ASSEMBLY BUDGET COMMITTEE

STATEMENT TO

[Third Reprint]

ASSEMBLY, No. 4914

with committee amendments

STATE OF NEW JERSEY

DATED:  JUNE 27, 2023

      The Assembly Budget Committee reports favorably and with committee amendments Assembly Bill No. 4914 (3R).

      As amended by the committee, this bill establishes the "Hospital at Home Act."

      Under the bill as amended, the Department of Health (department) is to establish a State program to permit a hospital to provide acute care services to an individual outside of the hospital’s licensed facility and within a private residence designated by the individual.  The State program is to be established in a manner that is consistent with the provisions of the federal Acute Hospital Care at Home Program (federal program), as authorized by the federal Centers for Medicare and Medicaid Services, or any successor federal program.  Any hospital issued a waiver to operate, or otherwise approved to participate in, the federal Acute Hospital Care at Home Program will be permitted to operate the federal program to the extent permitted under federal law for such time as the federal program remains in effect. 

      Under the bill as amended, the NJ FamilyCare and Medicaid programs, and any carrier that offers a health benefits plan in this State, is to provide coverage for acute hospital care services provided to a covered person under the State Acute Hospital Care at Home Program established under the bill, on the same basis as when services are delivered within the facilities of a hospital.  Reimbursement payments are to be provided to the hospital, facility, or organization providing the services or the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs or contracts with the individual practitioner who delivered the reimbursable services.  Carriers are not to utilize more stringent utilization management criteria than apply when those services are provided within the facilities of a hospital.  As amended, the bill requires that a health care provider be credentialed by a health benefits plan as a condition of the services being deemed network services.

COMMITTEE AMENDMENTS:

      The committee amendments revise certain references to the federal Acute Hospital Care at Home Program to state that hospitals issued a waiver to participate in the federal program may continue to participate in the federal program for the duration of the federal program consistent with the requirements of the federal program. 

      The committee amendments remove language providing that participants in the federal program can be integrated into the State program established under the bill.

      The committee amendments add language providing that reimbursement payments provided under the bill will be established pursuant to the contract between the health benefits carrier and the hospital.

      The committee amendments add a provision requiring that providers providing hospital-at-home services under the program are to be credentialed by a health benefits carrier as a condition of the provider’s services being deemed network services, and remove a separate reference to services being provided by a credentialed health care provider.

FISCAL IMPACT:

      This bill has not been certified as requiring a fiscal note.