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PO Box 360
Trenton, NJ 08625-0360
|Poonam Alaigh, MD, MSHCPM, FACP|
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The Division of Senior Benefits and Utilization Management proposes to readopt N.J.A.C. 8:85 with amendments, repeals and new rules. N.J.A.C. 8:85 establishes standards for the operation of nursing facilities, the provision of nursing services by these facilities, and sets forth a process for the calculation of nursing facility Medicaid per diem rates and for auditing nursing facilities.
The proposed rules would establish a prospective case mix reimbursement system designed to calculate nursing facility-specific rates based on the resident care needs of Medicaid-eligible residents in each facility. The proposed rules would require nursing facilities to assess and identify residents’ nursing and care needs using the minimum data set (MDS) established by the Federal Centers for Medicare and Medicaid Services (CMS) and to file the MDS data electronically. The MDS data would be adjusted by the Department according to the CMS resource utilization group, which groups residents according to their status and anticipated uses of services and resources, and used by the Department to determine a nursing facility’s direct care rate component. Under the new rate-setting formula, a nursing facility’s rate would be comprised of the facility’s direct care case mix and direct care non-case mix costs, the operating and administrative price, the facility-specific fair rental value allowance, and the provider tax pass-through per diem provide by N.J.S.A. 26:2H-92 et seq.
The proposed new rules contain a stop loss/gain provision by which nursing facilities will not lose or gain more than five dollars per day in their state fiscal year (SFY) 2011 rates as compared with their SFY 2010 rates, and not lose or gain more than $10 per day in their SFY 2012 rates as compared with their SFY 2010 rates.
The proposed amendments would specify that the Department’s regional Offices of Community Choice Options shall be responsible for the management of the nursing facility pre-admission screening process. The proposed amendments would also specify the types of evaluations required during pre-admission screening and resident review (PASRR), the responsibility for conducting these evaluations, and the responsibility for notifying interested parties of the results.
The proposal appears in the August 16, 2010 issue of the New Jersey Register. LexisNexis® provides free on-line public access to the New Jersey Administrative Code and the New Jersey Register at http://lexisnexis.com/njoal.
The public has until October 15, 2010 to comment on the proposal. Persons wishing to comment on the proposal must submit their comments in writing to Ruth Charbonneau, Director, Office of Legal and Regulatory Affairs, New Jersey Department of Health and Senior Services,
Department of Health
P. O. Box 360, Trenton, NJ 08625-0360