Bill Text: NJ S3019 | 2024-2025 | Regular Session | Introduced
Bill Title: Requires certain nursing homes to improve quality ratings.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced) 2024-04-08 - Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee [S3019 Detail]
Download: New_Jersey-2024-S3019-Introduced.html
Sponsored by:
Senator JOSEPH PENNACCHIO
District 26 (Morris and Passaic)
SYNOPSIS
Requires certain nursing homes to improve quality ratings.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning the quality of nursing homes under the Medicaid 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. A nursing home certified to participate in the Medicaid program with an overall rating on the CMS Five-Star Quality Rating System of one star, upon the effective date of this act or upon the release of subsequent ratings by CMS, shall be required to develop and implement a corrective action plan to improve the nursing home's rating as a condition of receiving reimbursement under the Medicaid program.
b. To fulfill the purposes of this section, at a minimum:
(1) A nursing home with a one star rating shall submit a corrective action plan to the Department of Human Services, in a manner and method to be determined by the Commissioner of Human Services, providing a description of the action steps to be taken by the nursing home over a six-month period to resolve quality issues indicated by the nursing home's domain ratings within the CMS federal Quality Rating System. The plan, at a minimum, shall include steps that would improve the nursing home's overall rating to a minimum of two stars after the implementation of the plan;
(2) The department, in cooperation with the Department of Health, shall review the plan. The nursing home shall immediately commence implementing the plan upon written approval by the department. Any plan that is not approved shall be returned to the nursing home by the department with a written explanation of the plan's deficiencies. The nursing home shall resubmit an updated corrective action plan to the department for review within 30 days of receipt of this notification;
(3) Within 60 days of the completion of the nursing home's approved corrective action plan and every 60 days thereafter, the facility shall submit a report to the department documenting the execution of the plan, as well as the outcomes of the action steps. The department, in cooperation with the Department of Health, shall evaluate the facility's report and determine the facility's compliance in implementing the plan as approved by the department. At the Commissioner of Human Services' discretion, a nursing home determined to be non-compliant with the implementation of the facility's plan may be provided additional time to fulfill the action steps outlined in the plan; and
(4) A nursing home with a one star rating determined by the Commissioner of Human Services to be non-compliant with any
provisions of this section shall be ineligible to receive reimbursement under the Medicaid program, provided that reimbursement for services shall continue until all Medicaid beneficiaries residing at the facility have been relocated. The nursing home shall be responsible for informing Medicaid residents, in writing, of the facility's non-compliance with this section and for providing the department with a patient-centered discharge plan for current Medicaid residents within 30 days of the receipt of the department's written determination of non-compliance with this section. The department shall include information on an appeals process, to be established by the Commissioner of Human Services, in the written documentation provided to non-compliant nursing homes.
c. As used in this section:
"CMS" means the federal Centers for Medicare and Medicaid Services.
"Five-Star Quality Rating System" means the quality rating system for nursing homes that participate in the Medicare or Medicaid programs created by the federal Centers for Medicare and Medicaid Services and based on nursing homes' performance on health inspection surveys, staffing levels, and a set of quality measures derived from the Minimum Data Set and Medicare claims data. The system includes ratings for each of these domains along with an overall rating.
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Minimum Data Set" means part of the federally mandated process for clinical assessment of all residents in Medicare and Medicaid certified nursing homes. This process provides a comprehensive assessment of each resident's functional capabilities.
"Nursing home" means the same as that term is defined in section 1 of P.L.1975, c.397 (C.26:2H-29).
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 shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to effectuate the purposes of this act.
4. This act shall take
effect immediately.
STATEMENT
This bill requires nursing homes certified to participate in the Medicaid program with an overall rating on the CMS Five-Star Quality Rating System of one star to develop and implement a corrective action plan to improve the nursing home's rating as a condition of receiving reimbursement under the Medicaid program.
A nursing home with a one star rating will submit a corrective action plan to the Department of Human Services, providing a description of the action steps to be taken by the nursing home over a six-month period to resolve quality issues indicated by the nursing home's domain ratings within the CMS federal Quality Rating System. The plan, at a minimum, will include steps that would improve the nursing home's overall rating to a minimum of two stars after the implementation of the plan.
The department, in cooperation with the Department of Health, will review the plan. The nursing home will immediately commence implementing the plan upon written approval by the department. Any plan that is not approved will be returned to the nursing home by the department with a written explanation of the plan's deficiencies. The nursing home will resubmit an updated corrective action plan to the department for review within 30 days of receipt of this notification.
Within 60 days of the completion of the nursing home's approved corrective action plan and every 60 days thereafter, the facility will submit a report to the department documenting the execution of the plan, as well as the outcomes of the action steps. The department, in cooperation with the Department of Health, will evaluate the facility's report and determine the facility's compliance in implementing the plan as approved by the department. At the Commissioner of Human Services' discretion, a nursing home determined to be non-compliant with the implementation of the facility's plan may be provided additional time to fulfill the action steps outlined in the plan.
A nursing home with a one star rating determined by the Commissioner of Human Services to be non-compliant with any provisions of this bill will be ineligible to receive reimbursement under the Medicaid program, provided that reimbursement for services will continue until all Medicaid beneficiaries residing at the facility have been relocated. The nursing home will be responsible for informing Medicaid residents, in writing, of the facility's non-compliance with this bill and for providing the department with a patient-centered discharge plan for current Medicaid residents within 30 days of the receipt of the department's written determination of non-compliance. The department will include information on an appeals process, to be established by the Commissioner of Human Services, in the written documentation provided to non-compliant nursing homes.
