LEGISLATIVE FISCAL ESTIMATE

[Second Reprint]

ASSEMBLY, No. 5527

STATE OF NEW JERSEY

218th LEGISLATURE

 

DATED: JULY 26, 2019

 

 

SUMMARY

 

Synopsis:

Requires certain long-term care facilities to submit outbreak response plan to DOH.

Type of Impact:

Increase in State and county expenditures.

Agencies Affected:

Department of Health; Department of Military and Veterans Affairs; and certain county governments.

 

 

Office of Legislative Services Estimate

Fiscal Impact

Annual

 

State Cost Increase

Indeterminate

 

County Cost Increase

Indeterminate

 

 

 

 

·         The Office of Legislative Services (OLS) estimates that the Department of Health (DOH) may incur indeterminate costs under the bill in reviewing and verifying compliance of outbreak response plans submitted by long-term care facilities that provide care to ventilator-dependent residents, as required under the bill.   Without more information from the Executive, however, the OLS cannot quantify the costs that may be incurred by the DOH under the bill.

·         The OLS finds that nursing homes operated by the Department of Military and Veterans Affairs (DMAVA) and certain county governments may incur indeterminate increases in operating expenditures to develop and implement an outbreak response plan and, in the case of those facilities that provide care to ventilator-dependent residents, in submitting the plan to the department and complying with the staffing requirements of the bill.  Certain costs may be minimized to the extent that affected nursing homes currently fulfill the provisions of the bill and that the bill codifies existing regulatory requirements regarding mandatory infection control and sanitation.  The OLS, however, does not have access to information regarding the existing policies at these facilities or which of these facilities provide care to ventilator-dependent residents, and therefore cannot quantify the fiscal impact. 

BILL DESCRIPTION

 

      This bill directs the DOH to require long-term care facilities to develop an outbreak response plan within 180 days after the bill’s effective date that is developed in consultation with the facility’s infection control committee, if the facility has established an infection control committee.  At a minimum, the plan is to include: (1) a protocol for isolating and cohorting infected and at-risk patients in the event of an outbreak of a contagious disease until the cessation of the outbreak; (2) clear policies for the notification of residents, residents’ families, visitors, and staff in the event of an outbreak of a contagious disease at a facility; (3) information on the availability of laboratory testing, protocols for assessing whether facility visitors are ill, protocols to require ill staff to not present at the facility for work duties, and processes for implementing evidence-based outbreak response measures; (4) policies to conduct routine monitoring of residents and staff to quickly identify signs of a communicable disease that could develop into an outbreak; and (5) policies for reporting outbreaks to public health officials in accordance with applicable laws and regulations. 

      In addition to these requirements, the department is to require long-term care facilities that provide care to ventilator dependent residents to include in the facility’s outbreak response plan written policies to meet staffing, training, and facility demands during an infectious disease outbreak to successfully implement the outbreak response plan, including either employing on a full-time or part-time basis, or contracting with on an consultative basis, the following individuals: (1) an individual certified by the Certification Board of Infection Control and Epidemiology and (2) a physician who has completed an infectious disease  fellowship.

      Each long-term care facility that provides care to ventilator-dependent residents is to submit to the department the facility’s outbreak response plan within 180 days after the bill’s effective date and the department is to verify that the outbreak response plans are in compliance with the requirements of the bill.  If a long-term care facility that provides care to ventilator-dependent residents makes any material changes to its outbreak response plan, the facility, within 30 days after completing the material change, is to submit to the department an updated outbreak response plan, and the department is to verify that the plan is compliant with the requirements of the bill.

      The DOH is to require a long-term care facility that provides care to ventilator dependent residents to assign to its infection control committee: (1) an individual who is a physician who has completed an infectious disease fellowship and (2) an individual designated as the infection control coordinator, who has education, training, completed course work, or experience in infection control or epidemiology, including certification by the Certification Board of Infection Control and Epidemiology.  The infection control committee is to meet on at least a quarterly basis and both individuals assigned pursuant to the bill’s provisions are to attend at least half of the meetings held by the infection control committee.

 

 

FISCAL ANALYSIS

 

EXECUTIVE BRANCH

 

      None received.

 

OFFICE OF LEGISLATIVE SERVICES

 

      The OLS estimates that the DOH may incur indeterminate costs under the bill in reviewing and verifying compliance of outbreak response plans submitted by long-term care facilities that provide care to ventilator-dependent residents, as required under the bill.  According to the department, there are 843 long-term care facilities in New Jersey; however, the OLS is unable to determine which of those facilities provide care to ventilator-dependent residents.   

      As the nature of the bill generally reflect the department’s current duties, it is possible that tasks regarding the review of plans may be performed by the DOH’s existing entities, thereby minimizing costs.  For example, the department’s Communicable Disease Service (CDS) routinely works with health care partners to provide technical support and guidance regarding infection control.  Within the CDS, the Infection Control Assessment and Response team performs on-site assessments with a focus on the prevention of healthcare-associated infection investigations and prevention of infection control breaches in healthcare facilities through adherence to best practices and state and federal requirements.  Without more information from the Executive, however, the OLS cannot quantify the costs that may be incurred by the DOH under the bill.

      The OLS also finds that nursing homes operated by the DMAVA and certain county governments may incur indeterminate increases in operating expenditures to develop and implement an outbreak response plan and, in the case of those facilities that provide care to ventilator-dependent residents, in submitting the plan to the department and complying with the staffing requirements of the bill.  Certain costs may be minimized to the extent that the affected nursing homes currently fulfill the provisions of the bill and that the bill codifies existing regulatory requirements regarding mandatory infection control and sanitation.

      The OLS, however, does not have access to information regarding the existing policies at these facilities or which of these facilities provide care to ventilator-dependent residents, and therefore cannot quantify the fiscal impact.  Currently, the DMAVA operates three facilities, while there are nine county facilities: three in Bergen County; two in Middlesex County; and one each in Atlantic County, Cape May County, Gloucester County, and Passaic County.  

      Long-term care facilities are regulated under N.J.A.C.8:39-19.1 et seq. regarding mandatory infection control and sanitation.  To the extent that the bill requires a long-term care facility to present a documented plan for compliance with existing regulation, the costs incurred by the affected DMAVA and county nursing homes may be minimized.  For example, the bill requires a facility’s outbreak response plan to include policies to conduct routine monitoring of staff to quickly identify signs of a potential outbreak, while existing regulation prohibits staff who have symptoms of a communicable disease from performing functions that expose residents to risk of transmission of the disease.

      On the other hand, costs may be incurred under the bill as certain provisions expand the scope of existing regulatory requirements.  For example, pursuant to N.JA.C.8:39-19.1, a long-term care facility is required to have an infection prevention and control program conducted by an infection control committee.  The responsibility for the infection prevention and control program is to be assigned to an employee who is designated as the infection control coordinator, with education, training, completed course work, or experience in infection control or epidemiology; or contracted to an outside party.  The infection control coordinator is also to be certified in infection control by the Certification Board of Infection Control and Epidemiology.  Under the bill, long-term care facilities that provide care to ventilator dependent residents are to either employ on a full-time or part-time basis, or contract with on an consultative basis an individual certified by the Certification Board of Infection Control and Epidemiology, as required under regulation, as well as a physician who has completed an infectious disease fellowship.

 

 

Section:

Human Services

Analyst:

Sarah Schmidt

Senior Research Analyst

Approved:

Frank W. Haines III

Legislative Budget and Finance Officer

 

 

This legislative fiscal estimate has been produced by the Office of Legislative Services due to the failure of the Executive Branch to respond to our request for a fiscal note.

 

This fiscal estimate has been prepared pursuant to P.L.1980, c.67 (C.52:13B-6 et seq.).