Bill Text: NJ A4169 | 2014-2015 | Regular Session | Chaptered

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Bill Title: Requires DHS to monitor utilization and billing of services for Medicaid home and community-based long-term care.

Spectrum: Partisan Bill (Democrat 12-0)

Status: (Passed) 2015-11-09 - Approved P.L.2015, c.153. [A4169 Detail]

Download: New_Jersey-2014-A4169-Chaptered.html

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§1 -

C.30:4D-17.38

§2 - Note

 

P.L.2015, CHAPTER 153, approved November 9, 2015

Assembly, No. 4169 (Second Reprint)

 

 

An Act concerning monitoring of long-term care 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 monitor the services provided to an individual receiving services under the Medicaid Managed Long Term Services and Supports section 1115 demonstration waiver ²[program or any other Medicaid home and community-based services long-term care program]², in accordance with this section.

     b.    In the case of an individual who receives services under one of these programs through a managed care organization, the department shall ¹[perform a monthly review] ²[implement a monitoring program which shall include, but not be limited to, quarterly case file audits and quarterly reviews¹] annually perform a review of a sample² of the ¹[number of encounters the individual has had with the managed care organization, as compared with the services authorized for the individual by the program] ²[consistency of an individual's assessment with a service authorization for the indivdual¹] number of encounters the individual has had with the managed care organization in a given month, as compared with the services authorized for the individual by the program², to help ensure efficient utilization of services from the managed care organization.

     c.     In the case of an individual who receives services under one of these programs through a provider whose claims are processed by a third-party billing agent, the department shall require the third party-billing agent to ²annually² perform a ²[monthly]² review of ²a sample of² the provider's billing limits and ²[of]² the services provided to the individual, to help ensure that:  services are provided if those services are authorized for the individual by the program; and claims are processed if those claims do not exceed the billing limits authorized for the individual by the program.
     2.    This act shall take effect on the first day of the ²[fourth] thirteenth² month next following the date of enactment, except the Commissioner of Human Services may take any anticipatory administrative action in advance as shall be necessary for the implementation of this act.

 

 

                                

 

     Requires DHS to monitor utilization and billing of services for Medicaid home and community-based long-term care.