New Jersey § 30:4d-7mm

§ 30:4d-7mm.

a. Notwithstanding the provisions of any other law or regulation to the contrary,

commencing upon the effective date of P.L.2023, c. 80 ( C.30:4D-7mm et seq. ), 1 assisted living residences, comprehensive personal care homes, and assisted living

programs shall receive a per diem rate of no less than $89.50, $79.50, and $89.50,

respectively, as reimbursement for each Medicaid beneficiary under the care of the

residence, home, or program, as applicable. b. In addition to the minimum per diem rates established pursuant to subsection a.

of this section, assisted living residences and comprehensive personal care homes

shall receive an increased per diem rate based on the percentage of residents who

are Medicaid beneficiaries. Rate increases for assisted living residences and comprehensive personal care homes

shall be as follows: (1) in the case of an assisted living residence or comprehensive personal care home

that is not a Medicaid partner community as described pursuant to subsection d. of

this section, the following rate increases shall apply: (a) those assisted living residences and comprehensive personal care homes with a

population of Medicaid beneficiaries that is at least 15 percent but less than 30

percent of the total resident population shall receive a per diem rate that is $10

higher than the minimum per diem rate established under subsection a. of this section; (b) those assisted living residences and comprehensive personal care homes with a

population of Medicaid beneficiaries that is at least 30 percent but less than 50

percent of the total resident population shall receive a per diem rate that is $15

higher than the minimum per diem rate established under subsection a. of this section; (c) those assisted living residences and comprehensive personal care homes with a

population of Medicaid beneficiaries that is at least 50 percent but less than 70

percent of the total resident population shall receive a per diem rate that is $30

higher than the minimum per diem rate established under subsection a. of this section;

and (d) those assisted living residences and comprehensive personal care homes with a

population of Medicaid beneficiaries that is at least 70 percent shall receive a per

diem rate that is $35 higher than the minimum per diem rate established under subsection

a. of this section. (2) in the case of an assisted living residence or comprehensive personal care home

that is a Medicaid partner community as described pursuant to subsection d. of this

section, a per diem rate that is $35 higher than the minimum per diem rate established

under subsection a. of this section shall apply. c For the purposes of subsection b. of this section, the population percentage of

Medicaid beneficiaries at an assisted living residence or comprehensive personal care

home shall be determined on a yearly basis using the average census of Medicaid beneficiaries

at the assisted living residence or comprehensive personal care home during the measurement

period, as determined by paid claims, measured against the total number of licensed

beds approved for the assisted living residence or comprehensive personal care home

by the Department of Health. d. For the purposes of applying the per diem rate established pursuant to paragraph

(2) of subsection b. of this section, an assisted living residence or comprehensive

personal care home shall be deemed to be a Medicaid partner community if the assisted

living residence or comprehensive personal care home: (1) has participated in the NJ FamilyCare program for two or fewer cycles of the yearly

rate measurement period described in subsection c. of this section or has submitted

its first NJ FamilyCare claim within the preceding 18 months, whichever period is

longer; (2) has provided NJ FamilyCare with a valid land use restriction agreement encumbering

the applicable facility site, which land use restriction agreement limits the use

of the facility to serving low-income residents such that 100 percent of residents

are required to have an annual income that is below 80 percent of the area median

income; (3) has not met the requirements in paragraphs (1) or (2) solely as the result of

a name change or change of ownership; and (4) meets such other requirements as may be required by the Commissioner of Human

Services. e. As used in this act: “ Area median income ” means the median income by household size for an applicable county as determined

by the division. “ Division ” means the Division of Medical Assistance and Health Services in the Department of

Human Services. “ NJ FamilyCare ” means the program established pursuant to P.L.2005, c. 156 ( C.30:4J-8 et al.), which includes the State's Medicaid Program and the Children's Health Insurance

Program. “ Medicaid ” means the Medicaid program established pursuant to P.L.1968, c. 413 ( C.30:4D-1 et seq. ). 1

L.2023, c. 80, eff. June 30, 2023.