ASSEMBLY HEALTH COMMITTEE

STATEMENT TO

[First Reprint]

ASSEMBLY, No. 5225

with committee amendments

STATE OF NEW JERSEY

DATED:  MAY 18, 2023

      The Assembly Health Committee reports favorably and with committee amendments Assembly Bill No. 5225 (1R).

      As amended by the committee, this bill provides coverage for community-based palliative care benefits under the Medicaid program.  Currently, Medicaid covers services provided by a hospice.  However, in order to be eligible for hospice services, a Medicaid beneficiary, among other things, must be certified with a medical prognosis that provides a life expectancy of six months or less and, for Medicaid beneficiaries 21 years of age or older, must waive all rights to curative treatment, or services that are related to the treatment of that terminal condition. 

      Under the bill, the Medicaid community–based palliative care benefit is to include, but not be limited to, all of the following:

      1)   specialized medical care and emotional and spiritual support for beneficiaries with serious advanced illnesses;

      2)   relief of symptoms, pain, and stress of serious illness;

      3)   improvement of quality of life for both the beneficiary and the beneficiary’s family; and

      4)   appropriate care for any age and for any stage of serious illness, along with curative treatment.

      The Medicaid community–based palliative care benefit is to include services provided by a hospice pursuant to existing law, provided that:

      1)   hospice services may be provided at the same time that curative treatment is available, to the extent that services are not duplicative;

      2)   hospice services may be provided to beneficiaries whose conditions may result in death, regardless of the estimated length of the beneficiary’s remaining period of life; and

      3)   the Division of Medical Assistance and Health Services in the Department of Human Services may include any other service deemed appropriate under the benefits provided in the bill.

      Providers authorized to deliver the Medicaid community–based palliative care benefit include Medicaid-approved licensed hospice agencies and home health agencies licensed that provide hospice care.  Nothing in the bill is to be construed to result in the elimination or reduction of covered benefits or services under Medicaid.  Moreover, the bill explicitly states that its provisions are not to affect a beneficiary’s eligibility to receive, concurrently with community–based palliative care services, any services, including home health services, for which the beneficiary would have been eligible in the absence of the bill, to the extent that services are not duplicative.

COMMITTEE AMENDMENTS:

      The committee amendments provide that community-based palliative benefits are to include services provided by Medicaid-approved licensed hospice agencies, Medicaid-approved home health agencies licensed to provide hospice care, and other Medicaid-approved licensed health care providers.  The amendments also make technical changes to the bill involving numbering and usage.