Sponsored by:
Senator JEFF VAN DREW
District 1 (Atlantic, Cape May and Cumberland)
SYNOPSIS
Establishes Medicaid demonstration project to cover room and board services for certain terminally ill patients in the home or other non-institutional setting.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning Medicaid and supplementing P.L.1968, c.413 (C.30:4D-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. As used in this act:
"Commissioner" means the Commissioner of Human Services.
"General public assistance" means the Work First New Jersey General Public Assistance program established pursuant to P.L.1947, c.156 (C.44:8-107 et seq.).
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Medicare" means the federal Medicare program established pursuant to Title XVIII of the "Social Security Act," Pub.L.89-97 (42 U.S.C. s.1395 et seq.).
"Other non-institutional setting" means an assisted living residence, a comprehensive personal care home, an assisted living program in subsidized housing, a rooming or boarding house, a free-standing residential health care facility, or any other non-institutional setting as may be determined by regulation of the commissioner.
"Room and board services" means the provision of such assistance in paying mortgage or rental, food, and other expenses, and the provision of such other services, as a hospice patient requires to be able to remain in that person's home or other non-institutional setting.
2. a. The Division of Medical Assistance and Health Services in the Department of Human Services, subject to federal approval and the availability of federal financial participation under Title XIX of the Social Security Act, shall establish a three-year Medicaid demonstration project as provided in this act. The demonstration project shall be developed in consultation, and implemented, with the managed care organizations that contract with the Medicaid program to provide health care services to Medicaid recipients or with other appropriate entities that contract with the Medicaid program to provide health care services to general public assistance recipients.
b. The demonstration project shall be designed to:
(1) provide Medicaid coverage for room and board services in a home or other non-institutional setting to a terminally ill Medicaid recipient who:
(a) is receiving hospice care under Medicare;
(b) requires room and board services in order to be sustained in the person's home or other non-institutional setting;
(c) would otherwise be eligible for Medicaid coverage of room and board services only in a hospital, nursing home, or other institutional setting; and
(2) ensure that the costs to Medicaid of providing coverage as set forth in paragraph (1) of this subsection to a recipient under the demonstration project do not exceed the costs that would be incurred by Medicaid for the recipient in a hospital, nursing home, or other institutional setting.
3. The Director of the Division of Medical Assistance and Health Services shall evaluate the demonstration project annually to assess whether it has achieved its objectives in accordance with the provisions of subsection b. of section 2 of this act.
4. The Commissioner of Human Services, no later than six months after the effective date of this act, 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.
5. The commissioner shall report annually to the Governor, and to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), on the results of the demonstration project, and shall include in that report the commissioner's findings and recommendations based upon those results.
6. The commissioner, in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt such rules and regulations as the commissioner deems necessary to carry out the provisions of this act.
7. This act shall take effect on the first day of the seventh month next following the date of enactment and shall expire three years after the date that the Division of Medical Assistance and Health Services commences implementation of the demonstration project, but the commissioner may take such anticipatory administrative action in advance thereof as shall be necessary for the implementation of this act.
STATEMENT
This bill establishes a three-year Medicaid demonstration project, subject to federal approval and the availability of federal financial participation for State Medicaid expenditures under the federal Medicaid program.
The demonstration project will be designed to:
(1) provide Medicaid coverage for room and board services in a home or other non-institutional setting to a terminally ill Medicaid recipient who: is receiving hospice care under Medicare; requires room and board services in order to be sustained in the person's home or other non-institutional setting; and would otherwise be eligible for Medicaid coverage of room and board services only in a hospital, nursing home, or other institutional setting; and
(2) ensure that the costs to Medicaid of providing this coverage to a recipient under the demonstration project do not exceed the costs that would be incurred by Medicaid for the recipient in a hospital, nursing home, or other institutional setting.
The bill defines:
"Room and board services" to mean the provision of such assistance in paying mortgage or rental, food, and other expenses, and the provision of such other services, as a hospice patient requires to be able to remain in that person's home or other non-institutional setting; and
"Other non-institutional setting" to mean an assisted living residence, a comprehensive personal care home, an assisted living program in subsidized housing, a rooming or boarding house, a free-standing residential health care facility, or any other non-institutional setting as may be determined by regulation of the Commissioner of Human Services.
The Director of the Division of Medical Assistance and Health Services in the Department of Human Services is to evaluate the demonstration project annually, in order to assess whether it has achieved its objectives in accordance with the provisions of the bill.
The Commissioner of Human Services, no later than six months after the effective date of the bill, is to apply for such State plan amendments or waivers as may be necessary to implement the provisions of the bill and to secure federal financial participation for State Medicaid expenditures under the demonstration project.
In addition, the commissioner is to report annually to the Governor and the Legislature on the results of the demonstration project, and to include in that report the commissioner's findings and recommendations based upon those results.
The bill takes effect on the first day of the seventh month following enactment and expires three years after the date that the Division of Medical Assistance and Health Services commences implementation of the demonstration project, but authorizes the Commissioner of Human Services to take prior administrative action as necessary for its implementation.
This bill is seeking to alleviate a problem for terminally ill Medicaid patients who wish to receive hospice care at home or in another non-institutional setting but, even though they are eligible for the Medicare hospice benefit, have insufficient financial resources to be sustained in that setting. These persons are effectively required to receive hospice care in an institutional setting because federal law prohibits Medicaid from paying for room and board in a non-institutional setting.