Bill Text: NJ S3587 | 2022-2023 | Regular Session | Introduced
Bill Title: Establishes Medicaid per diem rate for pediatric medical day care services delivered by provider offering on-site services; appropriates $3.6 million to DHS.
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Introduced - Dead) 2023-06-30 - Substituted by A5082 (3R) [S3587 Detail]
Download: New_Jersey-2022-S3587-Introduced.html
Sponsored by:
Senator JOSEPH A. LAGANA
District 38 (Bergen and Passaic)
SYNOPSIS
Establishes Medicaid per diem rate for pediatric medical day care services delivered by provider offering on-site services; appropriates $3.6 million to DHS.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning per diem rates for pediatric medical day care services, appropriating funds, 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. Notwithstanding any other provision of law or regulation to the contrary, the per diem reimbursement rate for pediatric medical day care services delivered by a pediatric medical day care provider offering on-site services shall be as follows:
(1) Upon the effective date of this act and continuing through June 30, 2023, the per diem reimbursement rate shall be $390.00. A provider that reopened for on-site services pursuant to the Department of Health Executive Directive No.22-001, which set forth the health and safety requirements for the reopening of a pediatric medical day care facility following the mandatory onsite closure of such facilities due to the onset of the coronavirus 2019 pandemic, on or before September 30, 2022 shall receive a retroactive per diem reimbursement for services delivered from July 1, 2022 through the effective date of this act that shall be equal to $390.00, less the per diem amount the provider has been reimbursed for those services rendered during this period of time; and
(2) Beginning July 1, 2023, and annually adjusted in each subsequent fiscal year, the per diem reimbursement rate shall be equal to 45 percent of the average prevailing Medicaid fee-for-service per diem rate for all pediatric skilled care nursing facilities in the State.
b. The provisions of this act shall apply to pediatric medical day care services provided under the Medicaid fee-for-service and managed care delivery systems.
c. As used in this section,
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Pediatric medical day care services" means a health care service designed to meet the medical, developmental, educational, nutritional and psycho-social needs of medically complex or technology-dependent children whose medical condition requires treatment and services beyond the scope provided to children with special health care needs by day care centers or preschool programs.
2. The Commissioner of
Human Services 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.
3. The Commissioner of Human Services shall adopt rules and regulations pursuant to the "Administrative Procedure Act" P.L.1968, c.410 (C.52:14B-1 et seq.) to effectuate the purposes of this act.
4. There is appropriated from the General Fund to the Department of Human Services the sum of $3,600,000 for payment to pediatric medical day care service providers in order to comply with the requirements of paragraph (1) of subsection a. of section 1 of this act.
5. This act shall take effect immediately.
STATEMENT
This bill sets a Medicaid fee-for-service (FFS) and managed care per diem rate for pediatric medical day care services and provides a supplemental appropriation to support the fiscal year (FY) 2023 rate established under the bill.
Providers of pediatric medical day care services deliver complex medical, developmental, educational and other socialization services to medically fragile children, thereby supporting a more normal developmental process for these children. These providers also allow parents of medically fragile children to participate in the workforce and to avoid the expense of a private duty nurse.
Currently, the FFS per diem rate for pediatric medical day care services is $330.81; however, this rate, along with the proprietary rates provided under managed care, have not been sufficient to support providers of this service. As a result, several pediatric medical day care facilities have closed, and many more have not reopened for on-site services following the issuance of the Department of Health's Executive Directive No. 22-001 on April 6, 2022, which rescinded the moratorium on on-site pediatric medical day care programs imposed by the department on March 20, 2020 at the start of the coronavirus 2019 pandemic.
This bill would increase the FY 2023 per diem rate to $390.00, effectively immediately upon the bill's adoption, for pediatric medical day care services delivered by a pediatric medical day care provider offering on-site services. Additionally, the bill directs that providers which reopened for on-site services on or before September 30, 2022 are to receive a retroactive per diem reimbursement for services delivered from July 1, 2022 through the effective date of the bill that is to be equal to $390.00, less the per diem amount the provider has been reimbursed for those services rendered during this period of time. The bill makes a supplemental appropriation of $3.6 million to the Department of Human Services for this increase in the reimbursement rate.
Additionally, beginning FY 2024, and annually adjusted in each subsequent fiscal year, the bill would establish a Medicaid per diem rate for pediatric medical day care services delivered by a pediatric medical day care provider offering on-site services equal to 45 percent of the average Medicaid fee-for-service per diem rate for in-patient pediatric skilled care nursing facilities. Currently, in FY 2023, 45 percent of the average Medicaid fee-for-service per diem rate for in-patient pediatric skilled care nursing facilities is equal to $390.50.
