A4582

An Act concerning long-term care facilities and supplementing Title 26 of the Revised Statutes.

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

1. The Commissioner of Health shall:

a. develop a demonstration project to incentivize the creation of dementia care villages that consist of small home models of care;

b. encourage new construction and major renovations of nursing homes with focus on private rooms and baths, clustering, neighborhood unit configuration, and increased outdoor recreation space and access to natural sunlight;

c. aim to eliminate higher occupancy bedrooms in nursing homes that consist of three or more persons per bedroom;

d. promulgate regulations to prevent the construction of new large, hospital-style nursing homes;

e. facilitate a planned and orderly downsizing of nursing homes, through a grant program from available funds to fund certain downsizing expenses for voluntary bed reductions to promote single rooms or repurposing;

f. in conjunction with the Division of Veterans' Healthcare Services in the Department of Military and Veterans' Affairs, ensure that at least one State veterans’ memorial home has the ability to care for veterans who require ventilator care, and ensure that each resident of a State veterans’ memorial home has access to mental health services;

g. develop an action plan to elevate the timeliness of nursing home standard surveys in order to reach and surpass national standards;

h. publish easily accessible data on the type and number of deficiencies cited in nursing homes, including comparative data from other states;

i. update State nursing home regulations to meet or exceed federal regulations, with particular focus on the regulations that concern the rights of residents;

j. expand funding for Mission Critical Long-Term Care Teams from available funds;

k. curtail admissions in appropriate circumstances if a nursing home consistently fails to meet minimum staffing ratios;

l. review results of federal research on nursing home staffing standards and determine whether further refinement or modification of New Jersey’s existing minimum staffing standards is necessary;

m. review the accuracy and relevance of nursing procedures and clinical characteristics used to adjust staffing minimums in nursing home staffing standards;

n. in conjunction with the Department of Human Services, include detailed and verifiable ownership information about any person or group that owns any part of a nursing home in State cost reports;

o. require annual independently audited financial statements for individual nursing homes that report nursing home spending on related party transactions;

p. collaborate with the Department of Human Services to adjust Medicaid payment rates based on differences in acuity of residents, with strong consideration given to the patient-driven payment model, and undertake a careful re-examination of Medicaid capital payment policies in order to support and incentivize small homes and single rooms for residents;

q. reform the State’s quality incentive payment program for nursing homes in order to incorporate meaningful and actionable performance metrics such as 24 hour per day registered nurse coverage, nursing turnover rate, weekend staffing, and presence of single rooms for residents;

r. establish standards for improving airflow systems in nursing homes;

s. adopt more rigorous certification standards for infection preventionists working in nursing homes than what is required by the federal government;

t. work with the federal government to streamline and align federal policy guidance regarding infection control and prevention to the maximum extent appropriate;

u. develop a Statewide essential caregiver policy, which is consistent with applicable federal and State laws, regulations, and guidance, that permits residents to designate essential caregivers who may visit with them during an outbreak, epidemic, or pandemic of an infectious disease;

v. provide incentives for nursing homes that vaccinate at least 90 percent of the residents;

w. prioritize enforcement of the federal requirement that nursing homes have an active resident council, and develop a plan to expand the number of family councils present in nursing homes; and

x. establish a Statewide resident and family support network to provide feedback to State agencies and departments, including the Department of Health, Department of Human Services, and the Office of the State Long-Term Care Ombudsman.

2. The Commissioner of Health shall adopt rules and regulations, in accordance with the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), as are necessary to effectuate the provisions of this act.

3. This act shall take effect immediately.

STATEMENT

This bill requires the Department of Health to make various changes to the provision of long-term care.

Under the bill, the Commissioner of Health is to: 1) develop a demonstration project to incentivize the creation of dementia care villages that consist of small home models of care; 2) encourage new construction and major renovations of nursing homes with focus on private rooms and baths, clustering, neighborhood unit configuration, and increased outdoor recreation space and access to natural sunlight; 3) aim to eliminate higher occupancy bedrooms in nursing homes that consist of three or more persons per bedroom; 4) promulgate regulations to prevent the construction of new large, hospital-style nursing homes; 5) facilitate a planned and orderly downsizing of nursing homes, through a grant program from available funds to fund certain downsizing expenses for voluntary bed reductions to promote single rooms or repurposing; 6) update State nursing home regulations to meet or exceed federal regulations, with particular focus on the regulations that concern the rights of residents; 7) curtail admissions in appropriate circumstances if a nursing home consistently fails to meet minimum staffing ratios; 8) review results of federal research on nursing home staffing standards and determine whether further refinement or modification of New Jersey’s existing minimum staffing standards is necessary; 9) in conjunction with the Department of Human Services, include detailed and verifiable ownership information about any person or group that owns any part of a nursing home in State cost reports; 10) require annual independently audited financial statements for individual nursing homes that report nursing home spending on related party transactions; 11) reform the State’s quality incentive payment program for nursing homes in order to incorporate meaningful and actionable performance metrics such as 24 hour per day registered nurse coverage, nursing turnover rate, weekend staffing, and presence of single rooms for residents; 12) establish standards for improving airflow systems in nursing homes; 13) adopt more rigorous certification standards for infection preventionists working in nursing homes than what is required by the federal government; 14) work with the federal government to streamline and align federal policy guidance regarding infection control and prevention to the maximum extent appropriate; 15) develop a Statewide essential caregiver policy, which is consistent with applicable federal and State laws, regulations, and guidance, that permits residents to designate essential caregivers who may visit with them during an outbreak, epidemic, or pandemic of an infectious disease; 16) provide incentives for nursing homes that vaccinate at least 90 percent of the residents; and 17) prioritize enforcement of the federal requirement that nursing homes have an active resident council, and develop a plan to expand the number of family councils present in nursing homes.