NJ
New Jersey Assembly Bill A1409

New Jersey 2024-2025 Regular Session

New Jersey Assembly Bill A1409

Introduced
1/9/24  

Caption

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.

Companion Bills

NJ S761

Same As Requires Medicaid fee-for-service coverage of managed long term services and supports when beneficiary is pending enrollment in managed care organization.

NJ S413

Carry Over Requires Medicaid fee-for-service coverage of managed long term services and supports when beneficiary is pending enrollment in managed care organization.

NJ A4012

Carry Over Requires Medicaid fee-for-service coverage of managed long term services and supports when beneficiary is pending enrollment in managed care organization.

Previously Filed As

NJ A4012

Requires Medicaid fee-for-service coverage of managed long term services and supports when beneficiary is pending enrollment in managed care organization.

NJ S413

Requires Medicaid fee-for-service coverage of managed long term services and supports when beneficiary is pending enrollment in managed care organization.

NJ S761

Requires Medicaid fee-for-service coverage of managed long term services and supports when beneficiary is pending enrollment in managed care organization.

NJ A4020

Requires Medicaid managed care organizations to notify certain beneficiaries of maximum coverage for personal care service hours.

NJ S1498

Requires Medicaid managed care organizations to notify certain beneficiaries of maximum coverage for personal care service hours.

NJ A4583

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.

NJ A3588

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.

NJ A4467

Establishes Medicaid Managed Care Organization Oversight Program.

NJ S888

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.

NJ S4179

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.

Similar Bills

NJ S3495

Provides for presumptive eligibility for home and community-based services and services provided through program of all-inclusive care for the elderly under Medicaid.

NJ A4049

Provides for presumptive eligibility for home and community-based services and services provided through program of all-inclusive care for the elderly under Medicaid.

MS HB1565

Medicaid; seek federal waiver to provide for presumptive eligibility for persons who need mental health or substance use disorder services.

NJ S1961

Provides for presumptive eligibility for home and community-based services and services provided through program of all-inclusive care for the elderly under Medicaid.

MS HB1465

Medicaid; extend coverage for eligible women for 12 months postpartum.

MS HB1363

Medicaid; extend coverage for eligible women for 12 months postpartum.

MS HB1364

Medicaid; extend coverage for eligible women for 12 months postpartum.

MS HB426

Medicaid; extend coverage for eligible women for 12 months postpartum.