Bill > S1951

Introduced Session

This bill requires the Division of Medical Assistance and Health Services in the Department of Human Services (DHS) to take certain actions involving nursing homes that receive a one-star quality rating from the federal Centers for Medicare and Medicaid Services (CMS). The CMS currently rates the quality of care in nursing homes on a scale of one to five stars. Specifically, if the nursing home receives a one-star rating, but did not receive a one-star rating in the preceding quarter, the division will be required to issue a warning to the nursing home: 1) urging the nursing home to improve the quality of care provided to residents; 2) advising the nursing home that a second or subsequent one-star rating may result in the division requiring the nursing home to take specific steps to improve the quality of care; and 3) advising the nursing home that the failure to improve quality of care at the nursing home may result in the division imposing sanctions against the nursing home. If the nursing home receives a one-star CMS rating in two consecutive quarters, the division will be required to evaluate whether to impose sanctions against the nursing home, which sanctions may include, but will not be limited to: issuing an order prohibiting the nursing home from admitting new Medicaid enrollees; limiting the total number of Medicaid enrollees who may be admitted to the nursing home; and reducing or limiting payments to the nursing home under the DHS quality incentive payment program. If the nursing home receives a one-star CMS rating in three consecutive quarters, the division will be required to evaluate whether to impose additional sanctions against the nursing home, which sanctions will be in addition to, and more severe than, any sanctions imposed for a one-star CMS rating in two consecutive quarters. The sanctions may include, but will not be limited to: issuing an order prohibiting the nursing home from admitting new residents; removing current residents who are Medicaid enrollees from the nursing home; stopping all payments to the nursing home under the DHS quality incentive payment program; declining to approve or revoking the approval of the owner or operator of the nursing home to participate in Medicaid; and, in consultation with the Department of Health (DOH), prohibiting the owner or operator of the nursing home from obtaining an interest in, or contracting with, any other nursing home in the State. The division may additionally institute any actions as are necessary to protect the health and well-being of residents and staff at the nursing home. When evaluating whether to impose sanctions against a nursing home, the division will be required to consult with the DOH concerning its recommendations for action against the nursing home and review the information concerning the nursing home that is available on the DOH's nursing home data dashboard. In the event the division does not take action against a nursing home as authorized under the bill, the division will be required to document the reason why action was not taken. In addition to any other actions taken against a nursing home under the bill, the division is to require a nursing home that receives a one-star CMS rating in three or more consecutive quarters to submit an improvement plan to the division, in a manner and method to be determined by division, providing a description of the action steps to be taken by the nursing home over an 18-month period to resolve the quality issues indicated by nursing home's consecutive one-star ratings. The division, in consultation with the DOH, will review the plan and either approve it or return it to the nursing home with a description of the changes needed for the plan to be approved. Upon approval of its improvement plan, a nursing home will be required to begin implementing the plan immediately. If an improvement plan is returned to the nursing home for revision, the nursing home will then have 30 days to submit an updated plan to the division for approval. If the division determines the updated plan cannot be approved, it will have the discretion to allow the nursing home to submit a second updated plan or to make a determination that the nursing home is noncompliant with improvement plan requirements, which will result in the division removing all Medicaid enrollees from the nursing home, as outlined below. Within 60 days after completing its improvement plan, a nursing home will be required to submit a report to the division documenting the execution of the plan, as well as the outcomes of the action steps. The division, in consultation with the DOH, will evaluate the report and determine the nursing home's compliance in implementing the plan as approved by the division. At the division's discretion, a nursing home determined to be noncompliant with the implementation of the facility's improvement plan may be provided additional time to fulfill the actions steps outlined in the plan. A nursing home that fails to comply with the requirements concerning the submission and implementation of an improvement plan will be ineligible to receive reimbursement under the Medicaid program, although reimbursement for services will continue until all Medicaid beneficiaries residing at the nursing home have been relocated. The nursing home will be responsible for: 1) informing Medicaid residents, in writing, of the nursing home's noncompliance with the improvement plan requirements; and 2) providing the division with a patient-centered discharge plan for current Medicaid residents within 30 days of the determination of noncompliance. Nursing homes will have the right to appeal the determination of noncompliance. Commencing one year after the effective date of the bill, and annually thereafter, the division will be required to prepare and submit a report to the Governor and the Legislature outlining the sanctions imposed against nursing homes under the bill in each quarter of the preceding year, explaining the reason why sanctions were not imposed against any nursing home for which sanctions were authorized under the bill, and outlining the results of any nursing home improvement plans required under the bill and the actions taken against each nursing home that was determined to be noncompliant with the improvement plan requirements established under the bill. In addition to the sanctions authorized under the bill, the bill specifies that the division may, at any time, institute any actions necessary to protect the health and well-being of residents and staff at a nursing home. Nothing in the bill is to be construed to diminish the authority of the DOH or any other department or agency having regulatory authority over nursing homes, and a sanction or other action imposed against a nursing home under the bill will be in addition to any other penalties imposed against the nursing home for violations of State or federal law. The division will be required to promulgate regulations establishing the criteria the division will consider when determining whether to impose sanctions against a nursing home and which sanctions are appropriate for the nursing home. These criteria will include, at a minimum, consideration of the preferences of nursing home residents and the availability of other nursing homes in the same region. The division will be also be required to promulgate regulations establishing an appeals process for noncompliant nursing homes. This bill implements the recommendations of the Office of the State Comptroller outlined in its February 2022 report titled, "An Examination of the Lowest-Rated Long Term Care Facilities Participating in New Jersey's Medicaid Program."

Committee Categories

Joe Cryan (D)*,  Joe Vitale (D)*,  Teresa Ruiz (D), 

Referred to Senate Budget and Appropriations Committee (on 06/09/2025)

Official Document