Bill > S1744

Introduced Session

This bill would require a group home for individuals with developmental disabilities to reserve and hold the room and bed of a Medicaid beneficiary who is temporarily absent from the group home due to therapeutic leave. "Therapeutic leave" is defined to mean the temporary absence of a resident from a group home for therapeutic, non-medical reasons, including, but not limited to, vacations, visits with parents, other family members, or caregivers, attendance at a residential camp, or residence in a temporary shelter. The bill prohibits a group home from allowing a Medicaid beneficiary's bed to be occupied by another individual during the period of time in which the beneficiary is on therapeutic leave. The bill further provides that a Medicaid recipient who is temporarily absent from the group home for the purposes of therapeutic leave will continue to be covered by the medical assistance program for the number of days, not exceeding 12 days per calendar year, that the group home maintains the resident's bed. The New Jersey Medicaid program will reimburse a group home licensee, at the per diem rate, for the group home's reservation of a bed for a Medicaid beneficiary who is on therapeutic leave, for the maximum period of up to 12 days per calendar year. A Medicaid beneficiary's temporary absence from a group home for the purpose of therapeutic leave is to be consistent with the beneficiary's individualized habilitation plan and authorized in writing by the beneficiary's treatment team. The dates and purpose of each such temporary absence are to be documented in the Medicaid beneficiary's individualized habilitation plan and health record. The group home licensee will also be required to maintain accurate and up-to-date internal records regarding residents' use of therapeutic leave days, and make those records available for review by the department, upon request. The bill provides that, in instances where a Medicaid beneficiary transfers residence from one group home to another within a calendar year, the receiving group home will be required determine the number of therapeutic leave days that have already been allowed by the previous group home of residence within the same calendar year. A record of any therapeutic leave days that have been used by the resident is to be included by the sending facility in the information that is provided to the receiving facility in association with the transfer of the resident thereto. A Medicaid beneficiary will only be deemed to be temporarily absent from a group home for therapeutic leave, for the purposes of obtaining reimbursement under the bill, if the beneficiary is not present in the facility for a full and consecutive 24-hour period beginning and ending at midnight. If the beneficiary is present in the group home for any portion of a day, beginning and ending at midnight, reimbursement for that day may not be sought or provided under the bill. A group home will be required to notify the Division of Medical Assistance and Health Services in the Department of Human Services upon the commencement of a period of therapeutic leave, and the division will be required to confirm the need to maintain the resident's bed, and certify the group home's eligibility to receive payment under the Medicaid program.

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Committee Categories

Joe Pennacchio (R)*,  Stephen Sweeney (D)*, 

Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee (on 02/13/2020)