[First Reprint]
ASSEMBLY, No. 463
STATE OF NEW JERSEY
PRE-FILED FOR INTRODUCTION IN THE 1996 SESSION
By Assemblymen ROMA and AZZOLINA
An Act concerning a veterans alternative health care assessment and demonstration program.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. This act shall be known and may be cited as the "Veterans Alternative Health Care Assessment and Demonstration Act."
2. As used in this act:
"Adjutant General" means the Adjutant General of the Department of Military and Veterans' Affairs.
"Department" means the Department of Military and Veterans Affairs.
"Program" means the "Veterans Alternative Health Care Demonstration Program" established pursuant to this act.
"Veteran" means a person who has served in any branch of the armed services of the United States for at least 90 days other than for training and who has been honorably separated therefrom.
3. The Adjutant General shall, within six months of the effective date of this act, complete an assessment of the alternative health care opportunities currently available for veterans in the State. Based on this assessment, the Adjutant General shall make a recommendation to the Governor and the Legislature as to whether or not a Veterans Alternative Health Care Demonstration Program is necessary for the State, or whether State funds would be better utilized by facilitating veterans' access to existing alternative health care programs throughout the State. The Governor and the Legislature shall make a determination with respect to the recommendation.
If the Governor and the Legislature determine existing alternative health care programs throughout the State will better assist frail, elderly or disabled veterans, the department shall use the cost savings realized by the State, if any, to provide placement for additional veterans into existing alternative health care programs.
If the Governor and the Legislature determine a Veterans Alternative Health Care Demonstration Program is necessary, the Adjutant General shall: a. establish such a program to provide non-institutional health care such as home health care, adult day care or assistive living services, or a combination thereof, to frail, elderly or disabled veterans through agencies, organizations or other entities approved by the Adjutant General for the purpose of enabling these veterans to remain in their homes and communities rather than being placed in a nursing home or other long-tern care facility; b. solicit proposals for pilot projects to provide home health care, adult day care or assistive living services, or a combination thereof, to veterans from agencies, organizations or other entities interested in participating in the program; and c. review the project proposals, approve and fund, within the limits of moneys appropriated for the purpose of this program, a maximum of three proposals which best meet the objectives of the program and which include procedures for evaluating the effectiveness of the proposed project.
4. A frail, elderly or disabled veteran who is a resident of this State shall be eligible for the program if:
a. the veteran meets financial eligibility limits for the program to be established by the Adjutant General;
b. the agency organization or other entity administering the pilot program from which the veteran is seeking services certifies that the veteran is at risk of placement in a nursing home or other long-term care facility but could be appropriately cared for in his or her home or in the community if services provided under the program are available to the veteran;
c. the estimated cost of the services provided to the veteran under the program does not exceed 70% of the average cost of a comparable level of nursing home or long-term care; and
d. the veteran is not eligible for the same or similar services under the Medicaid program established pursuant to P.L.1968, c.413 (C:30:4D-1 et seq.).
5. a. The agency, organization or other entity administering a pilot project under the program shall perform a comprehensive medical, social and financial assessment of each applicant for services, according to guidelines established by the Adjutant General, to determine if the applicant is eligible for the program pursuant to section 4 of this act.
b. The assessment shall be used by the agency, organization or other entity administering the pilot project as a basis for preparing a services plan designed to meet the specific health and social needs of each applicant who is eligible for the program which shall include: a list of the services to be provided; an estimate of the frequency with which, and total length of time that, each service will be provided; and estimate of the cost of each service and the total cost of implementing the plan; and a statement of the percentage or amount of money that an eligible veteran shall be required to contribute toward the cost of services provided under the plan which shall be determined by the agency, organization or other entity in accordance with the sliding fee scale established by the Adjutant General pursuant to section 7 of this act. The plan shall be revised as frequently as necessary, but a comprehensive reassessment of each eligible veteran shall be made annually.
c. The plan shall be discussed with the eligible veteran and his or her spouse, if married. The plan shall not be approved until the eligible veteran and his or her spouse approve the plan in writing.
d. The assessment and the services plan shall be completed on the forms prescribed by the Adjutant General.
6. a. The Adjutant General shall, by regulation, stipulate which home health, adult day care and assistive living services are eligible for reimbursement under the program.
b. The Adjutant General shall establish a written contract with each agency, organization or other entity which is approved to administer a pilot project under the program pursuant to section 3 of this act, setting in forth detail the services to be provided to eligible veterans by the pilot project and the obligations and responsibilities of the agency, organization or other entity.
7. a. The Adjutant General shall establish a sliding fee scale which shall be used to determine the percentage or amount of money that an eligible veteran and his or her spouse, if married, shall be required to contribute toward the cost of services provided under the program. This percentage or amount shall be based on an eligible veteran's and his or her spouse's, if married, ability to pay for the services under the program, except that no eligible veteran and spouse shall have to pay more than 50% of the cost of services provided pursuant to this act.
b. If the costs of providing services to an eligible veteran under the program are covered in whole or in part by any other State or federal government program or insurance contract, the other government program or insurance carrier shall be the primary payer and the program shall be the secondary payer.
8. The Adjutant General shall establish a fee schedule for payments or reimbursements to providers of home health care, adult day care and assistive living services under the program.
9. The Adjutant General shall report to the Governor and the Legislature no later than 24 months after the effective date of this act on the activities of the program and its effectiveness in meeting its objectives, including an assessment of the most efficient and effective method of establishing a Statewide program and the projected cost of doing so, and accompanying the report with any recommendations for changes in the law or regulations governing the program that the Adjutant General deems necessary.
10. The Adjutant General, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations necessary to effectuate the purposes of this act.
11. This assessment and pilot program, if necessary, shall be self-financed 1to the extent possible1 by the Department of Military and Veterans' Affairs through 1savings and cost avoidance realized by1 increased efficiencies within the department 1[and through revenues generated by increased per diem reimbursed from the federal Veterans Administration effective October 1, 1994]1.
12. This act shall take effect immediately and shall expire two years after the effective date.
The "Veterans Alternative Health Care Assessment and Demonstration Act."