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S3894
SENATE, No. 3894
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED MARCH 12, 2026
Sponsored by:
Senator� ANGELA V. MCKNIGHT
District 31 (Hudson)
SYNOPSIS
���� Revises requirements for assessing nursing home
health, safety, and operations and for taking action against low-performing
nursing homes.
CURRENT VERSION OF TEXT
���� As introduced.
��
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.