Sponsored by:
Senator JON M. BRAMNICK
District 21 (Middlesex, Morris, Somerset and Union)
SYNOPSIS
Requires parity in Medicaid reimbursement rates for certain routine inpatient hospice room and board services.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning Medicaid reimbursement for inpatient hospice care and amending P.L.1968, c.413.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 6 of P.L.1968, c.413 (C.30:4D-6) is amended to read as follows:
6. a. Subject to the requirements of Title XIX of the federal Social Security Act, the limitations imposed by this act and by the rules and regulations promulgated pursuant thereto, the department shall provide medical assistance to qualified applicants, including authorized services within each of the following classifications:
(1) Inpatient hospital services
(2) Outpatient hospital services;
(3) Other laboratory and X-ray services;
(4) (a). Skilled nursing or intermediate care facility services;
(b) Early and periodic screening and diagnosis of individuals who are eligible under the program and are under age 21, to ascertain their physical or mental health status and the health care, treatment, and other measures to correct or ameliorate defects and chronic conditions discovered thereby, as may be provided in regulation of the Secretary of the federal Department of Health and Human Services and approved by the commissioner;
(5) Physician's services furnished in the office, the patient's home, a hospital, a skilled nursing, or intermediate care facility or elsewhere.
As used in this subsection, "laboratory and X-ray services" includes HIV drug resistance testing, including, but not limited to, genotype assays that have been cleared or approved by the federal Food and Drug Administration, laboratory developed genotype assays, phenotype assays, and other assays using phenotype prediction with genotype comparison, for persons diagnosed with HIV infection or AIDS.
b. Subject to the limitations imposed by federal law, by this act, and by the rules and regulations promulgated pursuant thereto, the medical assistance program may be expanded to include authorized services within each of the following classifications:
(1) Medical care not included in subsection a.(5) above, or any other type of remedial care recognized under State law, furnished by licensed practitioners within the scope of their practice, as defined by State law;
(2) Home health care services;
(3) Clinic services;
(4) Dental services;
(5) Physical therapy and related services;
(6) Prescribed drugs, dentures, and prosthetic devices; and eyeglasses prescribed by a physician skilled in diseases of the eye or by an optometrist, whichever the individual may select;
(7) Optometric services;
(8) Podiatric services;
(9) Chiropractic services;
(10) Psychological services;
(11) Inpatient psychiatric hospital services for individuals under 21 years of age, or under age 22 if they are receiving such services immediately before attaining age 21;
(12) Other diagnostic, screening, preventative, and rehabilitative services, and other remedial care;
(13) Inpatient hospital services, nursing facility services, and immediate care facility services for individuals 65 years of age or over in an institution for mental diseases;
(14) Intermediate care facility services;
(15) Transportation services;
(16) Services in connection with the inpatient or outpatient treatment or care of substance use disorder, when the treatment is prescribed by a physician and provided in a licensed hospital or in a narcotic and substance use disorder treatment center approved by the Department of Health pursuant to P.L.1970, c.334 (C.26:2G-21 et. seq.) and whose staff includes a medical director, and limited those services eligible for federal financial participation under Title XIX of the federal Social Security Act;
(17) Any other medical care and any other type of remedial care recognized under State law, specified by the Secretary of the federal Department of Health and Human Services, and approved by the commissioner;
(18) Comprehensive maternity care, which may include: the basic number of prenatal and postpartum visits recommended by the American College of Obstetrics and Gynecology; additional prenatal and postpartum visits that are medically necessary; necessary laboratory, nutritional assessment and counseling, health education, personal counseling, managed care, outreach, and follow-up services; treatment of conditions which may complicate pregnancy doula care; and physician or certified nurse midwife delivery services. For the purposes of this paragraph, "doula" means a trained professional who provides continuous physical, emotional, and informational support to a mother before, during, and shortly after childbirth, to help her to achieve the healthiest, most satisfying experience possible;
(19) Comprehensive pediatric care, which may include: ambulatory, preventive, and primary care health services. The preventive services shall include, at a minimum, the basic number of preventive visits recommended by the American Academy of Pediatrics;
(20) (a) Services provided by a hospice which is participating in the Medicare program established pursuant to Title XVIII of the Social Security Act, Pub.L.89-97 (42 U.S.C. s.1395 et seq.). Hospice services shall be provided subject to approval of the Secretary of the federal Department of Health and Human Services for federal reimbursement.
(b) Notwithstanding any other provision of law to the contrary, the reimbursement rate for inpatient room and board services provided in an inpatient unit by a hospice care program licensed pursuant to P.L.1997, c.78 (C.26:2H-79 et seq.) shall be no less than the reimbursement rate for room and board services provided by a nursing home licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) to a resident receiving hospice services from the nursing home.
(c) The reimbursement rate provided in subparagraph (b) of this paragraph shall not apply to hospice benefit coverage for hospice medical services otherwise provided in a patients home or for days of inpatient care otherwise covered by the hospice medical benefit under 42 CFR 418.108 and 42 CFR 418.110.
(d) For patients admitted to the inpatient unit of an inpatient hospice care program licensed pursuant to P.L.1997, c.78 (C.26:2H-79 et seq.), the reimbursement rate provided in subparagraph (b) of this paragraph shall apply to days of care during which the patient is on the routine level of hospice care, as that level of care is defined for the purposes of the federal Medicaid program, as well as to any days during which the patient is no longer receiving hospice care services from the program but continues to reside with the program pending transfer to another facility;
(21) Mammograms, subject to approval of the Secretary of the federal Department of Health and Human Services for federal reimbursement, including one baseline mammogram for women who are at least 35 but less than 40 years of age; one mammogram examination every two years or more frequently, if recommended by a physician, for women who are at least 40 but less than 50 years of age; and one mammogram examination every year for women age 50 and over;
(22) Upon referral by a physician, advanced practice nurse, or physician assistant of a person who has