LEGISLATIVE FISCAL ESTIMATE

[First Reprint]

SENATE, No. 3484

STATE OF NEW JERSEY

218th LEGISLATURE

 

DATED: JUNE 17, 2019

 

 

SUMMARY

 

Synopsis:

Establishes certain requirements concerning rights of lesbian, gay, bisexual, transgender, questioning, queer, intersex, and HIV-positive residents of long-term care facilities.

Type of Impact:

Indeterminate annual impacts on State expenditures and revenue, General Fund; Indeterminate annual impact on expenditures of certain counties.

Agencies Affected:

New Jersey Office of the State Long-Term Care Ombudsman; Department of Human Services, Department of Health; Department of Military and Veterans Affairs; certain county governments.

 

 

Office of Legislative Services Estimate

Fiscal Impact

Annual

 

State Revenue Impact

Indeterminate Increase

 

State Expenditure Impact

Indeterminate Increase

 

County Expenditure Impact

Indeterminate Increase

 

 

 

 

·         The Office of Legislative Services (OLS) finds that nursing homes operated by the Department of Military and Veterans Affairs (DMAVA) and certain county governments will incur an indeterminate increase in costs to implement the provisions of the bill, such as the biennial training of administrators and staff, as outlined in the bill.

 

·         Furthermore, the New Jersey Office of the State Long-Term Care Ombudsman, an entity in but not of the Department of the Treasury, may experience an indeterminate increase in State expenditures resulting from the investigation and resolution of complaints associated with violations of the provisions of the bill.  These State costs may be offset by the collection of penalties for such violations, as provided under the bill.

 

 

BILL DESCRIPTION

 

      This bill establishes certain requirements concerning the rights of residents of long-term care
facilities who are lesbian, gay, bisexual, transgender, questioning, queer, or intersex (LGBTQI).  Specifically, the bill provides that it will be prohibited for a long-term care facility, or for staff at the facility, to take certain actions, as outlined in the bill, based in whole or in part on a person’s actual or perceived sexual orientation, gender identity, gender expression, intersex status or condition, or human immunodeficiency virus (HIV) status.

      All facilities will be required to prominently post notice stating that the facility does not discriminate and does not permit discrimination on the basis of actual or perceived sexual orientation, gender identity, gender expression, intersex status or condition, or HIV status, or based on association with another individual on account of that individual’s actual or perceived sexual orientation, gender identity, gender expression, or HIV status.  The notice will include the contact information for the Office of the State Long-Term Care Ombudsman.

      Each long-term care facility will be: 1) required to ensure that resident records include the resident’s gender identity and the resident’s chosen name and pronouns, as indicated by the resident; and 2) prohibited from disclosing personally identifiable information regarding: a resident’s sexual orientation; whether a resident is transgender; a resident’s transition history; a resident’s intersex status or condition; or a resident’s HIV status.

      The bill also enumerates certain rights of long-term care residents regarding the presence of facility staff during physical examinations, access to medical and mental health care providers who are knowledgeable about the health care needs of the LGBTQI population; and access to such transition-related assessments, therapy, and treatments as have been recommended by the resident’s health care provider.

      The bill requires each long-term care facility to ensure that the administrators and staff at the facility receive training, on at least a biennial basis, concerning care for LGBTQI seniors and seniors living with HIV and preventing discrimination based on sexual orientation, gender identity or expression, intersex status or condition, and HIV status.  The training is to be provided by an entity that has expertise in identifying the legal, social, and medical challenges faced by LGBTQI seniors and seniors living with HIV who reside in long-term care facilities.  The training will be a condition of new or ongoing employment at a long-term care facility, and facilities are to document completion of the training by each administrator and staff member.  Long-term care facilities are to assume the cost of providing the training.

      The bill provides that, for the purposes of administering the federal “Older Americans Act of 1965,” Pub. L. 89-73 (42 U.S.C. s.3001 et seq.), the Division on Aging Services in the Department of Human Services will be required to treat LGBTQI seniors and seniors living with HIV as older individuals who have the greatest social need.  The division is to apply for any State plan amendments or waivers as are necessary to implement this requirement. 

      A long-term care facility that violates the requirements of the bill, or that employs a staff member who violates the requirements of the bill, will be liable to a civil penalty of no more than $500 for a first offense, no more than $1,000 for a second offense occurring within a 12-month period, and no more than $5,000 for a third or subsequent offense occurring within a 12-month period.  Each violation will constitute a separate offense.  Nothing in the bill is to be construed to limit the ability to bring any civil, criminal, or administrative action for conduct constituting a violation of any other provision of law.

 

 

FISCAL ANALYSIS

 

EXECUTIVE BRANCH

 

      None received.

OFFICE OF LEGISLATIVE SERVICES

 

      The OLS finds that nursing homes operated by the DMAVA and certain county governments will incur an indeterminate increase in costs to provide biennial training to administrators and staff, as outlined and required under the bill.  The bill requires that an entity with specific expertise provide the training.  Therefore, until a facility administrator or staff person meets such qualifications, it is likely that facilities, will need to contract these services to outside organizations, resulting in higher costs.  Other less significant costs to DMAVA and county nursing homes may include:  1) the reformatting of forms to ensure that resident records include the resident’s gender identity and chosen name and pronouns and 2) the documentation, and the retention of such documentation, indicating the completion of training.  Currently, the DMAVA operates three facilities.  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.

      In addition, the New Jersey Office of the State Long-Term Care Ombudsman, an entity in but not of the Department of the Treasury, may experience an indeterminate increase in State expenditures resulting from the investigation and resolution of complaints associated with violations of the provisions of the bill.  These State costs may be offset by the collection of penalties for such violations, as provided under the bill.  The nature and number of complaints that may be reported and infractions that may be committed, however, is unpredictable.  As such, the OLS cannot quantify the cost to investigate complaints or the amount of revenue generated from penalties and fines under the bill.

      For reference, the New Jersey Office of the State Long-Term Care Ombudsman advocates for residents of long-term care facilities who are over the age of 60 by investigating and resolving complaints made by or on behalf of those residents.  Per state law, the Ombudsperson is directly appointed by the Governor.  In federal fiscal year 2017, the office expended $1,615,083 in State funds. The work of the office was conducted by 22 full-time employees, six part-time employees and approximately 250 volunteer advocates.

 

 

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.).