Sponsored by:
Assemblywoman ANGELA V. MCKNIGHT
District 31 (Hudson)
Assemblyman ROBERT J. KARABINCHAK
District 18 (Middlesex)
Assemblyman GARY S. SCHAER
District 36 (Bergen and Passaic)
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 homes operational metrics, as determined based on the facilitys 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 facilitys 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 homes improvement plan, the division shall return the disapproved plan to the nursing home with a written explanation of the plans 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 homes 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 plans 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 subsect