N.J. Admin. Code § 8:39-5.1

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

Section 8:39-5.1 - Mandatory policies and procedures for access to care

(a) The facility shall comply with applicable Federal, State, and local laws, rules, and regulations.

(b) There shall be no discrimination against any resident or group of residents based on method of payment.

(c) The facility shall meet all currently applicable conditions attached to any certificate of need that has been granted to it.

(d) If a facility has reason to believe, based on a resident's behavior, that the resident poses a danger to himself or herself or others, and that the facility is not capable of providing proper care to the resident, then an evaluation should be performed and documented in accordance with the Guidelines for Inappropriate Behavior and Resident to Resident Abuse in Appendix B, incorporated herein by reference.

(e) The facility shall make available to indigent individuals at least five percent of its beds or, if the facility is licensed for 100 or more beds, at least 10 percent of its beds. For purposes of this section, an individual is "indigent" if he or she is an applicant for admission or a current resident of the facility, and if he or she would otherwise meet the eligibility requirements of Medicaid reimbursement or county or municipal financial assistance for nursing home care.

CASE NOTES

Former N.J.A.C. 8:30-14.4(a), which required nursing homes to make available "a reasonable number of their beds to indigent persons" as a condition of licensure under 26:2H-5, 26:2H-8, and 26:2H-12, did not exceed the power given to the State under 26:2H-1 et seq.; the argument that the State was attempting to regulate the quantity of health care services, rather than the quality of health care services was rejected because the acute shortage of nursing home beds for indigent persons was a public health concern, and the regulations were not arbitrary or unreasonable. In re Health Care Admin. Board, 83 N.J. 67, 415 A.2d 1147, 1980 N.J. LEXIS 1365 (1980), writ of certiorari denied by 449 U.S. 944, 101 S. Ct. 342, 66 L. Ed. 2d 208, 1980 U.S. LEXIS 3668, 49 U.S.L.W. 3331 (1980).

Former N.J.A.C. 8:30-14.4(a), which required nursing homes to make available "a reasonable number of their beds to indigent persons" as a condition of licensure under 26:2H-5, did not constitute a taking without just compensation under N.J. Const. art. I, para. 20 because the regulation served a valid public purpose and the nursing home was given a right to administrative and judicial review of any allotment of beds. In re Health Care Admin. Board, 83 N.J. 67, 415 A.2d 1147, 1980 N.J. LEXIS 1365 (1980), writ of certiorari denied by 449 U.S. 944, 101 S. Ct. 342, 66 L. Ed. 2d 208, 1980 U.S. LEXIS 3668, 49 U.S.L.W. 3331 (1980).

Former N.J.A.C. 8:30-14.4(a), which required nursing homes to make available "a reasonable number of their beds to indigent persons" as a condition of licensure under 26:2H-5, did not violate the equal protection rights of private facilities because the private facilities were involved in a quasi-public activity and were therefore subject to extensive regulation in the public interest; the classification was not suspect and did not implicate a fundamental right and the nursing home's obligation to serve the public interest was rationally related to the regulations. In re Health Care Admin. Board, 83 N.J. 67, 415 A.2d 1147, 1980 N.J. LEXIS 1365 (1980), writ of certiorari denied by 449 U.S. 944, 101 S. Ct. 342, 66 L. Ed. 2d 208, 1980 U.S. LEXIS 3668, 49 U.S.L.W. 3331 (1980).

Former N.J.A.C. 8:30-14.4(a), which required nursing homes to make available "a reasonable number of their beds to indigent persons" as a condition of licensure under 26:2H-5, did not conflict with the federal Medicaid statute, 42 U.S.C. § 1396 et seq.; there was no factual evidence presented to support the claim that the reimbursement rates set in the program violated the federal rates or that compelled participation in the state program violated the voluntary nature of the federal program, constituting an unjust taking, because there was no requirement in the regulations that a facility seek reimbursement from Medicaid. In re Health Care Admin. Board, 83 N.J. 67, 415 A.2d 1147, 1980 N.J. LEXIS 1365 (1980), writ of certiorari denied by 449 U.S. 944, 101 S. Ct. 342, 66 L. Ed. 2d 208, 1980 U.S. LEXIS 3668, 49 U.S.L.W. 3331 (1980).

N.J. Admin. Code § 8:39-5.1