Requires Medicaid fee-for-service coverage of managed long term services and supports when beneficiary is pending enrollment in managed care organization.
Impact
The legislation addresses significant issues faced by assisted living programs in New Jersey, particularly those related to financial instability due to delayed reimbursements. Individuals found clinically and financially eligible for Medicaid services might experience a waiting period of up to 60 days before their MCO enrollment becomes effective. The new provision will ensure that these individuals receive necessary services during this waiting period, preventing disruption in care and financial burden on care providers.
Summary
Assembly Bill 1409, introduced in the New Jersey legislature, mandates that the Division of Medical Assistance and Health Services (DMAHS) provide Medicaid coverage through a fee-for-service (FFS) model for managed long term services and supports (MLTSS). This coverage is specifically for individuals eligible for MLTSS who are awaiting enrollment in a managed care organization (MCO). The bill aims to close the gap in service payments for patients in assisted living and similar facilities who are in this transitional phase of care.
Contention
While the bill is largely seen as a positive move toward ensuring continuous care for vulnerable populations, concerns may arise regarding the implications of implementing a fee-for-service model. Stakeholders may debate the effectiveness and efficiency of FFS compared to managed care solutions. There are also discussions to be had around the administrative burden on the DMAHS as they navigate necessary state plan amendments to comply with the new mandate, and the overall financial impact on the state's Medicaid budget.
Same As
Requires Medicaid fee-for-service coverage of managed long term services and supports when beneficiary is pending enrollment in managed care organization.
Carry Over
Requires Medicaid fee-for-service coverage of managed long term services and supports when beneficiary is pending enrollment in managed care organization.
Carry Over
Requires Medicaid fee-for-service coverage of managed long term services and supports when beneficiary is pending enrollment in managed care organization.
Requires Medicaid fee-for-service coverage of managed long term services and supports when beneficiary is pending enrollment in managed care organization.
Requires Medicaid fee-for-service coverage of managed long term services and supports when beneficiary is pending enrollment in managed care organization.
Requires DHS to review, and implement certain improvements to, Medicaid Managed Long-Term Services and Supports Program and to establish public-facing report card of managed care organization's coordination of program.
Requires Commissioner of Human Services to ensure coverage of respite care services for eligible Medicaid beneficiaries when primary payer denies coverage of such services for any reason.
Provides for certain pediatric NJ FamilyCare beneficiaries to maintain private duty nursing hours when transitioning to Managed Long Term Services and Supports; codifies and expands appeals provisions for private duty nursing services.
Provides for certain pediatric NJ FamilyCare beneficiaries to maintain private duty nursing hours when transitioning to Managed Long Term Services and Supports; codifies and expands appeals provisions for private duty nursing services.
"Healthy Smiles Act"; increases NJ FamilyCare fee-for-service reimbursement rates for pediatric dental services; requires NJ FamilyCare managed care rates for identical services be no less than fee-for-service rates.