SENATE, No. 1744

STATE OF NEW JERSEY

219th LEGISLATURE

 

INTRODUCED FEBRUARY 13, 2020

 

 

Sponsored by:

Senator  JOSEPH PENNACCHIO

District 26 (Essex, Morris and Passaic)

Senator  STEPHEN M. SWEENEY

District 3 (Cumberland, Gloucester and Salem)

 

 

 

 

SYNOPSIS

     Provides for certain group home licensees to obtain Medicaid reimbursement for reservation of beds used by residents on therapeutic leave.

 

CURRENT VERSION OF TEXT

     As introduced.

  

An Act concerning Medicaid reimbursement for therapeutic leave days taken by residents of group homes for persons with developmental disabilities, and supplementing Title 30 of the Revised Statutes.

 

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

 

     1.    As used in this act:

     "Commissioner" means the Commissioner of Human Services.

     "Department" means the Department of Human Services.

     "Developmental disability" means a developmental disability as defined in the "Developmentally Disabled Rights Act," P.L.1977, c.82 (C.30:6D-1 et seq.).

     "Group home" means a living arrangement that is licensed by the department and operated in a residence or residences leased or owned by a licensee; which provides the opportunity for adults with developmental disabilities to live together in a home, sharing in chores and the overall management of the residence; and in which staff provides supervision, training, or assistance, in a variety of forms and intensity, as required to assist the individuals as they move toward independence.

     "Licensee" means an individual, partnership, or corporation that is licensed by the division, and is responsible for providing services associated with the operation of a group home.

     "Therapeutic leave" means the temporary absence of a resident from a group home for therapeutic, non-medical reasons, including, but not limited to, vacations, visits with parents, other family members, or caregivers, attendance at a residential camp, or residence in a temporary shelter.

 

     2.    a.  A group home shall reserve and hold the room and bed of a Medicaid beneficiary who is temporarily absent from the group home due to therapeutic leave.  The Medicaid beneficiary's bed shall not be occupied by another individual during the period of time in which the beneficiary is on therapeutic leave.

     b.    The New Jersey Medicaid program shall provide reimbursement to a group home licensee, at the per diem rate, for the reservation of a bed for a Medicaid beneficiary who is temporarily absent from the facility, for a maximum period of 12 days per calendar year, for the purposes of therapeutic leave.  No unused leave days may be carried over into the next calendar year.

     c.     A Medicaid beneficiary's temporary absence from a group home for the purpose of therapeutic leave shall be consistent with the beneficiary's individualized habilitation plan and authorized in writing by the beneficiary's treatment team.

     d.    The dates and purpose of each temporary absence occurring as a result of therapeutic leave shall be documented in the Medicaid beneficiary's individualized habilitation plan and health record.  The group home licensee shall also maintain accurate and up-to-date internal records regarding residents' use of therapeutic leave days, and shall make those records available for review by the department, upon request.

     e.     In those instances where a Medicaid beneficiary transfers residence from one group home to another within a calendar year, the receiving group home shall determine the number of therapeutic leave days that have already been allowed by the previous group home of residence within the same calendar year.  A record of any therapeutic leave days that have been used by the resident shall be included by the sending facility in the information that is provided to the receiving facility in association with the transfer of the resident thereto.

     f.     For the purposes of reimbursement under this section, a Medicaid beneficiary shall only be deemed to be temporarily absent from the group home for therapeutic leave if the beneficiary is not present in the facility for a full and consecutive 24-hour period beginning and ending at midnight.  If the beneficiary is present in the facility for any portion of a day, beginning and ending at midnight, reimbursement for that day shall not be sought or provided under this section.

 

     3.    A resident of a group home for persons with developmental disabilities who is a recipient of medical assistance payments under P.L.1968, c.410 (C.30:4D-1 et seq.), and who is temporarily absent from the group home for the purposes of therapeutic leave, as authorized by section 2 of P.L.    , c.    (C.        ) (pending before the Legislature as this bill), shall be covered by the medical assistance program for the number of days that the group home maintains the resident's bed.

 

     4.    Every group home for persons with developmental disabilities in the State shall maintain a room and bed for an eligible resident, as provided by section 2 of P.L.    , c.    (C.        ) (pending before the Legislature as this bill), for a period of up to 12 days per calendar year, when the resident is temporarily absent from the group home for the purposes of therapeutic leave.  The group home shall notify the Division of Medical Assistance and Health Services in the Department of Human Services upon the commencement of a period of therapeutic leave, and the division shall confirm the need to maintain the resident's bed, and shall certify the group home's eligibility to receive payment.

 

     5.    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. 

 

     6.    The Commissioner 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.), as may be necessary to implement the provisions of this act.

 

     7.    This act shall take effect on the first day of the fourth month next following the date of enactment, except the Commissioner of Human Services may take any anticipatory administrative action in advance of the effective date as shall be necessary for the implementation of this act.

 

 

STATEMENT

 

     This bill would require a group home for individuals with developmental disabilities to reserve and hold the room and bed of a Medicaid beneficiary who is temporarily absent from the group home due to therapeutic leave.  "Therapeutic leave" is defined to mean the temporary absence of a resident from a group home for therapeutic, non-medical reasons, including, but not limited to, vacations, visits with parents, other family members, or caregivers, attendance at a residential camp, or residence in a temporary shelter.  The bill prohibits a group home from allowing a Medicaid beneficiary's bed to be occupied by another individual during the period of time in which the beneficiary is on therapeutic leave.

     The bill further provides that a Medicaid recipient who is temporarily absent from the group home for the purposes of therapeutic leave will continue to be covered by the medical assistance program for the number of days, not exceeding 12 days per calendar year, that the group home maintains the resident's bed.  The New Jersey Medicaid program will reimburse a group home licensee, at the per diem rate, for the group home's reservation of a bed for a Medicaid beneficiary who is on therapeutic leave, for the maximum period of up to 12 days per calendar year.

     A Medicaid beneficiary's temporary absence from a group home for the purpose of therapeutic leave is to be consistent with the beneficiary's individualized habilitation plan and authorized in writing by the beneficiary's treatment team.  The dates and purpose of each such temporary absence are to be documented in the Medicaid beneficiary's individualized habilitation plan and health record.  The group home licensee will also be required to maintain accurate and up-to-date internal records regarding residents' use of therapeutic leave days, and make those records available for review by the department, upon request.

     The bill provides that, in instances where a Medicaid beneficiary transfers residence from one group home to another within a calendar year, the receiving group home will be required determine the number of therapeutic leave days that have already been allowed by the previous group home of residence within the same calendar year.  A record of any therapeutic leave days that have been used by the resident is to be included by the sending facility in the information that is provided to the receiving facility in association with the transfer of the resident thereto.

     A Medicaid beneficiary will only be deemed to be temporarily absent from a group home for therapeutic leave, for the purposes of obtaining reimbursement under the bill, if the beneficiary is not present in the facility for a full and consecutive 24-hour period beginning and ending at midnight.  If the beneficiary is present in the group home for any portion of a day, beginning and ending at midnight, reimbursement for that day may not be sought or provided under the bill.

     A group home will be required to notify the Division of Medical Assistance and Health Services in the Department of Human Services upon the commencement of a period of therapeutic leave, and the division will be required to confirm the need to maintain the resident's bed, and certify the group home's eligibility to receive payment under the Medicaid program.