Bill Text: NJ S1961 | 2024-2025 | Regular Session | Introduced
Bill Title: Provides for presumptive eligibility for home and community-based services and services provided through program of all-inclusive care for the elderly under Medicaid.
Spectrum: Moderate Partisan Bill (Democrat 5-1)
Status: (Passed) 2024-01-09 - Withdrawn Because Approved P.L.2023, c.306. [S1961 Detail]
Download: New_Jersey-2024-S1961-Introduced.html
STATE OF NEW JERSEY
221st LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2024 SESSION
Sponsored by:
Senator JOSEPH F. VITALE
District 19 (Middlesex)
Senator GORDON M. JOHNSON
District 37 (Bergen)
Co-Sponsored by:
Senators Diegnan, Singer, Turner and Ruiz
SYNOPSIS
Provides for presumptive eligibility for home and community-based services and services provided through program of all-inclusive care for the elderly under Medicaid.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning presumptive eligibility for Medicaid home and community-based services and services provided through programs of all-inclusive care for the elderly, 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 provide for the presumptive eligibility for home and community-based services and services provided through PACE under Medicaid for an individual who is: seeking home and community-based services or PACE enrollment ; awaiting an eligibility determination for Medicaid and any applicable Medicaid waiver program offering home and community-based services or services provided through PACE; and likely to be financially and clinically eligible for Medicaid and any applicable Medicaid waiver program offering home and community-based services or services provided through PACE , as determined by the department.
b. The department shall provide Medicaid coverage for eligible home and community-based services or services provided through PACE to an individual who is granted presumptive eligibility pursuant to this section. Coverage provided under this subsection shall begin upon the receipt of an individual's request for services, pursuant to subsection c. of this section, and shall be terminated if the individual is determined clinically or financially ineligible for home and community-based services or services provided through PACE under Medicaid during the eligibility determination process.
c. An individual seeking presumptive eligibility for home and community-based services or services provided through PACE under Medicaid shall submit a request to the department in a manner and form as determined by the commissioner.
d. An individual granted presumptive eligibility pursuant to this section shall be required to submit a completed application for Medicaid and any applicable Medicaid waiver program offering home and community-based services or services provided through PACE no later than the end of the month following the month in which presumptive eligibility is granted.
e. A home and community-based services provider or PACE center shall be reimbursed for all Medicaid-eligible services rendered to an individual who has been granted presumptive eligibility pursuant to this section, regardless of whether the individual granted presumptive eligibility is determined clinically or financially ineligible for home and community-based services or services provided through PACE under Medicaid during the eligibility determination process.
f. The department shall provide each individual granted presumptive eligibility pursuant to this section a written notice explaining the terms and conditions of presumptive eligibility and the home and community-based services or services provided through PACE the individual will be eligible to receive.
g. The commissioner shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this section and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
h. As used in this section:
"Commissioner" means the Commissioner of Human Services.
"Department" means Department of Human Services.
"Eligibility determination" means the administrative process by which the Division of Medical Assistance and Health Services in the Department of Human Services or a county welfare agency reviews a beneficiary's income, financial resources, and circumstances relating to the beneficiary's application for benefits received under Medicaid or any applicable Medicaid waiver program offering home and community-based services or services provided through PACE.
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"PACE" means the program of all-inclusive care for the elderly as that term is defined in section 1 of P.L.1997, c.296 (C.26:2H-88).
2. The Commissioner of Human Services, in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt such rules and regulations as the commissioner deems necessary to carry out the provisions of this act.
3. This act shall take effect on the first day of the 18th month next following enactment, except that the Commissioner of Human Services may take any anticipatory administrative action in advance as shall be necessary for the implementation of this act.
STATEMENT
This bill requires the Department of Human Services (department) to provide for the presumptive eligibility for home and community-based services, nursing home services, and the program of all-inclusive care for the elderly (PACE) under Medicaid for an individual who is: seeking home and community-based services, nursing home care or PACE enrollment; awaiting an eligibility determination for Medicaid and any applicable Medicaid waiver program offering home and community-based services, nursing home services, or services provided through PACE; and likely to be financially and clinically eligible for Medicaid and any applicable Medicaid waiver program offering home and community-based services, nursing home services, or services provided through PACE as determined by the department.
The department will provide Medicaid coverage for eligible home and community-based services, nursing home services, services provided through PACE to an individual who is granted presumptive eligibility. Coverage will begin upon the receipt of an individual's request for services and will end if the individual is determined clinically or financially ineligible for home and community-based services, nursing home services, or services provided through PACE under Medicaid during the eligibility determination process.
An individual seeking presumptive eligibility for home and community-based services, nursing home services, or services provided through PACE under Medicaid will be required to submit a request to the department in a manner and form as determined by the Commissioner of Human Services (commissioner). An individual granted presumptive eligibility will be required to submit a completed application for Medicaid and any applicable Medicaid waiver program offering home and community-based services, nursing home services, or services provided through PACE no later than the end of the month following the month in which presumptive eligibility is granted. The department will provide each individual granted presumptive eligibility pursuant to this bill a written notice explaining the terms and conditions of presumptive eligibility and the home and community-based services, nursing home services, or services provided through PACE that the individual will be eligible to receive.
A home and community-based services provider, nursing home facility, or PACE center is to be reimbursed for all Medicaid-eligible services rendered to an individual who has been granted presumptive eligibility, regardless of whether the individual granted presumptive eligibility is determined clinically or financially ineligible for home and community-based services, nursing home services, or services provided through PACE under Medicaid during the eligibility determination process.
The commissioner will apply for such State plan amendments or waivers as may be necessary to implement the provisions of this bill and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
