Bill Text: NJ A4084 | 2020-2021 | Regular Session | Introduced
Bill Title: Clarifies DHS authority over sober living homes, and requires certain sober living homes to be dedicated for use by persons in substance use recovery who have other mental health disorders.
Spectrum: Slight Partisan Bill (Republican 2-1)
Status: (Introduced - Dead) 2020-05-07 - Introduced, Referred to Assembly Human Services Committee [A4084 Detail]
Download: New_Jersey-2020-A4084-Introduced.html
Sponsored by:
Assemblyman RONALD S. DANCER
District 12 (Burlington, Middlesex, Monmouth and Ocean)
SYNOPSIS
Clarifies DHS authority over sober living homes, and requires certain sober living homes to be dedicated for use by persons in substance use recovery who have other mental health disorders.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning the regulation and categorization of sober living homes, and amending various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 2 of P.L.1975, c.305 (C.26:2B-8) is amended to read as follows:
2. [The following words as] As used in P.L.1975, c.305 (C.26:2B-7 et seq.) [shall, unless the context requires otherwise, have the following meanings]:
"Administrator" means the person in charge of the operation of a facility, or his designee.
"Admitted" means accepted for treatment at a facility.
"Alcoholic" means a person with an alcohol use disorder, as defined in this section.
"Authorized persons" means persons who serve as volunteer first aid or ambulance squad members, para-professional medical personnel, and rehabilitated persons with alcohol use disorder.
"Commissioner" means the Commissioner of [Health] Human Services.
"Department" means the Department of [Health] Human Services.
"Director" means the Director of the Division of [Alcoholism] Mental Health and Addiction Services.
"Division" means the Division of [Alcoholism] Mental Health and Addiction Services in the Department of Human Services.
"Facility" means any public[,] or private place, or portion thereof [providing] , which provides services especially designed for the treatment of intoxicated persons or the treatment or recovery of persons with an alcohol use disorder[;], including, but not limited to, intoxication treatment centers, inpatient treatment facilities, outpatient treatment facilities, and residential aftercare facilities such as transitional sober living homes, otherwise known as recovery residences, and halfway houses.
"Incapacitated" means the condition of a person who [is: a.], as a result of the use of alcohol[,] : is unconscious or has judgment so impaired that the person is incapable of realizing, and making a rational decision with respect to, the person's need for treatment [, b.]; is in need of substantial medical attention[,]; or [c.] is likely to suffer substantial physical harm.
"Independent physician" means a physician other than one holding an office or appointment in any department, board, or agency of the State, or in any public facility.
"Intoxicated person" means a person whose mental or physical functioning is substantially impaired as a result of the use of alcoholic beverages.
"Patient" means any person admitted to a facility.
"Person with an alcohol use disorder" means any person who chronically, habitually, or periodically consumes alcoholic beverages to the extent that: [a.] such use substantially injures the person's health or substantially interferes with the person's social or economic functioning in the community on a continuing basis[,]; or [b.] the person has lost the power of self-control with respect to the use of such beverages.
"Private facility" means a facility other than one operated by the federal government, the State of New Jersey, or any political subdivision thereof.
"Public facility" means a facility operated by the State of New Jersey or any political subdivision thereof.
"Recovery" means a period of time, following the completion of treatment for an alcohol use disorder, during which a patient receives transitional care, support, and sober housing to facilitate the patient's successful transition back into the community-at-large as a sober individual.
"Treatment" means services and programs for the care or rehabilitation of intoxicated persons and persons with an alcohol use disorder, including, but not limited to, medical, psychiatric, psychological, vocational, educational, recreational, and social services and programs. "Treatment" does not include services and programs that are provided for the transitional care or housing of a patient who is in recovery from an alcohol use disorder, following the receipt of treatment therefor.
(cf: P.L.2017, c.131, s.70)
2. Section 6 of P.L.1975, c.305 (C.26:2B-12) is amended to read as follows:
6. a. The department shall take cognizance of all matters affecting alcohol use disorder in the State, and shall establish and conduct a program for the treatment of intoxicated persons and persons with an alcohol use disorder.
The program may encourage the regionalization of services and, if not otherwise available, shall provide for the following facilities, which need not be separately located:
[a.] (1) Intoxication treatment centers, which centers shall render emergency medical care, including detoxification, shall be open 24 hours every day, and shall be located conveniently near population centers. Services shall be provided for the immediate physical and social needs, including the needs for medication and shelter, of intoxicated persons, and shall also provide for initial examination, diagnosis, and referral. To the extent possible, such treatment centers shall be affiliated with a general or other hospital.
[b.] (2) Inpatient facilities[,] for treatment of persons with an alcohol use disorder, which shall, to the extent possible, be affiliated with the medical service of a general hospital, mental hospital, community mental health center, or other hospital.
[c.] (3) Outpatient facilities for treatment of persons with an alcohol use disorder.
[d.] (4) Residential aftercare facilities, such as halfway houses or transitional sober living homes, which provide community housing and support to persons in recovery from an alcohol use disorder who do not have any other documented co-occurring mental health disorders; and
(5) Residential aftercare facilities, such as halfway houses or transitional sober living homes, which provide community housing and support to persons in recovery from an alcohol use disorder who have at least one other documented co-occurring mental health disorder.
b. The department shall maintain, supervise, and control all facilities operated by it pursuant to P.L.1975, c.305 (C.26:2B-7 et seq.), and all such facilities shall be staffed with an adequate number of qualified and trained personnel. The department shall require at least one mental health care professional to be on-call or on-site, at all times, at any residential aftercare facility operating under paragraph (5) of subsection a. of this section, which provides services to recovering alcoholics who have other documented co-occurring mental health disorders.
c. The administrator of each [such] facility shall make an annual report of its activities to the director in such manner and form as the director may deem appropriate. All appropriate resources, particularly community mental health centers, shall [whenever possible] be utilized in, and coordinated with, the program whenever possible.
d. [Services] (1) Recovery services delivered by the department pursuant to P.L.1975, c.305 (C.26:2B-7 et seq.) shall not be administered on the premises of any institution that is operated, in whole or in part, by the Department of Institutions and Agencies.
(2) Treatment services delivered by the department pursuant to P.L.1975, c.305 (C.26:2B-7 et seq.) may be administered on the premises of [institutions] an institution that is operated, in whole or in part, by the [department of institutions and agencies. Such] Department of Institutions and Agencies, except that any such treatment services shall be administered [as such services are] in the same way that they are administered in the other facilities of the department, and shall, in all respects, be therapeutic in nature rather than penal or correctional.
e. The department shall annually prepare [and], publish [annually], and post at a publicly accessible location on its Internet website, a list of all [services] facilities operating in accordance with P.L.1975, c.305 (C.26:2B-7 et seq.), which remain in good standing with the department, and shall make a hard copy of the list available, upon request, to members of the public. The department shall notify all law enforcement agencies and judges in the State of the location and capacity of intoxication treatment centers and other [services] facilities operating in accordance with [this act] P.L.1975, c.305 (C.26:2B-7 et seq.), which are situated in or near their jurisdictions.
(cf: P.L.2017, c.131, s.73)
3. Section 2 of P.L.1970, c.334 (C.26:2G-22) is amended to read as follows:
2. As used in this act:
"Commissioner" means the Commissioner of Human Services.
"Department" means the Department of Human Services.
"Narcotic drug" means any narcotic, drug, or dangerous controlled substance, as defined in any law of the State of New Jersey or of the United States.
"Narcotic [and substance] drug use disorder treatment or recovery center" means any public or private establishment, facility, or institution, [public or private,] whether operated for profit or not, which primarily offers, or purports to offer, maintain, or operate facilities for the residential or outpatient diagnosis, care, treatment, [or] rehabilitation , or transitional sober living and recovery of two or more nonrelated individuals[,] who are patients as defined herein[, excluding, however,] . "Narcotic drug use disorder treatment or recovery center" does not include any hospital or mental hospital otherwise licensed [by] pursuant to Title 30 of the Revised Statutes.
"Patient" means a person who is addicted to, or otherwise has a physical or mental impairment from the use of, narcotic drugs , or who is in recovery from such addiction or physical or mental suffering, and who requires the continuing care of a narcotic [and substance] drug use disorder treatment or recovery center.
["Narcotic drug" means any narcotic, drug, or dangerous controlled substance, as defined in any law of the State of New Jersey or of the United States.
"Commissioner" means the Commissioner of Health.]
"Person with a narcotic drug use disorder" means any person who chronically, habitually, or periodically consumes narcotic drugs to the extent that: such use substantially injures the person's health or substantially interferes with the person's social or economic functioning in the community on a continuing basis; or the person has lost the power of self-control with respect to the use of such narcotic drugs.
"Recovery" means a period of time, following the completion of treatment for narcotic drug use disorder, during which a patient receives transitional care, support, and sober housing to facilitate the patient's successful transition back into the community-at-large as a sober individual.
"Treatment" means services and programs for the care or rehabilitation of persons with a narcotic drug use disorder, including, but not limited to, medical, psychiatric, psychological, vocational, educational, recreational, and social services and programs. "Treatment" does not include services and programs that are provided for the transitional care, support, or housing of a patient who is in recovery from a narcotic drug use disorder, following the receipt of treatment therefor.
(cf: P.L.2017, c.131, s.88)
4. Section 3 of P.L.1970, c.334 (C.26:2G-23) is amended to read as follows:
3. No narcotic [and substance] drug use disorder treatment or recovery center shall operate within this State, except pursuant to a certificate of approval obtained from the commissioner[,] upon application made therefor. Such application shall be made upon forms furnished by the commissioner[,] and shall set forth the location of the narcotic [and substance] drug use disorder treatment or recovery center, the person in charge thereof, and the facilities for caring for patients who may seek treatment or engage in recovery therein. The applicant shall be required to furnish evidence of its ability to comply with minimum standards established hereunder, and of the good moral character of the applicant and the person in charge of the narcotic [and substance] drug use disorder treatment or recovery center. Any change in the facts set forth in the application shall be reported to the commissioner within 10 days after the occurrence thereof.
(cf: P.L.2017, c.131, s.89)
5. Section 4 of P.L.1970, c.334 (C.26:2G-24) is amended to read as follows:
4. a. Upon receipt of an application for a certificate of approval, the commissioner shall cause an investigation to be made of the applicant and the facilities, and shall issue a certificate of approval if it is found that the applicant is of good moral character, and that the facilities comply with the provisions of [this act] P.L.1970, c.334 (C.26:2G-21 et seq.), and [with] the regulations and standards [required] adopted by the commissioner pursuant hereto. The certificate of approval shall not be transferable or assignable or applicable to any premises or proprietor other than those specified therein. The certificate shall be conspicuously displayed within the narcotic [and substance] drug use disorder treatment or recovery center at all times.
b. The department shall annually prepare, publish, and post at a publicly accessible location on its Internet website, a list of all narcotic drug use disorder treatment or recovery centers operating in accordance with P.L.1970, c.334 (C.26:2G-21 et seq.), which remain in good standing with the department, and shall make a hard copy of the list available, upon request, to members of the public.
(cf: P.L.2017, c.131, s.90)
6. Section 5 of P.L.1970, c.334 (C.26:2G-25) is amended to read as follows:
5. a. The commissioner shall adopt, amend, promulgate and enforce such rules, regulations, and minimum standards for the treatment of patients of narcotic [and substance] drug use disorder treatment or recovery centers, as may be reasonably necessary to accomplish the purposes of P.L.1970, c.334 (C.26:2G-21 et seq.). Such narcotic [and substance] drug use disorder treatment or recovery centers may be classified into two or more classes with appropriate rules, regulations, and minimum standards for each such class. The department's facility classification system shall account for all types of narcotic drug use disorder treatment or recovery centers, including, but not limited to:
(1) facilities that provide patients with detoxification, medication-assisted treatment, or other intensive or emergency-level treatment for a narcotic drug use disorder on an inpatient basis;
(2) facilities that provide patients with detoxification, medication-assisted treatment, or other treatment for a narcotic drug use disorder on an outpatient basis;
(3) residential aftercare facilities, such as halfway houses and transitional sober living homes, which help persons who are in recovery from a substance use disorder, and who have no other co-occurring mental health disorders, make a successful and sober transition back into the community-at-large following their successful completion of treatment for a substance use disorder; and
(4) residential aftercare facilities, such as halfway houses and transitional sober living homes, which help persons who are in recovery from a substance use disorder, and who have one or more co-occurring mental health disorders, make a successful recovery and sober transition back into the community-at-large following their successful completion of treatment for a substance use disorder.
b. [No] A narcotic [or drug abuse] and substance use disorder treatment or recovery center, including, but not limited to, a transitional sober living home, halfway house, or other residential aftercare facility, shall not be permitted to deny admission to a prospective client on the basis that the person is currently receiving medication assisted treatment for a substance use disorder administered by a licensed treatment provider, including but not limited to methadone, buprenorphine, naltrexone, or any other medication approved by the Food and Drug Administration for the treatment of a substance use disorder.
c. The rules and regulations adopted pursuant to this section shall, at a minimum[,]:
(1) require at least one licensed mental health care professional to be on-call or on-site, at all times, at any transitional sober living home, halfway house, or other residential aftercare facility categorized under paragraph (4) of subsection a. of this section, which provides services to persons in recovery who have other documented co-occurring mental health disorders; and
(2) require a transitional sober living home, halfway house, or other residential aftercare facility categorized under either paragraph (3) or (4) of subsection a. of this section to provide notice to a patient's spouse, parent, legal guardian, designated next of kin, or other designated emergency contact, whenever the patient voluntarily withdraws, or is involuntarily evicted from, such facility, provided that: [(1)] (a) such notice is provided in a manner that is consistent with federal requirements under 42 CFR Part 2 and federal HIPAA requirements under 45 CFR Parts 160 and 164; and [(2)] (b) the patient, if an adult, has not withheld consent for such notice or expressly requested that notification not be given. If a patient who is not incapacitated withholds consent for [such] the notice that is to be provided under this paragraph, or expressly requests that such notification not be given, the department shall require the patient's wishes to be respected, unless the patient is a minor child or adolescent, in which case, the department shall require the minor's parent, legal guardian, designated next of kin, or other designated emergency contact to be notified, provided that such notification is not inconsistent with, and would not violate, federal requirements under 42 CFR Part 2 and federal HIPAA requirements under 45 CFR Parts 160 and 164.
(cf: P.L.2017, c.256, s.2)
7. Section 8 of P.L.1970, c.334 (C.26:2G-28) is amended to read as follows:
8. Any person, firm, corporation, partnership, society or association who shall operate or conduct a narcotic [and substance] drug use disorder treatment or recovery center without first obtaining the certificate of approval required by [this act] P.L.1970, c.334 (C.26:2G-21 et seq.), or who shall operate such establishment after revocation or suspension of a certificate of approval, shall be liable to a penalty of $25 for each day of operation in violation hereof for the first offense, and, for any subsequent offense, shall be liable to a penalty of $50 for each day of operation in violation hereof.
The penalties authorized by this section shall be recovered in a summary proceeding instituted by the Attorney General, at the request of the commissioner, pursuant to the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.). Money penalties, when recovered, shall be payable to the General State Fund.
(cf: P.L.2017, c.131, s.92)
8. Section 9 of P.L.1970, c.334 (C.26:2G-29) is amended to read as follows:
9. The commissioner may, in the manner provided by law, maintain an action in the name of the State of New Jersey for injunctive relief against any person, firm, corporation, partnership, society or association, which is continuing to conduct, manage, or operate a narcotic [and substance] drug use disorder treatment or recovery center without a certificate of approval, or after suspension or revocation of such certificate.
(cf: P.L.2017, c.131, s.93)
9. Section 1 of P.L.1982, c.149 (C.26:2H-11.1) is amended to read as follows:
1. In the case of an application for a certificate of need or initial licensure, as applicable, for a narcotic [and] drug [abuse] use disorder treatment or recovery center to be located within 500 feet from any building in this State used for the instruction of children between the ages of five and 18 years, the applicant shall notify the governing body of the municipality within which the applicant proposes to locate the treatment or recovery center of the applicant's intention to apply for the certificate of need or licensure and the proposed location of the center. Documentation of the notice shall be filed with the certificate of need or license application. The Commissioner of Health is hereby authorized to adopt reasonable rules and regulations, in accordance with the provisions of the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to effectuate the purposes of this [act] section. [For the purposes of] As used in this [act, the definition of] section, "narcotic [and] drug [abuse] use disorder treatment or recovery center" [shall be identical to the definition in subsection (a) of] means the same as that term is defined by section 2 of P.L.1970, c.334 (C.26:2G-22). [This act] The provisions of this section shall not apply to any narcotic [and] drug [abuse] use disorder treatment or recovery center for which an application was filed prior to the effective date of this [act] section.
(cf: P.L.2012, c.17, s.177)
10. Section 6 of P.L.1968, c.413 (C.30:4D-6) is amended to read as follows:
6. a. Subject to the requirements of Title XIX of the federal Social Security Act[,] and the limitations imposed by [this act] P.L.1968, c.413 (C.30:4D-1 et seq.) and [by] the rules and regulations promulgated pursuant thereto, the department shall provide medical assistance to qualified applicants, including authorized services within each of the following classifications:
(1) Inpatient hospital services;
(2) Outpatient hospital services;
(3) Other laboratory and X-ray services;
(4) (a) Skilled nursing or intermediate care facility services;
(b) Early and periodic screening and diagnosis of individuals who are eligible under the program and are under age 21, to ascertain their physical or mental health status and the health care, treatment, and other measures to correct or ameliorate defects and chronic conditions discovered thereby, as may be provided in regulations of the Secretary of the federal Department of Health and Human Services and approved by the commissioner;
(5) Physician's services furnished in the office, the patient's home, a hospital, a skilled nursing, or intermediate care facility or elsewhere.
As used in this subsection, "laboratory and X-ray services" includes HIV drug resistance testing, including, but not limited to, genotype assays that have been cleared or approved by the federal Food and Drug Administration, laboratory developed genotype assays, phenotype assays, and other assays using phenotype prediction with genotype comparison, for persons diagnosed with HIV infection or AIDS.
b. Subject to the limitations imposed by federal law, by [this act] P.L.1968, c.413 (C.30:4D-1 et seq.), and by the rules and regulations promulgated pursuant thereto, the medical assistance program may be expanded to include authorized services within each of the following classifications:
(1) Medical care not included in subsection a.(5) above, or any other type of remedial care recognized under State law, furnished by licensed practitioners within the scope of their practice, as defined by State law;
(2) Home health care services;
(3) Clinic services;
(4) Dental services;
(5) Physical therapy and related services;
(6) Prescribed drugs, dentures, and prosthetic devices; and eyeglasses prescribed by a physician skilled in diseases of the eye or by an optometrist, whichever the individual may select;
(7) Optometric services;
(8) Podiatric services;
(9) Chiropractic services;
(10) Psychological services;
(11) Inpatient psychiatric hospital services for individuals under 21 years of age, or under age 22 if they are receiving such services immediately before attaining age 21;
(12) Other diagnostic, screening, preventive, and rehabilitative services, and other remedial care;
(13) Inpatient hospital services, nursing facility services, and intermediate care facility services for individuals 65 years of age or over in an institution for mental diseases;
(14) Intermediate care facility services;
(15) Transportation services;
(16) Services in connection with the inpatient or outpatient treatment or care of [substance], or recovery from, a drug use disorder, when [the treatment is] such services are prescribed by a physician [and], are provided in a licensed hospital or in a narcotic and substance use disorder treatment center approved by the Department of Health pursuant to P.L.1970, c.334 (C.26:2G-21 et seq.) and whose staff includes a medical director, and [limited to those services] are eligible for federal financial participation under Title XIX of the federal Social Security Act;
(17) Any other medical care and any other type of remedial care recognized under State law, specified by the Secretary of the federal Department of Health and Human Services, and approved by the commissioner;
(18) Comprehensive maternity care, which may include: the basic number of prenatal and postpartum visits recommended by the American College of Obstetrics and Gynecology; additional prenatal and postpartum visits that are medically necessary; necessary laboratory, nutritional assessment and counseling, health education, personal counseling, managed care, outreach, and follow-up services; treatment of conditions which may complicate pregnancy; doula care and physician or certified nurse-midwife delivery services. For the purposes of this paragraph, "doula" means a trained professional who provides continuous physical, emotional, and informational support to a mother before, during, and shortly after childbirth, to help her to achieve the healthiest, most satisfying experience possible;
(19) Comprehensive pediatric care, which may include: ambulatory, preventive, and primary care health services. The preventive services shall include, at a minimum, the basic number of preventive visits recommended by the American Academy of Pediatrics;
(20) Services provided by a hospice which is participating in the Medicare program established pursuant to Title XVIII of the Social Security Act, Pub.L.89-97 (42 U.S.C. s.1395 et seq.). Hospice services shall be provided subject to approval of the Secretary of the federal Department of Health and Human Services for federal reimbursement;
(21) Mammograms, subject to approval of the Secretary of the federal Department of Health and Human Services for federal reimbursement, including one baseline mammogram for women who are at least 35 but less than 40 years of age; one mammogram examination every two years or more frequently, if recommended by a physician, for women who are at least 40 but less than 50 years of age; and one mammogram examination every year for women age 50 and over;
(22) Upon referral by a physician, advanced practice nurse, or physician assistant of a person who has been diagnosed with diabetes, gestational diabetes, or pre-diabetes, in accordance with standards adopted by the American Diabetes Association:
(a) Expenses for diabetes self-management education or training to ensure that a person with diabetes, gestational diabetes, or pre-diabetes can optimize metabolic control, prevent and manage complications, and maximize quality of life. Diabetes self-management education shall be provided by an in-State provider who is:
(i) a licensed, registered, or certified health care professional who is certified by the National Certification Board of Diabetes Educators as a Certified Diabetes Educator, or certified by the American Association of Diabetes Educators with a Board Certified-Advanced Diabetes Management credential, including, but not limited to: a physician, an advanced practice or registered nurse, a physician assistant, a pharmacist, a chiropractor, a dietitian registered by a nationally recognized professional association of dietitians, or a nutritionist holding a certified nutritionist specialist (CNS) credential from the Board for Certification of Nutrition Specialists; or
(ii) an entity meeting the National Standards for Diabetes Self-Management Education and Support, as evidenced by a recognition by the American Diabetes Association or accreditation by the American Association of Diabetes Educators;
(b) Expenses for medical nutrition therapy as an effective component of the person's overall treatment plan upon a: diagnosis of diabetes, gestational diabetes, or pre-diabetes; change in the beneficiary's medical condition, treatment, or diagnosis; or determination of a physician, advanced practice nurse, or physician assistant that reeducation or refresher education is necessary. Medical nutrition therapy shall be provided by an in-State provider who is a dietitian registered by a nationally-recognized professional association of dietitians, or a nutritionist holding a certified nutritionist specialist (CNS) credential from the Board for Certification of Nutrition Specialists, who is familiar with the components of diabetes medical nutrition therapy;
(c) For a person diagnosed with pre-diabetes, items and services furnished under an in-State diabetes prevention program that meets the standards of the National Diabetes Prevention Program, as established by the federal Centers for Disease Control and Prevention; and
(d) Expenses for any medically appropriate and necessary supplies and equipment recommended or prescribed by a physician, advanced practice nurse, or physician assistant for the management and treatment of diabetes, gestational diabetes, or pre-diabetes, including, but not limited to: equipment and supplies for self-management of blood glucose; insulin pens; insulin pumps and related supplies; and other insulin delivery devices;
(23) Expenses incurred for the provision of group prenatal care services to a pregnant woman, provided that:
(a) the provider of such services, which shall include, but not be limited to, a federally qualified health center or a community health center operating in the State:
(i) is a site accredited by the Centering Healthcare Institute, or is a site engaged in an active implementation contract with the Centering Healthcare Institute, that utilizes the Centering Pregnancy model; and
(ii) incorporates the applicable information outlined in any best practices manual for prenatal and postpartum maternal care developed by the Department of Health into the curriculum for each group prenatal visit;
(b) each group prenatal care visit is at least 1.5 hours in duration, with a minimum of two women and a maximum of 20 women in participation; and
(c) no more than 10 group prenatal care visits occur per pregnancy.
As used in this paragraph, "group prenatal care services" means a series of prenatal care visits provided in a group setting, which are based upon the Centering Pregnancy model developed by the Centering Healthcare Institute, and which include health assessments, social and clinical support, and educational activities; and
(24) Expenses incurred for the provision of pasteurized donated human breast milk, which shall include human milk fortifiers if indicated in a medical order provided by a licensed medical practitioner, to an infant under the age of six months; provided that the milk is obtained from a human milk bank that meets quality guidelines established by the Department of Health and a licensed medical practitioner has issued a medical order for the infant under at least one of the following circumstances:
(a) the infant is medically or physically unable to receive maternal breast milk or participate in breast feeding, or the infant's mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breast feeding despite optimal lactation support; or
(b) the infant meets any of the following conditions:
(i) the infant has a body weight below healthy levels, as determined by the licensed medical practitioner issuing the medical order for the infant;
(ii) the infant has a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or
(iii) the infant has a congenital or acquired condition that may benefit from the use of donor breast milk and human milk fortifiers, as determined by the Department of Health.
c. Payments for the foregoing services, goods, and supplies furnished pursuant to [this act] P.L.1968, c.413 (C.30:4D-1 et seq.), shall be made to the extent authorized by [this act,] P.L.1968, c.413 (C.30:4D-1 et seq.) and the rules and regulations promulgated pursuant thereto, and, where applicable, shall be subject to the agreement of insurance provided for under [this act] P.L.1968, c.413 (C.30:4D-1 et seq.). The payments shall constitute payment in full to the provider on behalf of the recipient. Every provider making a claim for payment pursuant to [this act] P.L.1968, c.413 (C.30:4D-1 et seq.) shall certify in writing on the claim submitted that no additional amount will be charged to the recipient, the recipient's family, the recipient's representative, or others on the recipient's behalf for the services, goods, and supplies furnished pursuant to [this act] P.L.1968, c.413 (C.30:4D-1 et seq.).
No provider whose claim for payment pursuant to [this act] P.L.1968, c.413 (C.30:4D-1 et seq.) has been denied because the services, goods, or supplies were determined to be medically unnecessary shall seek reimbursement from the recipient, his family, his representative, or others on his behalf for such services, goods, and supplies provided pursuant to [this act] P.L.1968, c.413 (C.30:4D-1 et seq.); provided, however, that a provider may seek reimbursement from a recipient for services, goods, or supplies not authorized by [this act,] P.L.1968, c.413 (C.30:4D-1 et seq.) if the recipient elected to receive the services, goods, or supplies with the knowledge that they were not authorized.
d. Any individual eligible for medical assistance (including drugs) may obtain such assistance from any person qualified to perform the service or services required (including an organization which provides such services, or arranges for their availability on a prepayment basis), who undertakes to provide the individual such services.
No copayment or other form of cost-sharing shall be imposed on any individual eligible for medical assistance, except as mandated by federal law as a condition of federal financial participation.
e. Anything in [this act] P.L.1968, c.413 (C.30:4D-1 et seq.) to the contrary notwithstanding, no payments for medical assistance shall be made under [this act] P.L.1968, c.413 (C.30:4D-1 et seq.) with respect to care or services for any individual who:
(1) Is an inmate of a public institution (except as a patient in a medical institution); provided, however, that an individual who is otherwise eligible may continue to receive services for the month in which he becomes an inmate, should the commissioner determine to expand the scope of Medicaid eligibility to include such an individual, subject to the limitations imposed by federal law and regulations, or
(2) Has not attained 65 years of age and [who] is a patient in an institution for mental diseases, or
(3) Is over 21 years of age and [who] is receiving inpatient psychiatric hospital services in a psychiatric facility; provided, however, that an individual who was receiving such services immediately prior to attaining age 21 may continue to receive such services until the individual reaches age 22. Nothing in this subsection shall prohibit the commissioner from extending medical assistance to all eligible persons receiving inpatient psychiatric services; provided that there is federal financial participation available.
f. (1) A third party as defined in section 3 of P.L.1968, c.413 (C.30:4D-3) shall not consider a person's eligibility for Medicaid in this or another state when determining the person's eligibility for enrollment or the provision of benefits by that third party.
(2) In addition, any provision in a contract of insurance, health benefits plan, or other health care coverage document, will, trust, agreement, court order, or other instrument which reduces or excludes coverage or payment for health care-related goods and services to or for an individual because of that individual's actual or potential eligibility for or receipt of Medicaid benefits shall be null and void, and no payments shall be made under [this act] P.L.1968, c.413 (C.30:4D-1 et seq.) as a result of any such provision.
(3) Notwithstanding any provision of law to the contrary, the provisions of paragraph (2) of this subsection shall not apply to a trust agreement that is established pursuant to 42 U.S.C. s.1396p (d)(4)(A) or (C) to supplement and augment assistance provided by government entities to a person who is disabled as defined in section 1614(a)(3) of the federal Social Security Act (42 U.S.C. s.1382c (a)(3)).
g. The following services shall be provided to eligible medically needy individuals as follows:
(1) Pregnant women shall be provided prenatal care and delivery services and postpartum care, including the services cited in subsections a.(1), (3), and (5) of this section and subsections b.(1)-(10), (12), (15), and (17) of this section, and nursing facility services cited in subsection b.(13) of this section.
(2) Dependent children shall be provided with services cited in subsections a.(3) and (5) of this section and subsections b.(1), (2), (3), (4), (5), (6), (7), (10), (12), (15), and (17) of this section, and nursing facility services cited in subsection b.(13) of this section.
(3) Individuals who are 65 years of age or older shall be provided with services cited in subsections a.(3) and (5) of this section and subsections b.(1)-(5), (6) excluding prescribed drugs, (7), (8), (10), (12), (15), and (17) of this section, and nursing facility services cited in subsection b.(13) of this section.
(4) Individuals who are blind or disabled shall be provided with services cited in subsections a.(3) and (5) of this section and subsections b.(1)-(5), (6) excluding prescribed drugs, (7), (8), (10), (12), (15), and (17) of this section, and nursing facility services cited in subsection b.(13) of this section.
(5) (a) Inpatient hospital services, subsection a.(1) of this section, shall only be provided to eligible medically needy individuals, other than pregnant women, if the federal Department of Health and Human Services discontinues the State's waiver to establish inpatient hospital reimbursement rates for the Medicare and Medicaid programs under the authority of section 601(c)(3) of the Social Security Act Amendments of 1983, Pub.L.98-21 (42 U.S.C. s.1395ww(c)(5)). Inpatient hospital services may be extended to other eligible medically needy individuals if the federal Department of Health and Human Services directs that these services be included.
(b) Outpatient hospital services, subsection a.(2) of this section, shall only be provided to eligible medically needy individuals if the federal Department of Health and Human Services discontinues the State's waiver to establish outpatient hospital reimbursement rates for the Medicare and Medicaid programs under the authority of section 601(c)(3) of the Social Security Amendments of 1983, Pub.L.98-21 (42 U.S.C. s.1395ww(c)(5)). Outpatient hospital services may be extended to all or to certain medically needy individuals if the federal Department of Health and Human Services directs that these services be included. However, the use of outpatient hospital services shall be limited to clinic services and to emergency room services for injuries and significant acute medical conditions.
(c) The division shall monitor the use of inpatient and outpatient hospital services by medically needy persons.
h. In the case of a qualified disabled and working individual pursuant to section 6408 of Pub.L.101-239 (42 U.S.C. s.1396d), the only medical assistance provided under [this act] P.L.1968, c.413 (C.30:4D-1 et seq.) shall be the payment of premiums for Medicare part A under 42 U.S.C. ss.1395i-2 and 1395r.
i. In the case of a specified low-income Medicare beneficiary pursuant to 42 U.S.C. s.1396a(a)10(E)iii, the only medical assistance provided under [this act] P.L.1968, c.413 (C.30:4D-1 et seq.) shall be the payment of premiums for Medicare part B under 42 U.S.C. s.1395r as provided for in 42 U.S.C. s.1396d(p)(3)(A)(ii).
j. In the case of a qualified individual pursuant to 42 U.S.C. s.1396a(aa), the only medical assistance provided under [this act] P.L.1968, c.413 (C.30:4D-1 et seq.) shall be payment for authorized services provided during the period in which the individual requires treatment for breast or cervical cancer, in accordance with criteria established by the commissioner.
k. In the case of a qualified individual pursuant to 42 U.S.C. s.1396a(ii), the only medical assistance provided under [this act] P.L.1968, c.413 (C.30:4D-1 et seq.) shall be payment for family planning services and supplies as described at 42 U.S.C. s.1396d(a)(4)(C), including medical diagnosis and treatment services that are provided pursuant to a family planning service in a family planning setting.
(cf: P.L.2019, c.317, s.1)
11. Section 2 of P.L.1974, c.120 (C.40:9B-4) is amended to read as follows:
2. The governing body of any county or municipality may annually appropriate funds to any approved, privately operated, nonprofit narcotic [and substance] drug use disorder treatment or recovery center certified by the Commissioner of Health pursuant to P.L.1970, c.334 (C.26:2G-21 et seq.), for the purpose of helping to defray expenses incurred in the provision of such facilities to prevent and control [substance] narcotic drug use [disorder] disorders, and to provide for the diagnosis, treatment, rehabilitation and aftercare [to] of persons with [substance] narcotic drug use disorders who are residents of [any] the county or municipality making such appropriations.
(cf: P.L.2017, c.131, s.167)
12. This act shall take effect on the 120th day after the date of enactment, except that the Department of Human Services may take such anticipatory administrative action in advance of the effective date as shall be necessary for the implementation of this act.
STATEMENT
This bill would make various changes to the statutory law, in order to clarify and strengthen the law pertaining to alcohol treatment facilities and narcotic and substance use disorder treatment centers (collectively referred to in this statement as "substance use disorder treatment facilities"). In particular, the bill would:
(1) expressly clarify that the Department of Human Services (DHS) has licensing and regulatory authority over residential substance use disorder aftercare facilities, including transitional sober living homes (otherwise known as recovery residences) and halfway houses, pursuant to the provisions of N.J.S.A.26:2B-7 et seq. and N.J.S.A.26:2G-21 et seq.; and
(2) clarify that residential aftercare facilities are to be categorized into two distinct classes: (a) residential aftercare facilities that provide services to persons who are recovering from a substance use disorder and who also have other documented, co-occurring mental health disorders; and (b) residential aftercare facilities that provide services to persons who are recovering from a substance use disorder, but who do not have any other documented co-occurring mental health disorders.
The bill would require those residential aftercare facilities in the former group to have a licensed mental health care professional on-site or on-call, at all times, in order to ensure that proper supports are available to recovering addicts to prevent their other mental health issues from hindering their progress in recovery.
The bill would also require the DHS to annually publish and post on its Internet website, a list of all substance use disorder treatment facilities, including the residential aftercare facilities listed above, which remain in good standing; and to provide a hard copy of such list to members of the public, upon request.
Finally, the bill would update the language used in the existing law, in order to ensure that it is consistent with current terminology and rules of statutory drafting. Most significantly, the bill would change the term "narcotic and substance use disorder treatment center" to "narcotic drug use disorder treatment or recovery center," in order to reflect the fact that the DHS is responsible for regulating facilities that provide either treatment or recovery services. The bill would also clarify that the law at N.J.S.A.26:2G-21 is applicable only to facilities that provide services to persons with drug use disorders (as opposed to facilities that provide services to persons with any and all substance use disorders, whether drug or alcohol related). Previous amendments to this law made an incorrect change to reference all "substance use disorders" (a term that, under existing regulations, includes both alcohol use disorders and drug use disorders). The use of that terminology, however, is inconsistent with the existing statutes, which incorporate separate chapters pertaining, respectively, to alcohol use disorders, and to drug use disorders. Accordingly, the bill would clarify this terminology to eliminate confusion.
This bill is intended to ensure that sober living homes in the State are subject to appropriate and uniform licensure, oversight, and inspection requirements, as necessary to ensure the quality of care provided throughout the recovery stage of substance use disorder treatment. Addiction is a serious and potentially fatal disease. However, unlike other diseases, the disease of addiction often cannot be successfully redressed through inpatient or outpatient treatment alone. Instead, the success of addiction treatment requires the implementation of a full continuum of addiction care, which includes not only medical and substance use disorder treatment services, but also continuing care and recovery services, supports, and housing, which are made available to addicts after the completion of their formal treatment, but prior to their complete transition into the community as sober individuals. Because the housing and other supports provided by sober living homes are often necessary to ensure that a person with a substance use disorder is successful in their treatment and recovery from addiction, it is both reasonable and necessary for the State to regulate these homes as part of the State's existing addiction treatment continuum of care.
Although the DHS currently has authority to regulate all substance use disorder treatment facilities in the State, including residential aftercare facilities such as halfway houses, the department has concluded that it does not have authority to regulate transitional sober living homes, because those homes do not provide "treatment" services to persons who are in recovery from a substance use disorder following the receipt of treatment therefor. While some types of sober living home remain subject to minimal oversight as rooming or boarding houses, pursuant to regulations adopted by the Department of Community Affairs, other types of sober living home are treated as ordinary residences, and, on that basis, are fully exempted from any State oversight. However, it is the sponsor's belief that successful recovery is an integral part of effective substance use disorder treatment, and that sober living homes, regardless of type, are distinct from ordinary residences, since they are designed and intended to provide the essential supports and housing necessary to ensure that the treatment of a recovering addict is successful in leading to a full recovery from the addiction for which treatment was sought.
Without proper and sufficient State oversight, sober living homes may fail to provide effective supports to recovering substance users, or may provide a living environment that is not conducive, or that runs counter, to successful recovery. In so doing, they may jeopardize or undermine the treatment that recovering substance users have undergone before entering the sober living home, thereby threatening the health and wellness of persons in recovery. Improper and unethical sober living home management has already been well documented in the media, and has been shown to cause injury to residents.
It is the State's responsibility to ensure that vulnerable persons who have received treatment and are in recovery from addiction are provided with safe and healthy housing and effective supports, as necessary to promote their recovery and enable them to succeed as sober individuals living in the community. This bill will ensure that the State has the ability to do so. The inclusion of sober living homes within the State's continuum of addiction care will also provide regulatory uniformity in this area by ensuring that all types of residential aftercare facilities, including halfway houses and recovery residences, are subject to the same licensure, oversight, and inspection requirements, and are all regulated by a single State agency with expertise in matters affecting substance use disorder treatment and aftercare.
