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Lagana, Mazzeo, Eustace, Andrzejczak & Vainieri Huttle Bill to Improve Delivery of Long-Term & Community-Based Services for the Elderly Becomes Law

Three-Bill Package Based on State Audit is also Designed to Maximize Federal Funding to Save New Jersey Taxpayers Money

A three-bill package sponsored by Assembly Democrats Joseph Lagana, Vince Mazzeo, Tim Eustace, Bob Andrzejczak and Valerie Vainieri Huttle to improve the delivery of state programs and services for the elderly in order to maximize their independence and protect taxpayer dollars has been signed into law.

“Essentially these laws provide a number of fixes that will increase the efficiency of existing programs designed to aid some of our most frail and vulnerable residents,” said Lagana (D-Bergen/Passaic). “At the same time, these laws also call for better notification procedures in order to make sure seniors are aware that they may be eligible for critical safety net programs.”

The laws were based on recommendations from a recent State Auditor report on selected community-based senior programs within the state Department of Human Services’ Division of Aging Services. The programs, which are funded by the state and federal government and the Casino Revenue Fund, are designed to provide services to elderly residents to avoid unnecessary institutional placement.

“Anyone with an aging parent or loved one knows how important it is to them to maximize their independence,” said Mazzeo (D-Atlantic). “We have a number of existing state programs designed to do just that but they’re not necessarily being utilized by everyone who is eligible. These laws will help correct that and ensure that the state is taking advantage of every federal dollar available in order to save our taxpayers money.”

“This audit was helpful in exposing several shortcomings that have either prevented seniors from accessing crucial programs or left important federal funding on the table,” said Eustace. “These changes are designed to ensure a more efficient delivery of home and community-based long-term care services while also ensuring that elderly residents and their families do not have to deal with the aggravation of trying to get authorized claims processed.”

The first law (A-4167) is geared towards enrollees in PACE (Program of All-Inclusive Care for the Elderly). PACE is a comprehensive health and social services delivery system that integrates acute and long-term care services to disabled and frail, elderly persons over the age of 55, who are certified by the state as nursing home-eligible, in order to maximize their autonomy and continued independence.

The law requires the Department of Human Services (DHS) to contact each person enrolled in a PACE program, prior to their 65th birthday, to notify them of their eligibility for the Medicare program.

The Department of Human Services is billed monthly by the facilities for each of the enrollees. The amount billed is a set amount and differs for those individuals who are dually eligible for Medicare and Medicaid and those who are solely eligible for Medicaid.

According to the state audit, the monthly rates for fiscal years 2012 and 2013 were $4,809.95 for Medicare and Medicaid recipients and $6,097.57 for Medicaid only recipients. The state pays for these charges and is reimbursed for 50 percent of the cost by the federal government.

The State Auditor identified 336 claims in which the recipient was over the age of 65 and therefore eligible for Medicare as well as Medicaid, but the recipient was not enrolled in Medicare. In these cases, the state was billed the higher Medicaid only rate and the State Auditor estimated that costs savings of over $432,000 could have been achieved if these individuals had been dual enrolled in Medicaid and Medicare.

This law is intended to increase the number of enrollees billed at the lower rate for dual eligible participants in order to reduce costs to the state.

“The cost for care and services for the elderly can be significant,” said Andrzejczak (D-Cape May/Atlantic/Cumberland). “Medicare and Medicaid are important safety nets to help families make sure their loved ones are being taken care of without the financial strain. We need to make sure as many people as possible are taking full advantage of these programs and that the programs are working for them.”

“One of the greatest fears most aging adults have is being forced to give up some of their independence,” said Vainieri Huttle (D-Bergen). “Fortunately, we have a number of programs to help the aging maintain as much freedom as possible. These laws will make sure that more seniors are aware of them and take full advantage of these opportunities.”

The second law (A-4168) would amend the current law governing PACE programs to specify that providers who contract to provide these programs on or after the law’s effective date must submit to DHS, on a monthly basis, expenditure details of the encounters which an enrollee has had with the program.

The law further requires that DHS utilize these expenditure details to analyze capitated rates and help ensure the efficient utilization of services from the programs.

The third law (A-4169) pertains to services provided under the Medicaid Managed Long-Term Services and Supports section 1115 demonstration waiver program or any other Medicaid home and community-based services long-term care program.

In the case of an individual who receives services under one of these programs through a managed care organization, DHS is required to implement a monitoring program which is to include quarterly case file audits and reviews of the consistency of assessments and service authorizations to help ensure efficient utilization of services from the managed care organization.

If services are received through a provider whose claims are processed by a third-party billing agent, DHS is to require the third party-billing agent to perform a review of the provider’s billing limits and of the services provided to the individual, to help ensure that services are provided and claims are processed if those services and claims are authorized for the individual.