Bill Text: NJ S2369 | 2022-2023 | Regular Session | Introduced
Bill Title: Establishes minimum NJ FamilyCare reimbursement rate for traumatic brain injury special care nursing facilities; establishes enhanced NJ FamilyCare reimbursement rate for nursing facilities under certain circumstances; makes an appropriation.
Spectrum: Bipartisan Bill
Status: (Passed) 2023-11-27 - Approved P.L.2023, c.181. [S2369 Detail]
Download: New_Jersey-2022-S2369-Introduced.html
Sponsored by:
Senator ROBERT W. SINGER
District 30 (Monmouth and Ocean)
SYNOPSIS
Establishes minimum NJ FamilyCare reimbursement rate for traumatic brain injury special care nursing facilities; establishes enhanced NJ FamilyCare reimbursement rate for nursing facilities under certain circumstances; makes an appropriation.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning NJ FamilyCare reimbursement rates for certain long-term care facilities, supplementing Title 30 of the Revised Statutes, and making an appropriation.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. As used in this act:
"Division" mean the Division of Medical Assistance and Health Services in the Department of Human Services.
"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.
"Nursing facility" means a long-term care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.), which has been approved by the Department of Human Services to provide care to NJ FamilyCare beneficiaries who require conventional nursing facility services.
"Special care nursing facility" means a nursing facility or a separate and distinct unit within a conventional nursing facility, licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.), which has been approved by the Department of Human Services to provide care to NJ FamilyCare beneficiaries who require specialized health care services beyond the scope of conventional nursing facility services.
"Traumatic brain injury" means an acquired injury to the brain, but does not include brain dysfunction caused by congenital or degenerative disorders, or birth trauma, but may include brain injuries caused by anoxia due to trauma.
"Traumatic brain injury unit" means an inpatient unit in special care nursing facility that provides services to NJ FamilyCare beneficiaries who require treatment for traumatic brain injuries.
2. The Division shall reimburse a special care nursing facility for services provided to a NJ FamilyCare beneficiary residing in a traumatic brain injury unit at a base per diem reimbursement rate that is $400 above the special care nursing facility's FY 2022 base per diem reimbursement rate in order to cover the higher staffing ratios required, and abundance of therapy services provided, in a traumatic brain injury unit. Issuance of the reimbursement rate established in this section shall require the special care nursing facility to be in compliance with all applicable State and federal laws and regulations concerning licensure, patient safety, and quality of care.
3. a. The Division shall reimburse a nursing facility for services provided to a NJ FamilyCare beneficiary residing in a single occupancy room at an enhanced per diem reimbursement rate equal to 150 percent of the nursing facility's base per diem reimbursement rate, provided that, on any date after the effective date of this act, the nursing facility voluntarily delicensed beds that were part of an unimplemented certificate of need in order to establish the single occupancy room in which the beneficiary resides.
b. Reimbursements received under this section by a nursing facility that are in excess of the facility's base per diem reimbursement rate shall be utilized by the facility for the following purposes:
(1) renovation costs to convert multiple occupancy rooms to single occupancy rooms;
(2) establishment and implementation of infection control policies and infrastructure, particularly for any remaining multi-occupancy rooms; and
(3) compensation for revenue losses due to the facility's decreased census.
c. Issuance of the enhanced reimbursement per diem rate established in subsection a. of this section shall be contingent upon the following:
(1) The nursing facility submits a proposed plan to, and receives approval from, the Department of Human Services and the Department of Health regarding the voluntary delicensing of beds. The plan shall include a description of the facility's use of reimbursement payments received under this section in excess of the facility's base rate; and
(2) The nursing facility is in compliance with applicable all State and federal laws and regulations concerning licensure, patient safety, and quality of care.
d. The Commissioners of Human Services and Health shall establish a method and manner for nursing facilities to submit plans, as required under paragraph (1) of subsection c. of this section. The evaluation of a nursing facility's plan shall include metrics for ensuring that the voluntary delicensing of beds at a nursing facility does not negatively affect the ability of the NJ FamilyCare program to provide nursing facility services to enrollees.
4. The Commissioner of Human Services and the Commissioner of Health shall adopt such rules and regulations, pursuant to the "Administrative Procedures Act," P.L.1968, c.410 (C.52:14B-1 et seq.), as shall be necessary to effectuate the provisions of this section.
5. The Commissioner of Human Services shall apply for such State plan amendments or waivers as shall be necessary to implement the provisions of this act and to ensure federal financial participation for State expenditures under the federal Medicaid program and the Children's Health Insurance Program.
6. There are appropriated from the General Fund to the Department of Human Services such sums as shall be necessary to effectuate the provisions of this act.
7. This act shall take effect on the first day of the second month next following the date of enactment, except the Commissioners of Human Services and Health may take any advance administrative action as shall be necessary for the implementation of this act.
STATEMENT
The bill increases the per diem reimbursement rate for certain nursing facilities under the NJ FamilyCare program and provides for an appropriation from the General Fund, in such amounts as is necessary, to support the rate increase. NJ FamilyCare is the State's public health insurance program for low-income individuals and families, and includes the State's Medicaid Program and the Children's Health Insurance Program.
First, the bill establishes a minimum NJ FamilyCare reimbursement rate for traumatic brain injury special care nursing facilities. A special care nursing facility is a State-licensed nursing facility which has been approved by the Department of Human Services to provide care to NJ FamilyCare beneficiaries who require specialized health care services beyond the scope of conventional nursing facility services. For the purpose of the bill, the health care services provided by the special care nursing facility are related to an acquired injury to the brain, also known as a traumatic brain injury.
Under the bill, the Division of Medical Assistance and Health Services (Division) in the Department of Human Services is required to reimburse a special care nursing facility for services provided to a NJ FamilyCare beneficiary residing in a traumatic brain injury unit at a base per diem reimbursement that is $400 above the special care nursing facility's FY 2022 base per diem reimbursement rate in order to cover the higher staffing ratios required, and abundance of therapy services provided, in a traumatic brain injury unit. Issuance of the reimbursement rate established in bill requires the special care nursing facility to be in compliance with all applicable State and federal laws and regulations concerning licensure, patient safety, and quality of care. The current reimbursement rate for such a facility is $340.01. Under the bill, the rate would increase to $740.01 per diem. This rate increase will align the reimbursement rate for traumatic brain injury special care nursing facilities with the reimbursement rate for other special care nursing facilities, which range from $402.84 to $946.51 per diem, with an average rate of $649.72 per diem.
Second, this bill establishes an enhanced NJ FamilyCare reimbursement rate for nursing facilities that voluntarily delicense beds that are part of an unimplemented certificate of need in order to create single occupancy rooms. This provision is in response to a report produced by Manatt Health that analyzed the factors that contributed to the large numbers of coronavirus disease 2019 (COVID-19) cases and deaths that occurred in nursing facilities in the early months of the COVID-19 pandemic. One of the recommendations included in the report was that nursing facilities improve their infection control policies and infrastructure by modernizing facilities with more single occupancy rooms. At the time of publication, the report noted that New Jersey had 370 nursing homes, with an 82 percent bed occupancy rate. Currently, 327 nursing facilities participate in NJ FamilyCare, with the majority receiving a per diem reimbursement rate ranging from $210 to 250. Under this bill, the per diem reimbursement rate for qualifying facilities would range from $315 to $375.
Under the bill, the Division is required to reimburse a nursing facility for services provided to a NJ FamilyCare beneficiary residing in a single occupancy room at an enhanced per diem reimbursement rate equal to 150 percent of the nursing facility's base per diem reimbursement rate, provided that, on any date after the effective date of the bill, the nursing facility voluntarily delicensed beds that were part of an unimplemented certificate of need in order to establish the single occupancy room in which the beneficiary resides. Reimbursements received by a nursing facility under the bill that are in excess of the facility's base rate are to be utilized by the facility for the following purposes: 1) renovation costs to convert multiple occupancy rooms to single occupancy rooms; 2) establishment and implementation of infection control policies and infrastructure, particularly for any remaining multi-occupancy rooms; and 3) compensation for revenue losses due to the facility's decreased census.
Issuance of the enhanced reimbursement per diem rate established under the bill is contingent upon the following:
1) The nursing facility submits a proposed plan to, and receives approval from, the Department of Human Services and the Department of Health regarding the voluntary delicensing of beds. The plan is to include a description of the facility's use of reimbursement payments received under this section in excess of the facility's base rate; and
2) The nursing facility is in compliance with all applicable State and federal laws and regulations concerning licensure, patient safety, and quality of care
The bill directs the Commissioners of Human Services and Health to establish a method and manner for nursing facilities to submit proposed plans, as required under the bill. The department's evaluation of a nursing facility's plan is to include metrics for ensuring that the voluntary delicensing of beds at a nursing facility does not negatively affect the ability of the NJ FamilyCare program to provide nursing facility services to enrollees.
