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 is significant for state Medicaid policy as it strengthens the existing approach of providing immediate assistance to eligible individuals who are pending enrollment in a managed care organization. By enforcing fee-for-service coverage, the bill seeks to prevent potential gaps in service that could adversely affect the health and well-being of vulnerable populations. This approach also reinforces the capabilities of the Division of Medical Assistance and Health Services to guide Medicaid beneficiaries effectively as they move into managed care.
Summary
Bill S761, introduced in the New Jersey 221st Legislature, mandates that Medicaid provide fee-for-service coverage for certain managed long term services and supports to individuals awaiting enrollment in a managed care organization. This initiative is aimed at ensuring that individuals who qualify for the Medicaid Managed Long Term Services and Supports program are not left without necessary services during the transition to a managed care environment. Specifically, it covers services from assisted living residences, personal care homes, assisted living programs, and adult family care providers.
Contention
While the bill addresses pressing concerns in Medicaid service continuity, it may spark discussions regarding its implementation and the costs associated with extending fee-for-service support. Opponents could argue about the financial implications for the state Medicaid budget, and whether the resources allocated for this program could be redirected toward enhancing other aspects of Medicaid services. Furthermore, there might be questions about how efficiently the Commissioner of Human Services can execute the necessary state plan amendments or waivers to meet federal standards and secure funding.
Notable_points
The bill serves to codify essentially what has been existing policy on Medicaid coverage into a formal legislative framework. This could help to prevent inconsistencies in coverage that may arise from administrative changes or fluctuations in policy interpretations. Moreover, by specifying the triggers for coverage commencement and cessation, the bill aims to provide clarity and reassurance to both service providers and beneficiaries regarding their rights and obligations under Medicaid.
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.
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.
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.
To Amend The Medicaid Fraud Act And The Medicaid Fraud False Claims Act; And To Update Language And Definitions To Reflect Changes Within The Healthcare System;.
Requires Medicaid reimbursement for covered behavioral health services provided by local education agency to student who is eligible Medicaid beneficiary.
Requires Medicaid reimbursement for covered behavioral health services provided by local education agency to student who is eligible Medicaid beneficiary.
Provides for presumptive eligibility for home and community-based services and services provided through program of all-inclusive care for the elderly under Medicaid.