Bill Text: NJ A3469 | 2012-2013 | Regular Session | Introduced
Bill Title: Amends Fiscal Year 2013 annual appropriations act to prohibit application of budget adjustment factor when determining Medicaid reimbursement rates for certain nursing facilities.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2012-11-19 - Introduced, Referred to Assembly Budget Committee [A3469 Detail]
Download: New_Jersey-2012-A3469-Introduced.html
Sponsored by:
Assemblyman THOMAS P. GIBLIN
District 34 (Essex and Passaic)
Assemblywoman ANGELICA M. JIMENEZ
District 32 (Bergen and Hudson)
Co-Sponsored by:
Assemblywoman McHose and Assemblyman Chiusano
SYNOPSIS
Amends Fiscal Year 2013 annual appropriations act to prohibit application of budget adjustment factor when determining Medicaid reimbursement rates for certain nursing facilities.
CURRENT VERSION OF TEXT
As introduced.
An Act amending the Fiscal Year 2013 annual appropriations act, P.L.2012, c.18.
Be It Enacted by the Senate and the General Assembly of the State of New Jersey:
1. The following language provisions in section 1 of P.L.2012, c.18, the annual appropriations act for State Fiscal Year 2013, are amended to read as follows:
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54 DEPARTMENT OF HUMAN SERVICES 20 Physical and Mental health 26 Division of Aging Services GRANTS-IN-AID |
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20-7530 Medical Services for the Aged |
Notwithstanding the provisions of N.J.A.C.8:85 or any law or other regulation to the contrary, the amounts hereinabove appropriated for Payments for Medical Assistance Recipients - Nursing Homes and Global Budget for Long Term Care shall be conditioned upon the following: (1) the per diem rate for each nursing home shall not be less than the per diem rate last received by that facility for Fiscal Year 2012; [and] (2) monies designated pursuant to subsection c. of section 6 of P.L.2003, c.105 (C.26:2H-97) for distribution to nursing homes less the portion of those funds to be paid as pass-through payments in accordance with paragraph 1 of subsection d. of section 6 of P.L.2003, c.105 (C.26:2H-97) shall be combined with amounts hereinabove appropriated for Payments for Medical Assistance Recipients - Nursing Homes and Global Budget for Long Term Care for the purpose of Medicaid reimbursement to nursing facilities according to the rate setting methodology established in N.J.A.C.8:85. For the purposes of this paragraph, a nursing facility's per diem reimbursement rate shall not include, if the nursing facility is eligible for reimbursement, the difference between the full calculated provider tax add-on and the quality of care portion of the provider tax add-on; and (3) the Medicaid per diem reimbursement rate for a nursing facility shall not be subject to the budget adjustment factor pursuant to N.J.A.C.8:85-3.13 for a facility that has a Medicaid case mix occupancy rate of 80 percent or greater according to the most recent facility cost report and that would have a final reimbursement rate for Fiscal Year 2013 in the lowest one-third of all nursing facilities in the State receiving Medicaid reimbursement if the budget adjustment factor were applied. The budget adjustment factor shall only be applied to those nursing facilities not included in the group of facilities that have 80 percent or greater Medicaid case mix occupancy rates according to the most recent facility cost reports and that would have final reimbursement rates for Fiscal Year 2013 in the lowest one-third of all nursing facilities if the budget adjustment factor were applied.
(cf: P.L.2012, c.18, s.1)
2. This act shall take effect immediately and be retroactive to July 1, 2012.
STATEMENT
This bill concerns the distribution of Medicaid reimbursements for nursing facilities.
The bill amends language provisions in P.L.2012, c.18, the annual appropriations act for State Fiscal Year 2013, so that a budget adjustment factor is not applied to nursing facilities that have Medicaid case mix occupancy rates of at least 80 percent and final reimbursement rates that would be in the lowest one-third of all nursing facilities in the State receiving Medicaid reimbursement if the budget adjustment factor were applied uniformly. In order to offset the cost of these rate increases, the bill requires that the budget adjustment factor continue to be applied to those nursing facilities not included in the group of facilities that have Medicaid case mix occupancy rates of 80 percent or greater according to the most recent facility cost reports and that would have final reimbursement rates in the lowest one-third of all nursing facilities Statewide if the budget adjustment factor were applied.
The Fiscal Year (FY) 2013 annual appropriations act includes the following provisions regarding Medicaid funding for nursing facilities: 1) the per diem reimbursement rate for each nursing facility is not to be less than the per diem rate last received by that facility for FY 2012; and 2) per diem reimbursement rates for nursing facilities will otherwise be calculated according to the rate-setting methodology adopted in FY 2011 and codified under N.J.A.C.8:85-3.1 et seq. Under this methodology, a significant portion of the reimbursement rate for each nursing facility is determined by the facility's direct care costs and capital costs. The methodology also imposes a budget adjustment factor, which has the effect of further reducing reimbursement rates for many facilities so that total spending does not exceed the total amount available for nursing facility reimbursements.
Although the FY 2013 annual appropriations act increased State appropriations for nursing facility reimbursement rates by $15 million above the FY 2012 appropriations, this increase does not fully offset a $25 million reduction in State appropriations for reimbursement rates and other reductions that occurred in FY 2012. Under the State's current rate-setting methodology, certain nursing facilities have experienced reductions or limited growth in reimbursement rates since FY 2011 due to low direct care costs and capital costs, which affect the initial rate setting, and the budget adjustment factor, which further reduces reimbursement rates. Some of these facilities serve high proportions of Medicaid clients and cannot easily reconcile growing costs with reduced or flat reimbursement rates by shifting costs to non-Medicaid clients. This bill supports nursing facilities with low costs and high proportions of Medicaid clients by preventing the budget adjustment factor from being applied to those facilities.
