STATE OF NEW JERSEY
222nd LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION
Sponsored by:
Assemblyman CHRIS TULLY
District 38 (Bergen)
SYNOPSIS
Requires DHS to review, and implement certain improvements to, Medicaid Managed Long-Term Services and Supports Program and to establish public-facing report card of managed care organization's coordination of program.
CURRENT VERSION OF TEXT
As reported by the Assembly Health Infrastructure Committee with technical review.
An Act concerning the Medicaid Managed Long-Term Services and Supports Program and supplementing Title 30 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. The Division of Medical Assistance and Health Services in the Department of Human Services shall conduct a review of the Medicaid Managed Long-Term Services and Support Program and the managed care organizations contracted with the division to administer and coordinate that program. The review, at a minimum, shall include:
(1) a survey and evaluation of the quality oversight measures in place upon the effective date of this act and used to assess the performance of each Medicaid managed care organization in administering and coordinating the Managed Long-Term Services and Supports Program;
(2) an assessment of the State’s barriers to transitioning Medicaid members enrolled in the Managed Long-Term Services and Supports Program from nursing home to community settings, when clinically appropriate and desired by the member; and
(3) a nationwide study of Medicaid Managed Long-Term Services and Supports Program payment models that have high rates of success in transitioning members from nursing home to community settings.
b. Following the completion of the review pursuant to subsection a. of this section, the division shall identify and implement improvements to the Medicaid Managed Long-Term Services and Supports Program based upon the division’s findings pursuant to paragraphs (1), (2), and (3) of subsection a. of this section. The improvements under this subsection shall also include requiring each managed care organization to:
(1) reduce care management caseloads for nursing home residents;
(2) more frequently visit nursing home residents on a face-to-face basis, during which visit a representative from the managed care organization shall ask members directly about, and document members’ responses regarding, the quality of the facility and satisfaction with the facility’s services;
(3) annually review the preferences and clinical needs of members residing in nursing homes and transition any member, when clinically appropriate and desired by the member, to a community setting; and
(4) establish a process, that includes reporting requirements and dedicated transition teams, for complex transitions from nursing home to community care.
c. No later than 18 months after the effective date of this act, the division shall submit a report to the Legislature, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), that summarizes the division’s findings regarding the Medicaid Managed Long-Term Services and Supports Program pursuant subsection a. of this section and describes the improvements made to the program pursuant to subsection b. of this section.
2. a. The Division of Medical Assistance and Health Services in the Department of Human Services shall establish a public-facing report card for each Medicaid managed care organization’s administration and coordination of the Medicaid Managed Long-Term Services and Support Program. Each report card shall be accessible on the department’s website and shall provide user-friendly performance and quality rating information, such that members of the public are able to easily compare managed care organizations and to make an informed decision when choosing a managed care organization for the coordination of long-term services and supports under the Medicaid program. Any Medicaid Managed Long-Term Services and Supports Program reports prepared by the department shall also be included on the same webpage as the report cards established pursuant to this section.
b. For each managed care organization, the report card shall include:
(1) the number of members enrolled in the Medicaid Managed Long-Term Services and Supports Program, disaggregated by service setting;
(2) monthly disenrollment data within the Medicaid Managed Long-Term Services and Supports Program, disaggregated by service setting;
(3) data on performance, quality, and compliance within the Medicaid Managed Long-Term Services and Supports Program, including access to services across different member populations;
(4) available member feedback and reviews; and
(5) any additional information deemed appropriate by the Commissioner of Human Services.
c. The division shall update each managed care organization’s report care annually.
3. This act shall take effect immediately and section 1 shall expire after the submission of the report to the Legislature pursuant to subsection c. of section 1 of this act.