N.J. Admin. Code § 8:33H-1.15

Current through Register Vol. 56, No. 21, November 4, 2024

Section 8:33H-1.15 - Utilization requirements for Medicaid-eligible residents and former psychiatric patients

(a) Applicants receiving certificate of need approval to add general or specialized long-term care beds to an existing facility or to construct a new nursing home or a replacement facility shall comply with the following utilization requirements:

1. Within one year from license issuance, a minimum of 36 percent of the total general long-term care bed complement shall be occupied by direct admission Medicaid-eligible residents, as defined in 8:33H-1.2. The facility shall continue to maintain at least 36 percent Medicaid-eligible direct admissions in its general long-term care beds annually thereafter.

2. Within one year from license issuance, a minimum of 36 percent of the total specialized long-term care bed complement shall be occupied by direct admission Medicaid-eligible residents, as defined in 8:33H-1.2. The facility shall continue to maintain at least 36 percent Medicaid-eligible direct admissions in its specialized long-term care beds annually thereafter.

3. A minimum of 45 percent of the total general long-term care bed complement shall be occupied by Medicaid-eligible residents who either have spent down to the level of Medicaid eligibility during their nursing home stay or who are directly admitted to the facility as Medicaid-eligible residents, as defined in 8:33H-1.2. The facility shall meet this 45 percent overall occupancy by Medicaid-eligible residents in its general long-term care beds by the end of the first year of licensure and continue meeting this percentage thereafter.

4. A minimum of 45 percent of the total specialized long-term care bed complement shall be occupied by Medicaid-eligible residents who either have spent down to the level of Medicaid eligibility during their nursing home stay or who are directly admitted to the facility as Medicaid-eligible residents, as defined in 8:33H-1.2. The facility shall meet this 45 percent overall occupancy by Medicaid-eligible patients in its specialized long-term care beds by the end of the first year of licensure and continue meeting this percentage thereafter.

5. As a condition of certificate of need approval, seven percent of the total number of long-term care beds shall be available for occupancy by persons in need of nursing home care who are present or former patients of State/county psychiatric hospitals or community inpatient psychiatric units.

i. Occupancy of beds by former psychiatric patients who are Medicaid-eligible may count toward the utilization requirements for Medicaid-eligible residents which are specified in (a) above, provided that the former psychiatric resident is Medicaid-eligible.

ii. At the time of initial licensure of any long-term care bed approved in accordance with this chapter, the nursing home shall sign and subsequently maintain a written transfer agreement with the Division of Mental Health and Addiction Services (within the New Jersey Department of Human Services) or at least one county psychiatric hospital or a facility with a community inpatient psychiatric unit, for the purpose of complying with the percentage requirement specified in (a)5 above.

(b) A nursing home that receives certificate of need approval for a change in scope shall comply with either the applicable utilization percentages for Medicare-to-Medicaid and Medicaid-eligible residents which were stated in the Commissioner's original certificate of need approval letter to that facility, or the utilization percentages which are outlined in this chapter, whichever percentages are higher.

(c) A certificate of need applicant proposing a new or expanded facility, or a change in scope to a previously approved project, or a transfer of ownership of an existing facility with previous certificate of need conditions, who can produce documentation that the utilization percentage requirements in this section will cause a financial hardship may request a review of the feasibility of those percentages, which may result in a finding by the Department that a lower percentage is required for financial feasibility.

N.J. Admin. Code § 8:33H-1.15

Amended by 49 N.J.R. 1222(a), effective 5/15/2017