Bill Text: NJ S2754 | 2012-2013 | Regular Session | Introduced
Bill Title: Establishes "New Jersey Structured Family Caregiving Program" as Medicaid demonstration project.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2013-05-13 - Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee [S2754 Detail]
Download: New_Jersey-2012-S2754-Introduced.html
Sponsored by:
Senator BRIAN P. STACK
District 33 (Hudson)
SYNOPSIS
Establishes "New Jersey Structured Family Caregiving Program" as Medicaid demonstration project.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning long-term care services for certain Medicaid recipients and supplementing P.L.1968, c.413 (C.30:4D-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. As used in this act:
"Commissioner" means the Commissioner of Human Services.
"Division" means the Division of Medical Assistance and Health Services in the Department of Human Services.
"Home" means a Medicaid recipient's private residence, including a room, house, apartment, or other premises, but does not include: a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.); a rooming or boarding house, the owner or operator of which is licensed pursuant to P.L.1979, c.496 (C.55:13B-1 et seq.); or any other public or private institution.
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
2. a. The Division of Medical Assistance and Health Services in the Department of Human Services, subject to federal approval and the availability of federal financial participation under Title XIX of the Social Security Act, shall establish a three-year Medicaid demonstration project as provided in this act.
(1) The demonstration project shall be known as the "New Jersey Structured Family Caregiving Program."
(2) The demonstration project shall be designed to ensure that the costs to Medicaid of providing coverage to a Medicaid recipient under the project do not exceed the costs that would be incurred by Medicaid for the recipient in a nursing home.
(3) The Commissioner of Human Services may contract with an independent entity to operate the demonstration project in collaboration with the division.
(4) The commissioner shall determine the county or counties in which the demonstration project is to operate.
(5) The demonstration project shall be developed and implemented in consultation with the managed care organizations that contract with the Medicaid program to provide health care services to Medicaid recipients or with other appropriate entities that contract with Medicaid to provide health care services to recipients of general public assistance pursuant to P.L.1947, c.156 (C.44:8-107 et seq.).
b. The demonstration project shall provide Medicaid coverage for long-term care services to a Medicaid recipient in the recipient's home in accordance with the provisions of this subsection.
(1) A Medicaid recipient shall not be eligible to receive services under the demonstration project unless that person has been determined by Medicaid to: require significant assistance with activities of daily living; be clinically and functionally qualified for placement in a nursing home; and otherwise eligible for Medicaid coverage of long-term care services only in a nursing home.
(2) Each Medicaid recipient participating in the demonstration project shall be assigned a caregiver, who may be a member of the recipient's immediate or extended family and shall reside in the recipient's home on a full-time basis during the demonstration project.
(3) A person selected as a caregiver to a Medicaid recipient shall meet such screening and credentialing requirements, including, but not limited to, a criminal history record background check, competency assessment, reference check, training, and caregiving requirements, as the commissioner prescribes by regulation, which requirements shall apply equally to a relative or non-relative of the recipient.
(4) A person selected as a caregiver shall assume such responsibilities for the purposes of the demonstration project as the commissioner shall prescribe by regulation or otherwise require and as are provided for in the plan of care developed for the Medicaid recipient pursuant to paragraph (6) of this subsection, which shall include, but not be limited to, any or all of the following: bathing, toileting, transferring, dressing, grooming, and feeding the Medicaid recipient, or assisting therewith; assisting the Medicaid recipient with the administration of medication and ambulation, exercise, and other aspects of personal hygiene; and homemaker services such as shopping, laundry, housekeeping, and meal preparation.
(5) The caregiver shall receive a stipend in such an amount as the commissioner determines necessary to meet the caregiver's responsibilities pursuant to paragraph (4) of this subsection.
(6) Each Medicaid recipient shall be assigned a care management team that includes a registered nurse and a licensed social worker. The care management team shall develop an initial plan of care for the recipient, and shall modify that plan on an ongoing basis as the care management team determines necessary for the recipient's welfare.
(7) The care management team shall provide continuous clinical, social, and emotional support for, and oversight of, participating caregivers to ensure compliance with each recipient's care plan, including, but not limited to, daily electronic communications, frequent telephone contact, scheduled and unscheduled visits to the recipient's home, coordination with the recipient's physician and other health care professionals providing services to the recipient, and respite care.
3. The Director of the Division of Medical Assistance and Health Services shall evaluate the demonstration project annually to assess whether the demonstration project has achieved its objectives in accordance with the provisions of subsection b. of section 2 of this act.
4. The commissioner, no later than six months after the effective date of this act, shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
5. The commissioner shall report annually to the Governor, and to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), on the results of the demonstration project, and shall include in that report the commissioner's findings and recommendations based upon those results.
6. The commissioner, 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.
7. This act shall take effect on the first day of the seventh month next following the date of enactment and shall expire three years after the date that the division commences implementation of the demonstration project, but the commissioner may take such anticipatory administrative action in advance thereof as shall be necessary for the implementation of this act.
STATEMENT
This bill establishes a three-year Medicaid demonstration project, which will be known as the "New Jersey Structured Family Caregiving Program," subject to federal approval and the availability of federal financial participation for State Medicaid expenditures under the federal Medicaid program.
The demonstration project will be designed to ensure that the costs to Medicaid of providing coverage to a Medicaid recipient for long-term care services under the project do not exceed the costs that would be incurred by Medicaid for the recipient in a nursing home.
The Commissioner of Human Services may contract with an independent entity to operate the demonstration project in collaboration with the Division of Medical Assistance and Health Services (DMAHS). The commissioner is to determine the county or counties in which the demonstration project will operate.
A Medicaid recipient will not be eligible to receive services under the demonstration project unless that person has been determined by Medicaid to: require significant assistance with activities of daily living; be clinically and functionally qualified for placement in a nursing home; and otherwise eligible for Medicaid coverage of long-term care services only in a nursing home.
Each Medicaid recipient participating in the demonstration project is to be assigned a caregiver, who may be a member of the recipient's immediate or extended family, and who will reside in the recipient's home on a full-time basis during the demonstration project.
A person selected as a caregiver to a Medicaid recipient: must meet such screening and credentialing requirements as the commissioner prescribes, which requirements will apply equally to a relative or non-relative of the recipient; is to assume such caregiving responsibilities for the purposes of the demonstration project as the commissioner requires and as are provided for in the plan of care developed for the Medicaid recipient; and will receive a stipend in such an amount as the commissioner determines necessary to meet the person's caregiving responsibilities.
Each Medicaid recipient in the demonstration project will be assigned a care management team that includes a registered nurse and a licensed social worker. The care management team will develop an initial plan of care for the recipient and modify that plan as the team determines necessary for the recipient's welfare. The care management team is to provide continuous support for, and oversight of, participating caregivers to ensure compliance with each recipient's care plan.
The Director of DMAHS is to evaluate the demonstration project annually, in order to assess whether it has achieved its objectives in accordance with the provisions of the bill.
The commissioner, no later than six months after the effective date of the bill, is to apply for such State plan amendments or waivers as may be necessary to implement the provisions of the bill and to secure federal financial participation for State Medicaid expenditures under the demonstration project. In addition, the commissioner is to report annually to the Governor and the Legislature on the results of the demonstration project, and to include in that report the commissioner's findings and recommendations based upon those results.
The bill takes effect on the first day of the seventh month following enactment and expires three years after the date that DMAHS commences implementation of the demonstration project, but authorizes the commissioner to take prior administrative action as necessary for its implementation.
