Bill Text: NJ A4167 | 2014-2015 | Regular Session | Introduced
Bill Title: Requires DHS to notify enrollees in Programs of All-Inclusive Care for the Elderly of Medicare eligibility.
Spectrum: Partisan Bill (Democrat 12-0)
Status: (Passed) 2015-11-09 - Approved P.L.2015, c.151. [A4167 Detail]
Download: New_Jersey-2014-A4167-Introduced.html
Sponsored by:
Assemblyman JOSEPH A. LAGANA
District 38 (Bergen and Passaic)
Assemblyman VINCENT MAZZEO
District 2 (Atlantic)
Assemblyman TIMOTHY J. EUSTACE
District 38 (Bergen and Passaic)
Assemblyman BOB ANDRZEJCZAK
District 1 (Atlantic, Cape May and Cumberland)
SYNOPSIS
Requires DHS to notify enrollees in Programs of All-Inclusive Care for the Elderly of Medicare eligibility.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning certain programs for the elderly and disabled and supplementing Title 26 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A person who applies to participate in the PACE or Pre-PACE program shall notify and provide to the Department of Human Services valid proof of their date of birth upon enrollment in the PACE or Pre-PACE program.
b. The department shall notify and provide to each enrollee in the PACE or Pre-PACE program, three months prior to the date on which the enrollee will be 65 years of age, contact and eligibility information for the Medicare program and any other information the commissioner shall deem necessary to ensure that enrollees in the PACE and Pre-PACE program have sufficient information to allow them to apply for Medicare coverage.
c. As used in this section, the definitions of section 1 of P.L.1997, c.296 (C.26:2H-88) shall apply.
2. 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.
3. This act shall take effect immediately.
STATEMENT
This bill will require the Department of Human Services to contact each person enrolled in a PACE or Pre-PACE program, prior to their 65th birthday, to notify them of their eligibility for the Medicare Program.
"PACE" means the "Program of All-Inclusive Care for the Elderly" operated by a public, private, nonprofit or proprietary entity, as permitted by federal law. The program is a comprehensive health and social services delivery system that integrates acute and long-term care services to disabled and frail elderly persons, over the age of 55, who are certified by the State as nursing home eligible to maximize their autonomy and continued independence.
"Pre-PACE" means a PACE program in its initial start-up phase and includes the same comprehensive scope of services as a PACE program. A Pre-PACE program may contract with the State to provide services to Medicaid-eligible persons for a limited scope of the PACE service package, with the remaining services reimbursed directly to the service providers by the Medicaid and Medicare programs.
The Department of Human Services is billed monthly by the facilities for each of the enrollees. The amount billed is a set amount and differs for those individuals who are dually eligible for Medicare and Medicaid and those who are solely eligible for Medicaid. According to information gathered for an audit of the program conducted by the State Auditor, the monthly rates for fiscal years 2012 and 2013 were $4,809.95 for Medicare and Medicaid recipients and $6,097.57 for Medicaid only recipients. The State pays for these charges and is reimbursed for 50 percent of the cost by the federal government.
The State Auditor identified 336 claims in which the recipient was over the age of 65 and therefore eligible for Medicare, as well as Medicaid; but, the recipient was not enrolled in Medicare. In these cases, the State was billed the higher Medicaid only rate and the State Auditor estimated that costs savings of over $432,000 may have been obtained if these individuals had been dual enrolled in Medicaid and Medicare.
This bill will require the department to notify the enrollees prior to their 65th birthday that they will be eligible for Medicare at the age of 65. This reminder is intended to increase the number of enrollees billed at the lower rate for dual eligible participants and reduce costs to the State.
