ASSEMBLY HUMAN SERVICES COMMITTEE

STATEMENT TO

[First Reprint]

ASSEMBLY, No. 4049

with committee amendments

STATE OF NEW JERSEY

DATED:  FEBRUARY 9, 2023

      The Assembly Human Services Committee reports favorably and with committee amendments Assembly Bill No.4049 (1R).

      As amended by the committee, this bill requires the Department of Human Services (department) to provide for the presumptive eligibility for home and community-based services, nursing home services, and programs of all-inclusive care for the elderly (PACE) under Medicaid for an individual who is: seeking home and community-based services, nursing home care or PACE enrollment; awaiting an eligibility determination for Medicaid and any applicable Medicaid waiver program offering home and community-based services, nursing home services, or services provided through PACE; and likely to be financially and clinically eligible for Medicaid and any applicable Medicaid waiver program offering home and community-based services, nursing home services, or services provided through PACE as determined by the department. 

      As amended, the department will provide Medicaid coverage for eligible home and community-based services, nursing home services, services provided through PACE to an individual who is granted presumptive eligibility.  Coverage will begin upon the receipt of an individual’s request for services and will end if the individual 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.

      As amended, an individual seeking presumptive eligibility for home and community-based services, nursing home services, or services provided through PACE under Medicaid will be required to submit a request to the department in a manner and form as determined by the Commissioner of Human Services (commissioner).  An individual granted presumptive eligibility will be required to submit a completed application for Medicaid and any applicable Medicaid waiver program offering home and community-based services, nursing home services, or services provided through PACE no later than the end of the month following the month in which presumptive eligibility is granted.  The department will provide each individual granted presumptive eligibility pursuant to this bill a written notice explaining the terms and conditions of presumptive eligibility and the home and community-based services, nursing home services, or services provided through PACE that the individual will be eligible to receive.

      As amended, a home and community-based services provider, nursing home facility, or PACE center is to be reimbursed for all Medicaid-eligible services rendered to an individual who has been granted presumptive eligibility, 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.

      The commissioner will apply for such State plan amendments or waivers as may be necessary to implement the provisions of this bill and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.

COMMITTEE AMENDMENTS

      The committee amended the bill to require the department to provide presumptive eligibility for nursing home services and services provided through programs of all-inclusive care for the elderly (PACE) to eligible individuals under Medicaid.  As introduced, the bill required the department to provide presumptive eligibility for home and community-based services to eligible individuals under Medicaid but did not require that the department provide such eligibility for nursing home services and services provided through PACE.

      The committee amendments stipulate that a home and community-based services provider, nursing home facility, or PACE center is to be reimbursed for all Medicaid-eligible services rendered to an individual who has been granted presumptive eligibility, 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.

      The committee amended the bill to update the title and synopsis of the bill to reflect the changes to the bill.