Bill Text: NJ A5059 | 2016-2017 | Regular Session | Introduced
Bill Title: Requires certain facilities to set aside beds for Medicaid-eligible individuals.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2017-06-26 - Introduced, Referred to Assembly Human Services Committee [A5059 Detail]
Download: New_Jersey-2016-A5059-Introduced.html
Sponsored by:
Assemblywoman VALERIE VAINIERI HUTTLE
District 37 (Bergen)
SYNOPSIS
Requires certain facilities to set aside beds for Medicaid-eligible individuals.
CURRENT VERSION OF TEXT
As introduced.
An Act requiring certain facilities to set aside beds for Medicaid-eligible individuals and amending and supplementing Title 26 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 8 of P.L.1975, c.305 (C.26:2B-14) is amended to read as follows:
The department shall issue for a term of 2 years, and may renew for like terms, a license, subject to revocation by it for cause, to any person, partnership, corporation, society, association or other agency or entity of any kind, other than a licensed general hospital, a department, agency, or institution of the [Federal Government] federal government, the State or any political subdivision thereof, deemed by it to be responsible and suitable to establish and maintain a facility and to meet applicable licensure standards and requirements. In the case of a department, agency or institution of the State or any political subdivision thereof, the department shall grant approval to establish and maintain a facility for a term of 2 years, and may renew such approval for like terms, subject to revocation by it for cause.
The department shall in the cases of public facilities, private facilities which contract on a fee-for-service basis with the State, and private facilities which accept for treatment persons assisted pursuant to section 10 of P.L.1975, c.305 (C.26:2B-16), promulgate rules and regulations establishing licensure and approval standards and requirements including, but not limited to:
a. the need for a facility in the community;
b. the financial and other qualifications of the applicant;
c. the proper operation of facilities;
d. the health and safety standards to be met by a facility;
e. the quality and nature of the treatment to be afforded patients at a facility;
f. licensing fees, and procedures for making and approving license and approval applications; and
g. the obligation of the facility to meet the Medicaid-eligible utilization requirements pursuant to section 4 of P.L. c. (C. ) (pending before the Legislature as this bill).
In the case of private facilities that neither contract on a fee-for-service basis with the State nor accept for treatment persons assisted by police officers pursuant to section 10 of P.L.1975, c.305 (C.26:2B-16), the department shall promulgate rules and regulations establishing licensure standards and requirements but such standards and requirements shall concern only:
a. the health and safety standards to be met by a facility;
b. misrepresentations as to the treatment to be afforded patients at a facility;
c. licensing fees[, and];
d. procedures for making and approving license applications; and
e. the obligation of the facility to meet the Medicaid-eligible utilization requirements pursuant to section 4 of P.L. c. (C. ) (pending before the Legislature as this bill).
All facilities shall be individually licensed or approved. Different kinds of licenses or approvals may be granted for different kinds of facilities.
Each facility shall file with the department from time to time, on request, such data, statistics, schedules or information as the department may reasonably require for the purposes of this section, and any licensee or other person operating a private facility who fails to furnish any such data, statistics, schedules or information as requested, or who files fraudulent returns thereof, shall be punished by a fine of not more than [$500.00] $500.
The department, after holding a hearing, may refuse to grant, suspend, revoke, limit or restrict the applicability of or refuse to renew any license or approval for any failure to meet the requirements of its rules and regulations or standards concerning such facilities. However, in the case of private facilities which neither contract on a fee-for-service basis with the State nor accept for treatment persons assisted by police officers pursuant to section 10 of P.L.1975, c.305 (C.26:2B-16), the department, after holding a hearing may refuse to grant, suspend, revoke, limit or restrict the applicability of or refuse to renew any license for the following reasons only:
a. for failure to meet the requirements of its rules and regulations concerning the health and safety standards of such facilities or
b. if there is a reasonable basis for the department to conclude that there is a discrepancy between representations by a facility as to the treatment services to be afforded patients and the treatment services actually rendered or to be rendered.
The department may temporarily suspend a license or approval in an emergency without holding a prior hearing; provided, however, that upon request of an aggrieved party, a hearing shall be held as soon after the license or approval is suspended as possible. Any party aggrieved by a final decision of the department pursuant to this section may petition for judicial review thereof.
No person, partnership, corporation, society, association, or other agency or entity of any kind, other than a licensed general hospital, a department, agency or institution of the [Federal Government] federal government, the State or any political subdivision thereof, shall operate a facility without a license and no department, agency or institution of the State or any political subdivision thereof shall operate a facility without approval from the department pursuant to this section. The Superior Court shall have jurisdiction in equity upon petition of the department to restrain any violation of the provisions of this section and to take such other action as equity and justice may require to enforce its provisions. Whoever knowingly establishes or maintains a private facility without a license granted pursuant to this section shall, for a first offense, be punished by a fine of not more than [$500.00] $500 and for each subsequent offense by a fine of not more than [$1,000.00] $1,000 or imprisonment for not more than 2 years, or both.
Each facility shall be subject to visitation and inspection by the department and the department shall inspect each facility prior to granting or renewing a license or approval. The department may examine the books and accounts of any facility if it deems such examination necessary for the purposes of this section. The department is hereby authorized to make a complaint to a judge of any court of record, who may thereupon issue a warrant to any officers or employees of the department authorizing them to enter and inspect at reasonable times, and to examine the books and accounts of, any private facility refusing to consent to such inspection or examination by the department which the department has reason to believe is operating in violation of the provisions of this act. Refusal by the operator or owner to allow such entry and inspection pursuant to such a warrant shall for a first offense be punishable by a fine of not more than [$100.00] $100 and for each subsequent offense by a fine of not more than [$1,000.00] $1,000 or imprisonment for not more than 2 years, or both.
The director may require public facilities, private facilities which contract on a fee-for-service basis with the State, and private facilities which accept for treatment persons assisted pursuant to section 10 of P.L.1975, c.305 (C.26:2B-16) to admit as an inpatient or outpatient any person to be afforded treatment pursuant to this act. The department shall promulgate rules and regulations governing the extent to which the department may require other private facilities to admit as an inpatient or outpatient any person to be afforded treatment pursuant to this act; provided, however, that no licensed general hospital shall refuse treatment for intoxication or alcoholism.
(cf: P.L.1975, c.305, s.8) .
2. Section 5 of P.L.1970, c.334 (C.26:2G-25) is amended to read as follows:
5. The commissioner shall adopt, amend, promulgate and enforce such rules, regulations and minimum standards for the treatment of patients of narcotic and drug abuse treatment 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 drug abuse treatment centers may be classified into two or more classes with appropriate rules, regulations and minimum standards for each such class.
The rules and regulations adopted pursuant to this section shall, at a minimum, require:
a. a transitional sober living home, halfway house, or other residential aftercare facility 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) 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) 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 notice, or expressly requests that 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; and
b. the obligation of the facility to meet the Medicaid-eligible utilization requirements pursuant to section 4 of P.L. c. (C. ) (pending before the Legislature as this bill).
(cf: P.L.2015, c.284, s.2)
3. Section 1 of P.L.2015, c.293 (C.26:2G-25.1) is amended to read as follows:
1. a. The Division of Mental Health and Addiction Services in the Department of Human Services shall oversee the development and maintenance of a database, which shall collect and track the daily information received pursuant to section 2 of [this act] P.L.2015, c.293 (C.26:2G-25.2) about the number of open beds that are available for treatment in each residential substance use disorders treatment facility in the State that receives State or county funding.
b. The information maintained in the database shall include, by county:
(1) the address and telephone number of the residential substance use disorders treatment facility;
(2) the type of services provided by the facility;
(3) the licensed bed capacity of the facility; [and]
(4) the number of open beds that are available for treatment, based on the information received pursuant to section 2 of this act;
(5) the number of beds in the facility reserved to meet the requirement established in section 4 of P.L. c. (C. ) (pending before the Legislature as this bill); and
(6) the number of open beds that are available for treatment and meet the requirement established in section 4 of P.L. c. (C. ) (pending before the Legislature as this bill).
c. The information described in subsection b. of this section shall be:
(1) prominently displayed on the website of the department;
(2) made available to the public, upon request, through the addictions telephone hotline and the Statewide 2-1-1 telephone system; and
(3) made available using any other means that the Commissioner of Human Services deems appropriate.
d. The commissioner is authorized to solicit, receive, and accept grants, funds, or anything of value from any public or private entity and receive and accept contributions of money, property, labor, or any other thing of value from any legitimate source for the purpose of the development and maintenance of a database pursuant to this act.
(cf: P.L.2015, c.293, s.1)
4. (New section) a. As used in this act:
"Facility" means a residential treatment facility licensed by the State pursuant to Section 8 of P.L.1975, c.305 (C.26:2B-14) or P.L.1970, c.334 (C.26:2G-21 et seq.)
"Medicaid" means the program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) or the NJ FamilyCare program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.).
"Medicaid-eligible" means that a person is determined to meet the eligibility standards for medical assistance under the State Medicaid program.
b. A facility that is licensed to operate pursuant to Section 8 of P.L.1975, c.305 (C.26:2B-14) or P.L.1970, c.334 (C.26:2G-21 et seq.) shall reserve 10 percent of its total bed compliment for use by Medicaid-eligible persons. The 10 percent utilization by Medicaid-eligible persons may be met through Medicaid conversion of persons who enter the facility as private paying persons and subsequently become eligible for Medicaid, or through direct admission of Medicaid-eligible persons.
c. A facility shall achieve this 10 percent utilization within one year of the effective date of this act to operate and shall maintain this level of utilization thereafter.
d. Existing facilities that add additional beds shall be required, as a condition of licensure approval, to maintain 10 percent of the additional beds for Medicaid-eligible persons through Medicaid conversion of persons who enter the facility as private paying persons and subsequently become eligible for Medicaid, or through direct admission of Medicaid-eligible persons. If the total number of additional beds is less than 10, at least one of the additional beds shall be reserved for a Medicaid-eligible person.
e. The Commissioner of Human Services may waive the 10 percent utilization requirement or reduce the required percentage by regulation for specific regions of the State or Statewide if the commissioner determines that sufficient numbers of facility beds are available in the State to meet the needs of Medicaid-eligible persons.
5. (New section) Nothing in P.L. c. (C. ) (pending before the Legislature as this bill) shall be construed to: prohibit a facility, which is not affected by P.L. c. (C. ) (pending before the Legislature as this bill) from participating in the Medicaid program; or create an entitlement to financing under the Medicaid program for services provided at facilities.
6. The Commissioner of Human Services, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations as the commissioners determine necessary to effectuate the purposes of this act.
7. This act shall take effect on the first day of the sixth month next following the date of the enactment, except the Commissioner of Human Services may take any anticipatory action in advance as shall be necessary for the implementation of this act.
STATEMENT
This bill would require all residential facilities which are licensed to provide treatment to individuals for substance use disorder and alcohol use disorder to dedicate 10 percent of the facilities' beds to individuals who are Medicaid beneficiaries. Facilities would be required to meet the standard within one year of the effective date of this act.
Furthermore, the residential substance use disorder treatment facilities will be required to report to the Department of Human Services the number of beds which are reserved for Medicaid clients, and the number of these beds which are available for treatment.
