An Act providing compensation relief to long term care
facilities when Medicaid eligibility determinations are delayed, designated the
“Uncompensated Pending Medicaid Beneficiary Payment
1. The Commissioner of
Human Services shall make an advance payment to a nursing facility, an assisted
living residence, or a comprehensive personal care home licensed pursuant to
P.L.1971, c.136 (C.26:2H-1 et seq.), at the facility’s request, whenever the
facility is providing uncompensated services to one or more residents whose
eligibility for Medicaid has not been determined more than ninety days after an
application has been filed. Any such advance payment shall not exceed fifty
percent of the estimated amount due for the uncompensated services. No later
than 30 days after any such application is granted and payment has been made to
the facility, or after any such application has been denied, the commissioner
shall: provide reimbursement for any balance due to the facility; or recover
any advance payments made on behalf of an applicant deemed ineligible for
Medicaid by reducing any payments due to the facility.
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, in accordance with the “Administrative Procedure Act,”
P.L.1968, c.410 (C.52:14B-1 et seq.), adopt any rules and regulations as the
commissioner deems necessary to carry out the provisions of this act.
4. This act shall take
effect on the first day of the fiscal year next following the date of
enactment, except that the Commissioner of Human Services may take such
anticipatory administrative action in advance thereof as shall be necessary for >
the implementation of the act.
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STATEMENT
This bill, designated the
“Uncompensated Pending Medicaid Beneficiary Payment Relief Act,” would provide
payments to certain long term care facilities for residents who have applied
for Medicaid but whose eligibility has not been determined more than 90 days
after the initial application. The bill requires the Commissioner of Human
Services to make advance payments to a nursing facility, an assisted living
residence, or a comprehensive personal care home, at the facility’s request,
whenever the facility is providing uncompensated services to one or more residents
whose eligibility for Medicaid has not been determined more than ninety days
after an application has been filed. Any such advance payment would not exceed
fifty percent of the estimated amount due for the uncompensated services. No
later than 30 days after any such application is granted and payment has been
made to the facility, or after any such application has been denied, the
commissioner would be required to: provide reimbursement for any balance due
to the facility; or recover any advance payments made on behalf of an applicant
deemed ineligible for Medicaid by reducing any payments due to the facility.
