S4834

An Act concerning street medicine programs and supplementing Title 26 of the Revised Statutes.

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

1. The Legislature finds and declares that:

a. Persons experiencing homelessness and other medically underserved individuals may face significant barriers to obtaining health care in traditional clinical settings, including lack of transportation, stable housing, insurance coverage, and reliable means of communication.

b. Providing health care where these individuals can be reached may improve access to preventive and primary care, continuity of treatment, and referrals to other services.

c. It is in the public interest to establish a framework for the approval and operation of street medicine programs in this State.

2. As used in this act:

“Administrator” means the individual designated by an approved street medicine program as responsible for its operation.

“Commissioner” means the Commissioner of Health.

“Department” means the Department of Health.

“Designated service area” means the geographic area approved by the department within which a street medicine program may provide street medicine services.

“Eligible applicant” means a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.), a federally qualified health center, a public health agency, or another entity that the commissioner determines has the capacity to operate a street medicine program.

“Health care provider” means an individual licensed or certified to provide health care services pursuant to Title 45 of the Revised Statutes or other applicable law.

“Medically underserved individual” means a person who experiences barriers to obtaining health care in a traditional clinical setting because of homelessness, housing instability, poverty, lack of transportation or health insurance coverage, a behavioral health condition or substance use disorder, a language or communication barrier, geographic isolation, or another circumstance that limits access to care.

“Person experiencing homelessness” means a person who lacks a fixed, regular, and adequate nighttime residence, including a person living outdoors, in a vehicle or place not designed for regular human habitation, in an emergency shelter or temporary housing program, or temporarily with another household or in a hotel or motel because the person lacks an alternative permanent residence.

“Staff member” means a person compensated by a street medicine program to perform services on its behalf.

“Street medicine program” means a program approved by the department pursuant to section 4 of this act to provide street medicine services.

“Street medicine services” means primary or behavioral health care services provided to persons experiencing homelessness or other medically underserved individuals outside a traditional clinical setting within a designated service area, including in public spaces, shelters, encampments, temporary residences, and other community locations approved by the department. Services may include screening, assessment, diagnosis, preventive care, wound care not requiring general anesthesia, medication services, care coordination, and referrals, to the extent authorized by the scope of practice of a participating health care provider and other applicable laws.

“Street medicine unit” means a motor vehicle or movable unit identified in an approved application for use by a street medicine program to transport personnel, medications, equipment, or supplies; provide an appropriate private setting for care; or provide nonemergency patient transportation to a health care facility when clinically appropriate.

“Volunteer” means a person who performs services on behalf of a street medicine program without compensation.

3. a. An eligible applicant shall obtain approval from the department before establishing and operating a street medicine program. The applicant shall identify on the application the proposed administrator, designated service area, scope of services, and any street medicine unit to be used by the program.

b. An application shall be submitted in the form and manner prescribed by the department and shall include:

(1) an infection prevention and control plan;

(2) if the program proposes to handle medications, a plan for their secure storage, control, administration, dispensing, and disposal in accordance with applicable law;

(3) a plan for the collection and quarterly submission to the department of aggregate or de-identified information concerning: the number and types of patient encounters and services provided; the number and types of encounters involving nonemergency transportation to a health care facility; the number and types of referrals for follow-up health care; and, to the extent known, the number of patients who obtained follow-up care; and

(4) any other information required by the department by regulation to evaluate the applicant's ability to operate safely and in compliance with this act.

c. A street medicine program and its participating health care providers shall comply with otherwise applicable requirements for reporting communicable diseases, infections, and conditions. The quarterly submission required by paragraph (3) of subsection b. of this section shall not replace or delay any report required under those requirements.

4. a. The department shall review an application submitted pursuant to section 3 of this act for completeness and compliance with that act.

b. Within 60 business days after receipt of an application, the department shall notify the applicant in writing that the application is approved or denied, that specified information is needed to complete the application, or that the department requires an additional period of not more than 60 calendar days to complete its review. A notice extending review shall state the date by which the department will make a determination. If the department finds an application incomplete, the applicant shall have an opportunity to provide the specified information. The period for a determination shall begin again upon the department's receipt of the information necessary to complete the application.

c. The department shall approve a complete application if it determines that the applicant and proposed street medicine program meet the requirements of this act and any regulations adopted pursuant thereto. A denial shall state the reasons for the determination and advise the applicant of the right to request a hearing pursuant to section 7 of this act.

5. a. A street medicine program shall provide services only within its designated service area and in accordance with the scope of its approval.

b. A street medicine program shall:

(1) not deny or delay services solely because of a patient's inability to pay or lack of health insurance coverage;

(2) provide staff members and volunteers with education and training appropriate to their responsibilities, including patient intake, referrals, infection prevention and control, field safety, and patient privacy, and maintain records of that education and training;

(3) handle and dispose of regulated medical waste in accordance with the “Comprehensive Regulated Medical Waste Management Act,” P.L.1989, c.34 (C.13:1E-48.1 et al.), and applicable regulations;

(4) protect patient information in accordance with applicable federal and State law; and

(5) collect and submit information as required pursuant to section 3 of this act.

c. A health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) that obtains approval to operate a street medicine program shall not be required, solely by reason of that approval or the provision of street medicine services, to obtain a separate facility license or approval of a change to its existing license, provided that the facility does not establish or hold out a location in the designated service area as a permanent outpatient department or fixed clinic and retains responsibility for the program through its management, quality assurance, patient safety, medical records, pharmacy, and infection control systems, as applicable. This subsection shall not exempt a permanent site or other separately regulated activity from an otherwise applicable licensure requirement.

d. The use of a street medicine unit identified in a program's approval shall not, solely by reason of that use, require a separate health care facility license or approval of a change to an existing health care facility license. The unit shall be clearly marked to identify the street medicine program and its affiliated organization and shall be maintained in safe operating condition in compliance with applicable motor vehicle laws. This subsection shall not exempt a unit from an otherwise applicable license, permit, or other requirement for services provided in the unit or transportation furnished by the unit.

6. a. An approval to operate a street medicine program shall be valid for three years from the date of approval and shall not be assignable or transferable.

b. A program may apply for renewal in the form and manner prescribed by the department not less than 60 calendar days before its approval expires. The department shall renew the approval if it determines that the program continues to meet the requirements of this act and any regulations adopted pursuant thereto. If a complete renewal application is submitted on time, the approval shall remain in effect until the department makes a determination, unless the approval is suspended or revoked pursuant to section 7 of this act.

c. A program shall obtain the department's approval before changing its designated service area or approved scope of services. The program shall notify the department in writing at least 14 calendar days before discontinuing services, except when advance notice is impracticable, in which case notice shall be given as soon as practicable.

d. A program shall notify the department in writing within 14 calendar days after a change to other information on file with the department, including its administrator, hours of operation, or methods of providing services.

7. a. The department may issue a written warning or suspend or revoke an approval if it determines that a street medicine program has violated this act or any regulation adopted pursuant thereto. The department may deny an application or refuse to renew an approval if the applicant or program fails to meet the requirements of that act or the regulations. The department may order an immediate suspension when necessary to address an imminent threat to public health or patient safety, subject to a prompt opportunity for a hearing.

b. The department shall provide written notice of a denial, suspension, revocation, or refusal to renew, stating the reasons for the action and the procedure for requesting a hearing. An applicant or program may request a hearing in writing within 30 calendar days after receipt of the notice. If no timely request is made, the action shall become final, subject to any review otherwise available by law.

c. A hearing pursuant to this section shall be conducted in accordance with the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), and applicable rules of administrative procedure.

8. An organization receiving grant funding from the department to provide street medicine services on the effective date of this act may continue providing services under the terms of its existing grant until the earlier of the expiration of the grant or the date on which the organization receives a determination on a complete application for approval submitted pursuant to section 3 of that act. This section shall not exempt the organization or its personnel from any otherwise applicable law governing the services provided.

9. a. Nothing in this act shall be construed to expand or limit the scope of practice or authority of a health care provider or to authorize any person to prescribe, dispense, administer, or transport medication except as otherwise permitted by law.

b. Nothing in this act shall be construed to preempt applicable municipal authority under the “Municipal Land Use Law,” P.L.1975, c.291 (C.40:55D-1 et seq.), or to require a determination that the provision of street medicine services constitutes an inherently beneficial use under that law.

c. An officer, employee, agent, participating health care provider, staff member, or volunteer of an approved street medicine program who, in good faith, provides street medicine services on behalf of the program shall not be liable for civil damages arising from an act or omission in providing those services, except for an act or omission constituting gross negligence, recklessness, or willful misconduct, or the negligent operation of a motor vehicle.

10. The commissioner may adopt rules and regulations pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), to the provisions of this act. The commissioner may adopt, immediately upon filing with the Office of Administrative Law, regulations necessary to implement that act, which shall be effective for a period not to exceed 180 days and which may thereafter be amended, adopted, or readopted in accordance with the “Administrative Procedure Act.”

11. This act shall take effect immediately.

STATEMENT

This bill permits an eligible health care facility, federally qualified health center, public health agency, or other entity approved by the Commissioner of Health to establish and operate a street medicine program. A program would provide primary or behavioral health care services outside traditional clinical settings to persons experiencing homelessness and other medically underserved individuals.

The bill requires Department of Health approval before a program begins operating. An application must identify the program's administrator, service area, services, and any vehicle or movable unit used by the program, and must include plans addressing infection control, medication security when applicable, and data collection. Programs must submit aggregate or de-identified information quarterly and continue to comply with separate communicable disease reporting requirements.

The bill sets operating standards, establishes a three-year approval and renewal process, and authorizes the department to deny, suspend, or revoke an approval for noncompliance. It permits organizations with existing department grants to continue providing services during a transition period. It also addresses facility and vehicle licensure, preserves professional scope-of-practice and municipal land-use requirements, provides qualified civil immunity for good-faith services, and authorizes implementing regulations.