SENATE, No. 2191

STATE OF NEW JERSEY

219th LEGISLATURE

INTRODUCED MARCH 16, 2020

 


 

Sponsored by:

Senator† LORETTA WEINBERG

District 37 (Bergen)

Senator† KRISTIN M. CORRADO

District 40 (Bergen, Essex, Morris and Passaic)

 

 

 

 

SYNOPSIS

†††† Establishes minimum Medicaid reimbursement rates for private duty nursing services.

 

CURRENT VERSION OF TEXT

†††† As introduced.

††


An Act concerning Medicaid reimbursement for private duty nursing services and supplementing Title 30 of the Revised Statutes.

 

†††† Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

†††† 1.††† a.† The hourly reimbursement rate for private duty nursing services under the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), whether the services are provided in the Medicaid fee-for-service delivery system or through a managed care delivery system, shall be no less than $60 per hour when a registered professional nurse provides the services and no less than $48 per hour when a licensed practical nurse provides the services.† The Division of Medical Assistance and Health Services in the Department of Human Services shall establish criteria indicating the portion of the hourly reimbursement rate that shall be used by providers for wages of workers who directly provide private duty nursing services.

†††† b.††† Every provider that receives reimbursement for private duty nursing services pursuant to a Medicaid managed care contract shall annually provide a report to the Division of Medical Assistance and Health Services in the Department of Human Services regarding the use of funds received as reimbursement for private duty nursing services, including the prior salary, current salary, and other changes to the salary of the workers who directly provide personal care services, in order to ensure compliance with subsection a. of this section.

 

†††† 2.††† Within 180 days after the enactment of this act, the Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.

 

†††† 3.††† The Commissioner of Human Services shall adopt rules and regulations, pursuant to the ďAdministrative Procedure Act,Ē P.L.1968, c.410 (C.52:14B-1 et seq.), to effectuate the purposes of this act.

 

†††† 4.††† This act shall take effect immediately, except that the provisions of section 1 shall remain inoperable until the commissioner receives approval, from the United States Secretary of Health and Human Services, of the State plan amendments or waivers that are necessary to obtain federal financial participation for the State Medicaid expenditures that are to be made pursuant to that section.

STATEMENT

 

†††† This bill would establish minimum Medicaid reimbursement rates for private duty nursing (PDN) services that are provided in the Medicaid fee-for-service delivery system or through a managed care delivery system.† PDN services are individualized nursing services that are provided by licensed nurses, on a continuous and non-intermittent basis, to certain beneficiaries in the home setting.† The bill provides that the minimum Medicaid reimbursement rate for such services is to be no less than $60 per hour when a registered professional nurse provides the services and no less than $48 per hour when a licensed practical nurse provides the services.† The Division of Medical Assistance and Health Services (DMAHS) in the Department of Human Services will be required to establish criteria indicating the portion of the hourly reimbursement rate that is to be used by providers for wages of workers who directly provide private duty nursing services.

†††† Every provider that receives reimbursement for private duty nursing services pursuant to a Medicaid managed care contract will be required to annually provide a report to the DMHAS regarding the use of funds received as reimbursement for private duty nursing services, including the prior salary, current salary, and other changes to the salary of the workers who directly provide personal care services.

†††† Existing State regulation, at N.J.A.C.10:60-11.2, establishes a maximum Medicaid reimbursement rate for PDN services.† Specifically, the regulation provides for reimbursement of PDN services at a rate of not more than $40 per hour when a registered professional nurse provides the services and not more than $28 when a licensed practical nurse provides the services.† These maximum reimbursement rates, however, are insufficient to cover the costs of service provision, and may effectively dissuade nurses from providing PDN services in the State.

†††† The bill would require the Commissioner of Human Services to apply for such State plan amendments or waivers as may be necessary to implement the billís provisions and secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.† The billís substantive provisions would remain inoperable until the commissioner receives approval, from the U.S. Secretary of Health and Human Services, of the State plan amendments or waivers that are necessary to obtain federal financial participation for the State Medicaid expenditures that are to be made pursuant to the bill.