Requires Medicaid fee-for-service coverage of managed long term services and supports when beneficiary is pending enrollment in managed care organization.

A2023

ASSEMBLY, No. 2023

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblywoman SHAMA A. HAIDER

District 37 (Bergen)

Assemblywoman ELLEN J. PARK

District 37 (Bergen)

SYNOPSIS

���� Requires Medicaid fee-for-service coverage of managed
long term services and supports when beneficiary is pending enrollment in
managed care organization.

CURRENT VERSION OF TEXT

���� Introduced Pending Technical Review by Legislative
Counsel.

��

An Act

concerning Medicaid coverage of certain managed
long term services and supports and supplementing Title 40 of the Revised
Statutes.

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

���� 1.��� The Division of Medical
Assistance and Health Services in the Department of Human Services shall
provide Medicaid coverage via the fee-for-service delivery system for eligible
services provided by an assisted living residence, a comprehensive personal care
home, an assisted living program, or an adult family care provider to an
individual who is determined eligible for the Medicaid Managed Long Term
Services and Supports program, but who is pending enrollment in a managed care
organization contracted by the division to provide health care services to
Medicaid recipients.� Fee-for-service coverage provided under this section
shall begin on the date on which the individual is determined clinically and
financially eligible for the Medicaid Managed Long Term Services and Supports
program, and shall end on the date on which the individual�s enrollment in a
Medicaid managed care organization becomes effective.

���� As used in this section,
�Medicaid� means the Medicaid program established pursuant to P.L.1968, c.413
(C.30:4D-1 et seq.).

���� 2.��� 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.

���� 3.��� The Commissioner of
Human Services, in accordance with the "Administrative Procedure
Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt such rules and
regulations as the commissioner deems necessary to carry out the provisions of
this act.�����������

���� 4.��� This act shall take
effect immediately.

STATEMENT

���� This bill requires Medicaid
fee-for-service (FFS) coverage of managed long term services and supports when
the beneficiary is pending enrollment in a managed care organization (MCO).� In
doing so, the bill codifies existing Medicaid policy established in Medicaid
Newsletter, Vol. 24, No. 14.

���� This policy was prompted due
to assisted living programs experiencing difficulties receiving reimbursement
for established residents who had been determined financially and clinically
eligible for Medicaid services, but who were awaiting enrollment in a MCO.
Under this scenario, MCO enrollment may require up to 60 days. In response to
this concern, the Division of Medical Assistance and Health Services (DMAHS) in
the Department of Human Services implemented a new billing procedure intended
to avoid a gap in service payment for Medicaid eligible beneficiaries residing
in assisted living programs in which assisted living programs are authorized to
request FFS payments during this gap period.

���� Specifically, the bill
requires the DMAHS to provide Medicaid coverage via the FFS delivery system for
eligible services provided by an assisted living residence, a comprehensive
personal care home, an assisted living program, or an adult family care provider
to an individual who is determined eligible for the Medicaid Managed Long Term
Services and Supports program, but who is pending enrollment in a MCO
contracted by the division to provide health care services to Medicaid
recipients.� FFS coverage provided under the bill shall begin on the date on
which the individual is determined clinically and financially eligible for services
provided under the Medicaid Managed Long Term Services and Supports program,
and shall end on the date on which the individual�s enrollment in a Medicaid
MCO becomes effective.

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