A5493

An Act concerning nursing homes and supplementing P.L.1976, c.120 (C.30:13-1 et seq.).

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. a. The Department of Health shall develop minimum standards for nursing homes for the metrics outlined in each of the following categories:

(1) the physical well-being of residents, as determined based on the number of residents who develop bed sores, the number of resident falls, the use of physical restraints on residents, the number of residents who develop urinary tract infections, the number of residents who are hospitalized, and significant fluctuations in resident weight;

(2) the mental well-being of residents, as determined based on the number of residents who are administered antipsychotic medications, the number of planned group activities and the percentage of residents participating in planned group activities, and the number of residents exhibiting symptoms of depression; and

(3) the nursing home’s operational metrics, as determined based on the facility’s CoreQ score, the number of residents vaccinated against SARS-CoV-2, the number of residents who have received the seasonal influenza vaccination, staff turnover at the facility, the number of single-occupancy rooms at the facility as compared against the number of multiple-occupancy rooms at the facility, the percentages of the resident census residing in single-occupancy and multiple-occupancy rooms, and the numbers of alleged and verified incidents involving abuse, neglect, or exploitation of facility residents.

b. The Department of Human Services and the Department of Health shall annually conduct a joint review of the standards developed by the Department of Health in the categories outlined in paragraphs (1), (2), and (3) of subsection a. of this section to determine their efficacy in evaluating health, safety, and operations in nursing homes, as well as the effectiveness of sanctions, corrective action plans, and other measures used by the Department of Human Services and the Department of Health to respond to a nursing home that fails to comply with health, safety, and operational requirements.

2. a. In the event that a nursing home receives a one-star rating from the federal Centers for Medicare and Medicaid Services, or fails to meet at least two of the standards developed by the Department of Health in each of the categories outlined in paragraphs (1), (2), and (3) of subsection a. of section 1 of this act, and the nursing home received a rating of two stars or higher in each of the three quarters preceding the quarter in which the facility received a one-star rating, the Division of Medical Assistance and Health Services in the Department of Human Services shall issue a warning to the nursing home:

(1) urging the nursing home to improve the quality of care provided to residents;

(2) advising the nursing home that a second or subsequent one-star rating may result in the division requiring the nursing home to take specific steps to improve the quality of care; and

(3) advising the nursing home that the failure to improve quality of care at the nursing home may result in the division imposing sanctions against the nursing home.

b. In the event a nursing home receives a one-star rating from the federal Centers for Medicare and Medicaid Services, or fails to meet at least two of the standards developed by the Department of Health in each of the categories outlined in paragraphs (1), (2), and (3) of subsection a. of section 1 of this act, in any two of the preceding four quarters, the division shall evaluate whether to impose sanctions against the nursing home, which sanctions may include, but shall not be limited to: issuing an order prohibiting the nursing home from admitting new Medicaid enrollees; limiting the total number of Medicaid enrollees who may be admitted to the nursing home; and reducing or limiting payments to the nursing home under the Department of Human Services’ quality incentive payment program.

c. In the event a nursing home receives a one-star rating from the federal Centers for Medicare and Medicaid Services, or fails to meet at least two of the standards developed by the Department of Health in each of the categories outlined in paragraphs (1), (2), and (3) of subsection a. of section 1 of this act, in any three of the preceding four quarters, the division shall evaluate whether to impose additional sanctions against the nursing home, which sanctions shall be in addition to, and more severe than, any sanctions imposed pursuant to subsection b. of this section. Sanctions imposed pursuant to this subsection may include, but shall not be limited to: issuing an order prohibiting the nursing home from admitting new residents; removing current residents who are Medicaid enrollees from the nursing home; suspending all payments to the nursing home under the Department of Human Services’ quality incentive payment program; declining to approve or revoking the approval of the owner or operator of the nursing home to participate in Medicaid; and, in consultation with the Department of Health, prohibiting the owner or operator of the nursing home from obtaining an interest in, or contracting with, any other nursing home in the State.

d. (1) In addition to any other actions taken pursuant to subsection b. or c. of this section, the division shall require a nursing home that receives a one-star rating from the federal Centers for Medicare and Medicaid Services, or fails to meet at least two of the standards developed by the Department of Health in each of the categories outlined in paragraphs (1), (2), and (3) of subsection a. of section 1 of this act, in any three of the preceding four quarters, to submit an improvement plan to the division, in a manner and method to be determined by the division, providing a description of the action steps to be taken by the nursing home over an 18-month period to resolve the quality issues indicated by facility’s consecutive one-star ratings or continuing failure to meet at least two of the standards developed by the Department of Health in the categories outlined in paragraphs (1), (2), and (3) of subsection a. of section 1of this act.

(2) The division, in consultation with the Department of Health, shall review a plan submitted by a nursing home pursuant to paragraph (1) of this subsection. A nursing home shall immediately commence implementing the plan upon written approval by the division. If the division does not approve a nursing home’s improvement plan, the division shall return the disapproved plan to the nursing home with a written explanation of the plan’s deficiencies. The nursing home shall have 30 days from receipt of a disapproved plan to submit an updated improvement plan to the division for approval. If the division determines a nursing home’s updated improvement plan cannot be approved, the division shall have the discretion to return the plan to the nursing home with a written explanation of the plan’s deficiencies and allow the nursing home to submit a second updated plan, or to make a determination that the nursing home is noncompliant with the requirements of this subsection.

(3) Within 60 days of the completion of the nursing home’s approved improvement plan, the nursing home shall submit a report to the division documenting the execution of the plan, as well as the outcomes of the action steps. The division, in consultation with the Department of Health, shall evaluate the report and determine whether the nursing home was compliant in implementing the plan as approved by the division. At the division’s discretion, a nursing home determined to be noncompliant with the implementation of its improvement plan may be provided additional time to fulfill the actions steps outlined in the plan.

(4) A nursing home that fails to comply with the requirements of this subsection shall be ineligible to receive reimbursement under the Medicaid program, provided that reimbursement for services shall continue until all Medicaid beneficiaries residing at the nursing home have been relocated. The nursing home shall be responsible for informing Medicaid residents, in writing, of the nursing home’s non-compliance with the requirements of this subsection, and shall provide the division with a patient-centered discharge plan for current Medicaid residents within 30 days of the receipt of the division’s written determination of noncompliance with the requirements of this subsection. The division shall include information on the appeals process, established pursuant to subsection i. of this section, in the written documentation provided to a noncompliant nursing home.

e. In the event a nursing home’s quality incentive payments are reduced or suspended pursuant to subsection b. or subsection c. of this section, the full payment amounts shall not be resumed unless the owners and operators of the nursing home and relevant nursing home staff complete a training module, to be developed by the Department of Health, concerning compliance with the standards developed by the Department of Health in the categories outlined in paragraphs (1), (2), and (3) of subsection a. of section 1 of this act.

f. When evaluating whether to impose sanctions against a nursing home as provided under subsection b. and subsection c. of this section, the division shall consult with the Department of Health concerning its recommendations for action against the nursing home, and shall review the information concerning the nursing home that is available on the data dashboard maintained by the Department of Health pursuant to subsection f. of section 3 of P.L.2021, c.457 (C.26:2H-46.3). In the event the division does not take action against a nursing home as authorized under subsection b. or subsection c. of this section, the division shall document the reason why action was not taken.

g. In addition to any actions taken pursuant to subsections b., c., or d. of this section, the division may, at any time, institute any actions as shall be necessary to protect the health and well-being of residents and staff at a nursing home.

h. Nothing in this section shall be construed to diminish the authority of the Department of Human Services, the Department of Health, or any other department or agency having regulatory authority over nursing homes. A sanction or other action imposed against a nursing home pursuant to this section shall be in addition to any other actions, including sanctions and penalties, taken against the nursing home for violations of State or federal law by the Department of Health or any other department or agency having jurisdiction.

i. The Assistant Commissioner for the Division of Medical Assistance and Health Services in the Department of Human Services shall adopt rules and regulations, pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), establishing:

(1) the criteria the division shall consider when determining whether to impose sanctions against a nursing home pursuant to this section and when determining which sanctions are appropriate for the nursing home, which criteria shall include, at a minimum, the preferences of nursing home residents and the availability of other nursing homes in the same region; and

(2) a process by which a nursing home deemed to be in noncompliance with the requirements of subsection d. of this section may file an appeal with the division.

3. a. Except as provided in subsections b., c., and e. of section 2 of this act, the Department of Human Services shall make quality incentive payments on a biannual basis.

b. The Department of Human Services shall reserve a portion of quality incentive payment funds for the purpose of making incentive payments to nursing homes that do not otherwise qualify for quality incentive payments, but that have demonstrated a cumulative 20 percent improvement or greater in the standards developed by the Department of Health in the categories outlined in paragraphs (1), (2), and (3) of subsection a. of section 1 of this act over a period of four consecutive quarters.

c. Commencing one year after the effective date of this act, and annually thereafter, the Assistant Commissioner for the Division of Medical Assistance and Health Services in the Department of Human Services and the Commissioner of Health shall prepare and submit a joint report to the Governor and, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), to the Legislature, outlining the implementation of this act, including details concerning any sanctions imposed pursuant to this act in each quarter of the preceding year, providing the reasons why sanctions were not imposed against any nursing home for which sanctions were authorized pursuant to subsection b. or subsection c. of section 2 of this act, outlining the results of any improvement plans required pursuant to subsection d. of section 2 of this act and actions taken against nursing homes determined to be non-compliant with the requirements of subsection d. of section 2 of this act, and evaluating the effectiveness of providing incentive payments pursuant to subsection b. of this section to nursing homes that do not otherwise qualify for participation in the quality inventive payment program in fostering improvements in the health, safety, and quality of care provided in nursing homes.

4. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.

5. This act shall take effect 90 days after the date of enactment.

STATEMENT

This bill revises the requirements to take action against low-performing nursing homes.

Specifically, the bill requires the Department of Health (DOH) to develop standards in three categories encompassing the physical well-being of residents, the mental well-being of residents, and the nursing home’s operational metrics. The DHS and DOH will annually review standards to determine their efficacy in evaluating health, safety, and operations in nursing homes, as well as the effectiveness of sanctions, corrective action plans, and other measures used to respond to a low-performing nursing home.

In the event a nursing home receives a one-star rating from the federal Centers for Medicare and Medicaid Services (CMS) or fails to meet at least two of the DOH’s standards in each of the three categories, the Division of Medical Assistance and Health Services in the Department of Human Services (DHS) will be required to take a series of scaling actions against the nursing home, with the penalties and sanctions increasing in each additional quarter in which the nursing home has a one-star CMS rating or fails to meet the DOH standards.

When evaluating whether to impose sanctions against a nursing home, the division will be required to consult with the DOH and review the information concerning the nursing home that is available on the DOH’s nursing home data dashboard. In the event the division does not take action against a nursing home, the division will be required to document the reason why action was not taken.

Under the bill, the division is to require a nursing home that receives a one-star CMS rating or fails to meet the DOH standards in any three of the preceding four quarters to submit an improvement plan. A nursing home that fails to comply with the requirements concerning the submission and implementation of an improvement plan will be ineligible to receive reimbursement under the Medicaid program.

The bill specifies that nothing in its provisions is to be construed to diminish the authority of the DHS, DOH, or any other department or agency overseeing nursing homes, and that actions taken against a nursing home under the bill will be in addition to any other penalties that may be imposed against the nursing home for health or safety violations.

The DOH and DHS will be required to prepare and submit a joint annual report to the Governor and the Legislature outlining the implementation of the bill and an evaluation of the effectiveness of the provisions of the bill in fostering improvements in the health, safety, and quality of care provided in nursing homes.