Increases cap on personal care assistant services from 40 hours to 91 hours per week for Medicaid beneficiary determined clinically eligible for nursing facility level of care.

A2208

ASSEMBLY, No. 2208

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblywoman SHANIQUE SPEIGHT

District 29 (Essex and Hudson)

Co-Sponsored by:

Assemblywoman Reynolds-Jackson

SYNOPSIS

���� Increases cap on personal care assistant services
from 40 hours to 91 hours per week for Medicaid beneficiary determined
clinically eligible for nursing facility level of care.

CURRENT VERSION OF TEXT

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

��

An Act
concerning personal care assistant services provided
under Medicaid and supplementing Title 30 of the Revised Statutes.

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

���� 1.� Notwithstanding any
regulation to the contrary, the Department of Human Services shall approve, as
medically necessary, up to 91 hours of personal care assistant services per
calendar week for any eligible Medicaid beneficiary who is clinically eligible for
nursing facility level of care. The department shall modify the existing
assessment tool for personal care assistant services in accordance with the
provisions of this section.

�����
Prior to the
implementation of the provisions of
P.L. , c. (C. )
(pending before the Legislature as this bill), the Commissioner of Human
Services shall provide a separate rate certification for an increase of
personal care assistant services hours pursuant to this section within the
State�s managed long-term services and supports program in compliance with
federal standards, including but not limited to 42 C.F.R. 438.4.� Implementation
of an increase of personal care assistant services hours during a State Fiscal
Year shall require a mid-year rate adjustment for the managed long term
services and supports program.

���� As used in this section,

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

���� "Personal care assistant
services" means health related tasks associated with the cueing,
supervision, or the completion of activities of daily living, as well as
related tasks, performed by a qualified individual in a beneficiary's home, or
at a place of employment or post-secondary educational or training program,
under the supervision of a registered professional nurse, certified as
medically necessary, and in accordance with a beneficiary's written plan of
care.

����
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 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 increases the cap on personal care
assistant (PCA) services from 40 hours to 91 hours per week for a Medicaid
beneficiary determined clinically eligible for nursing facility level of care.�

����� The bill requires that prior to the implementation of
the provisions of the bill, the Commissioner of Human Services is to provide a
separate rate certification for an increase of personal care assistant services
hours within the State�s managed long-term services and supports program in
compliance with federal standards, including but not limited to 42 C.F.R.
438.4.� Implementation of an increase of personal care assistant services hours
during a State Fiscal Year is to require a mid-year rate adjustment for the
managed long term services and supports program.

����� The bill also directs the Department of Human
Services to modify the existing assessment tool for PCA services to reflect the
provisions of this bill.

����� The bill defines �personal care assistant services�
to mean health related tasks associated with the cueing, supervision, or the
completion of activities of daily living, as well as related tasks.� PCA
services are certified as medically necessary; delivered in accordance with a
beneficiary's written plan of care; and performed by a qualified individual,
typically in a beneficiary's home, and under the supervision of a registered
professional nurse.

���� Currently, pursuant to State regulation, the Medicaid
program limits PCA services to a maximum of 40 hours per week per beneficiary.�
Additional hours of service may be approved by the Department of Human Services
on a case-by-case basis and based on exceptional circumstances.� Increasing the
service cap to 91 hours per week for the State�s most vulnerable Medicaid
beneficiaries will ensure that they can thrive within the community for
additional years.