Bill Text: NJ A3549 | 2014-2015 | Regular Session | Amended
Bill Title: Requires Medicaid managed care organizations to meet certain conditions prior to reducing reimbursement rates for personal care assistant services and home-based supportive care services.
Spectrum: Slight Partisan Bill (Democrat 8-3)
Status: (Introduced - Dead) 2014-12-18 - Substituted by S2284 (1R) [A3549 Detail]
Download: New_Jersey-2014-A3549-Amended.html
Sponsored by:
Assemblyman GARY S. SCHAER
District 36 (Bergen and Passaic)
Assemblywoman VALERIE VAINIERI HUTTLE
District 37 (Bergen)
Assemblyman JAY WEBBER
District 26 (Essex, Morris and Passaic)
SYNOPSIS
Requires Medicaid managed care organizations to meet certain conditions prior to reducing reimbursement rates for personal care assistant services and home-based supportive care services.
CURRENT VERSION OF TEXT
As reported by the Assembly Financial Institutions and Insurance Committee on December 4, 2014, with amendments.
An Act concerning Medicaid managed care organizations and supplementing Title 30 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Notwithstanding any law, rule, or regulation to the contrary:
a. A health maintenance organization that contracts with the Division of Medical Assistance and Health Services in the Department of Human Services to provide benefits under a managed care plan to persons who are eligible for Medicaid shall not reduce reimbursement rates for personal care assistant services or home-based supportive care services without meeting the requirements of this section.
b. Prior to any reduction in reimbursement rates for personal care assistant services or home-based supportive care services under the health maintenance organization's Medicaid managed care plan, the health maintenance organization shall be required to:
(1) meet 1[with a set] individually with each1 of 1the1 home health care providers that, in aggregate, deliver personal care assistant services or home-based supportive care services to no fewer than 25 percent of the total clients receiving personal care assistant services or home-based supportive care services under the managed care plan, when aggregating clients enrolled in the managed care plan across the set of home health care providers;
(2) discuss, at 1[any meetings] each individual meeting1 with home health care providers conducted pursuant to this subsection: the proposed reduction in provider reimbursement rates; and alternatives to the proposed reduction in provider reimbursement rates that maintain the quality of, and access to, care for affected clients; and
(3) provide written certification to the Director of the Division of Medical Assistance and Health Services in the Department of Human Services that includes the following: an assurance that the required meetings have been conducted with home health care providers pursuant to this subsection; the name of each home health care provider attending the required meetings; the number of clients receiving personal care assistant services or home-based supportive care services, under the managed care plan, from each home health care provider attending the required meetings; and the total number of clients receiving personal care assistant services or home-based supportive care services under the managed care plan.
c. The health maintenance organization shall not reduce reimbursement rates for personal care assistant services or home-
based supportive care services until 90 days after the date on which the written certification provided pursuant to subsection b. of this section is received by the Director of the Division of Medical Assistance and Health Services.
d. As used in this section:
"Health care service firm" means any person who operates a firm that employs individuals directly or indirectly for the purpose of assigning the employed individuals to provide health care or personal care services either directly in the home or at a care-giving facility as defined in P.L.2002, c.126 (C.34:8-45.1 et seq.).
"Home-based supportive care services" means Medicaid services by that name, or any similar Medicaid services, provided under: the New Jersey Global Options for Long-Term Care Waiver in effect as of October 1, 2011; the New Jersey Comprehensive Waiver in effect as of October 1, 2012; or any successor programs. Home-based supportive care services include, but are not limited to, services that provide assistance with: activities of daily living, such as bathing, dressing, toileting, transferring, eating, bed mobility, and locomotion; or instrumental activities of daily living, such as preparing meals, shopping, managing money, housework, laundry, medication administration, transportation, and mobility outside the home.
"Home health care provider" means any provider of personal care assistant services or home-based supportive care services, including, but not limited to, health care service firms.
"Medicaid" means the State Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Personal care assistant services" means Medicaid services that involve health-related tasks performed by a qualified individual in a beneficiary's home, under the supervision of a registered professional nurse, as certified by a physician in accordance with a beneficiary's written plan of care and as described in N.J.A.C.10:60-3.3.
2. This act shall take effect immediately, and shall apply to any contract that a health maintenance organization has entered into with the Division of Medical Assistance and Health Services in the Department of Human Services to provide benefits under a managed care plan to persons who are eligible for medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.) which is in effect on the effective date of this act or executed thereafter.
