilyCare enrollees who participate in the pilot program.

e. In implementing the pilot program established in subsection a. of this section, the Department of Human Services shall incorporate program integrity safeguards, including:

(1) a process to verify participant eligibility for the program;

(2) utilization review; and

(3) periodic audits to prevent program fraud, waste, and abuse.

f. As used in this section:

“Diet-related medical condition” means Type II diabetes, hypertension, or obesity.

“Food prescription” means a prescription, written by a licensed health care provider, for certain foods as a treatment for diet-related health conditions.

“Retail pharmacy” means any establishment, including a community pharmacy, licensed by the State to dispense prescription medications directly to patients.

g. The Department of Human Services shall report annually to the Governor, and to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), concerning:

(1) pilot program participation rates;

(2) participants’ health outcomes;

(3) State costs for the pilot program;

(4) any reduction in overall Medicaid expenditures associated with participation in the program including, but not limited to, reductions in emergency department visits, hospitalizations, and prescription drug utilization; and

(5) any recommendations for program expansion.

h. Following submission of the final annual report pursuant to subsection g. of this section, the Department of Human Services may, upon Legislative authorization and the receipt of any necessary federal approvals, expand the scope of the pilot program established in subsection a. of this section.

i. The Commissioner of Human Services shall apply for such Medicaid waivers or state plan amendments as may be necessary to ensure continued federal reimbursements for State expenditures under the federal Medicaid program.

10. There is appropriated from the General Fund to the Department of Human Services $500,000 to implement the provisions of this act.

11. The Commissioner of Human Services and the Commissioner of Health shall, in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), adopt rules and regulations as necessary to implement this act.

12. The provisions of P.L. , c. (C. ) (pending before the Legislature as this bill) shall take effect on the first day of the fourth month next following the date of enactment, and section 9 shall expire three years thereafter.

STATEMENT

This bill requires the NJ FamilyCare program to establish a three year pilot program to cover food prescriptions for healthy foods when written by a licensed health care provider for a NJ FamilyCare enrollee who has been diagnosed with a diet-related medical condition. The pilot program will be designed to reduce overall Medicaid expenditures through improved management of diet-related conditions.

The bill defines “diet-related medical condition” to mean Type II diabetes, hypertension, or obesity. Under the bill, a food prescription includes: fresh fruits, fresh vegetables, culturally-appropriate staple foods, and other medically-appropriate grocery items as identified by the Commissioner of Human Services in consultation with the Commissioner of Health. The bill provides that, in implementing the pilot program, the Department of Human Services (department) will prioritize partnerships with local farmers and food suppliers, to the extent practicable.

Where practicable and permissible under federal and State law, the department will engage community-based organizations and community health workers to provide educational resources for program participants, encourage compliance, and facilitate access to prescribed foods.

The Commissioner of Human Services will monitor the number of food prescriptions written for, and filled by, NJ FamilyCare enrollees who participate in the pilot program, health outcomes for pilot program participants, and any improvements in access to healthy foods for NJ FamilyCare enrollees who participate in the pilot program.

In implementing the pilot program, the department will incorporate program integrity safeguards, including eligibility verification, utilization review, and periodic audits to prevent waste, fraud, and abuse.

The bill additionally amends the "Healthy Small Food Retailer Act" (the act) to allow retail pharmacies to participate in the program to market and sell healthy foods in rural and urban low income and moderate income areas, and permit NJ FamilyCare enrollees to fill food prescriptions, written by licensed health care providers, at small food retailers and retail pharmacies. Retail pharmacies must become authorized Medicaid providers in order to fill food prescriptions for NJ FamilyCare enrollees who enroll in the pilot program.

The bill further amends the act to provide that retail pharmacies may receive financial assistance from the Healthy Small Food Retailers Fund for refrigeration, display shelving, or other equipment necessary to stock healthy foods and fresh produce, and increases the amount that each participating small food retailer or retail pharmacy may receive from $5,000 to $6,000. Retail pharmacies will also be eligible to receive mini-grants of up to $100 to cover the up-front costs to participate in the program.

The bill appropriates $500,000 from the General Fund to the Department of Human Services to implement the provisions therein.