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Assembly Approves Bipartisan Bill to Allow Medicaid Managed Care Programs to Assess Quality of Long-Term Care Facilities

  (TRENTON) – With the goal to provide greater oversight of long-term care centers, bipartisan legislation to strengthen the role of Medicaid in monitoring the quality of care delivered in long-term care facilities was approved Thursday by the full Assembly, 72-0.

          The bill (A-4480) would require the New Jersey Department of Human Services (DHS) to review existing requirements for Medicaid managed care organizations (MCOs) who contract with providers for nursing home services. Based on the review, DHS would determine whether to request State plan amendments or waivers to allow managed care organizations to suspend or terminate a contract with a nursing home that has a history of multiple licensure violations, or at least one violation that resulted in severe adverse health consequences for facility residents or staff.

          Additionally, DHS would evaluate whether managed care plans can assist the New Jersey Department of Health (DOH) in monitoring compliance and quality of care in nursing homes.

          The measure’s sponsors, Assembly Democrats Pedro Mejia (D-Bergen, Hudson), Nancy Pinkin (D-Middlesex) and Eliana Pintor Marin (D-Essex) and Assembly Republican BettyLou DeCroce (R-Essex, Morris, Passaic) released the following joint statement:

“Under current standards, Medicaid managed care organizations must contract with ‘any willing provider’ for long-term care services, meaning any facility in good standing with state and federal regulators that has agreed to accept Medicaid payment rates. While intended to prevent discrimination against providers, this system may also lock MCOs into contracts with facilities that deliver substandard care.

“As we continue working to reform long-term care in New Jersey, we should look into the option of allowing Medicaid MCOs to define their own standards for providers and terminate contracts with facilities with a history of deficiencies. Medicaid MCOs can provide another layer of oversight to long-term care facilities, which will help ensure residents receive the best quality of care.”