Requires Medicaid fee-for-service coverage of managed long term services and supports when beneficiary is pending enrollment in managed care organization.
Impact
The implementation of A4012 is expected to have a significant positive impact on individuals requiring long-term care services. By stipulating that FFS coverage begins from the moment an individual is deemed eligible for Medicaid services, the bill helps eliminate financial instability for both beneficiaries and service providers. This means that residents in assisted living facilities will not face sudden expenses or disruption in their care routines while waiting for MCO enrollment. Additionally, it aligns state policy with current practices that have emerged as necessary in response to payment processing challenges experienced by these facilities.
Summary
Bill A4012, introduced in the New Jersey legislature, mandates that Medicaid provide fee-for-service (FFS) coverage for certain long term services and supports to individuals awaiting enrollment in a managed care organization (MCO). This law is crucial for ensuring continuous health coverage, specifically for residents in assisted living facilities who are eligible for Medicaid but may experience delays in MCO enrollment which can take up to 60 days. The legislation's primary aim is to address the gap in payment for services rendered during this waiting period, thereby ensuring that assisted living programs can maintain their operations without financial interruption.
Contention
While the bill is largely seen as a step in the right direction for providing stable healthcare coverage, it may face scrutiny regarding the broader implications for Medicaid policy and funding. Opponents may raise concerns about the potential for increased costs to the state Medicaid budget and the implications of expanded FFS coverage, arguing that it may burden state resources. Supporters, however, argue that the stability provided by this coverage will ultimately benefit both state resources and the health of vulnerable populations by protecting them from service gaps during transitions to managed care.
Same As
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 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.
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.
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.
Relating to the administration and operation of Medicaid, including Medicaid managed care and the delivery of Medicaid acute care services and long-term services and supports to certain persons.
Provides for presumptive eligibility for home and community-based services and services provided through program of all-inclusive care for the elderly under Medicaid.
Provides for presumptive eligibility for home and community-based services and services provided through program of all-inclusive care for the elderly under Medicaid.
Provides for presumptive eligibility for home and community-based services and services provided through program of all-inclusive care for the elderly under Medicaid.