[Second Reprint]

ASSEMBLY, No. 4049

STATE OF NEW JERSEY

220th LEGISLATURE

INTRODUCED MAY 19, 2022

Sponsored by:

Assemblywoman  ANGELA V. MCKNIGHT

District 31 (Hudson)

Assemblywoman  VERLINA REYNOLDS-JACKSON

District 15 (Hunterdon and Mercer)

Assemblyman  DANIEL R. BENSON

District 14 (Mercer and Middlesex)

Co-Sponsored by:

Assemblymen Danielsen, Verrelli, Assemblywomen Jaffer, Jimenez, Assemblyman Guardian and Assemblywoman Carter

SYNOPSIS

     Provides for presumptive eligibility for home and community-based services, nursing home services, and services provided through programs of all-inclusive care for the elderly under Medicaid.

CURRENT VERSION OF TEXT

     As reported by the Assembly Human Services Committee on February 9, 2023, with amendments.

An Act concerning presumptive eligibility for Medicaid home and community-based services ², nursing home services, and services provided through programs of all-inclusive care for the elderly,² 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 Department of Human Services shall provide for the presumptive eligibility for home and community-based services ², nursing home services, and programs of all-inclusive care for the elderly (PACE)² under Medicaid for an individual who is: seeking home and community-based services ², nursing home services, or PACE enrollment²; awaiting an eligibility determination for Medicaid and any applicable Medicaid waiver program offering home and community-based services ², nursing home services, or services provided through PACE²; and likely to be financially and clinically eligible for Medicaid and any applicable Medicaid waiver program offering home and community-based services ², nursing home services, or services provided through PACE², as determined by the department.

     b.  The department shall provide Medicaid coverage for eligible home and community-based services ², nursing home services, or services provided through PACE² to an individual who is granted ¹[presumptively] presumptive¹ eligibility pursuant to this section.  Coverage provided under this subsection shall begin upon the receipt of an individual’s request for services, pursuant to subsection c of this section, and shall be terminated if the individual is determined clinically or financially ineligible for home and community-based services ², nursing home services, or services provided through PACE² under Medicaid during the eligibility determination process.

     c.  An individual seeking presumptive eligibility for home and community-based services ², nursing home services, or services provided through PACE² under Medicaid shall submit a request to the department in a manner and form as determined by the commissioner.

     d.  ¹[The] An¹ individual granted presumptive eligibility pursuant to this section shall be required to submit a completed application for Medicaid and any applicable Medicaid waiver program offering home and community-based services ², nursing home services, or services provided through PACE² no later than the end of the month following the month in which presumptive eligibility is granted.

     e.  ²A home and community-based services provider, nursing home facility, or PACE center shall be reimbursed for all Medicaid-eligible services rendered to an individual who has been granted presumptive eligibility pursuant to this section, regardless if the individual granted presumptive eligibility is determined clinically or financially ineligible for home and community-based services, nursing home services, or services provided through PACE under Medicaid during the eligibility determination process.

f.²  The department shall provide each individual granted presumptive eligibility pursuant to this section a written notice explaining the terms and conditions of presumptive eligibility and the home and community-based services ², nursing home services, or services provided through PACE² the individual will be eligible to receive.

²[f.] g.²  The commissioner shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this section and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.

²[g.] h.²  As used in this section:

     “Commissioner” means the Commissioner of Human Services.

     “Department” means Department of Human Services.

     “Eligibility determination” means the administrative process by which the Division of Medical Assistance and Health Services in the Department of Human Services or a county welfare agency reviews a beneficiary’s income, financial resources, and circumstances relating to the beneficiary’s application for benefits received under Medicaid or any applicable Medicaid waiver program offering home and community-based services ², nursing home services, or services provided through PACE².

     “Medicaid” means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).

     2.    The Commissioner of Human Services, 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.

     3.    This act shall take effect immediately.