N.J. Admin. Code § 8:33H-1.7

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

Section 8:33H-1.7 - Assisted living residences and assisted living programs

(a) The applicant for an assisted living residence or for an addition to an existing, licensed assisted living residence shall submit a Certificate of Need application for expedited review, in accordance with the applicable provisions of N.J.A.C. 8:33. Upon approval of a certificate of need, the applicant shall comply with the licensing requirements for assisted living residences at N.J.A.C. 8:36.

(b) The applicant for an assisted living program shall submit a Certificate of Need application for expedited review, in accordance with the applicable provisions of N.J.A.C. 8:33. Each licensed assisted living program office site may provide services in an area that covers no more than two contiguous counties. An applicant may establish and license sufficient sites to provide services for multiple counties, up to and including a Statewide service area. Upon approval of a certificate of need, the applicant shall comply with licensing requirements for assisted living programs at N.J.A.C. 8:36.

(c) Applicants who own, operate, or manage any licensed health care facilities in New Jersey or other states shall have their track record evaluated in accordance with the requirements in 8:33H-1.14.

(d) Certificate of Need applications submitted subsequent to the time that Medicaid reimbursement for assisted living residences becomes generally available beyond the limited number of slots authorized under the Medicaid waiver to section 1915(c) of the Social Security Act, 42 U.S.C. § 1396n shall include a statement of commitment to provide access and continuity of care for Medicaid-eligible patients, including former psychiatric patients, who need nursing home level care.

(e) In accordance with 26:2H-12.1 6, a new facility that is licensed to operate as an assisted living residence on or after August 31, 2001, shall reserve 10 percent of its total bed complement for use by Medicaid-eligible persons.

1. The 10 percent utilization by Medicaid-eligible persons shall be met through Medicaid conversion of persons who enter the assisted living residence as private paying persons and subsequently become eligible for Medicaid, or through direct admission of Medicaid-eligible persons.

2. An assisted living residence shall achieve this 10 percent Medicaid utilization within three years of licensure to operate and shall maintain this level of Medicaid utilization thereafter.

(f) Existing assisted living residences that add additional assisted living beds shall be required, as a condition of licensure approval, to maintain 10 percent of the additional licensed beds for Medicaid-eligible persons through Medicaid conversion of persons who enter the assisted living residence as private paying persons and subsequently become eligible for Medicaid, or through direct admission of Medicaid-eligible persons.

1. If the total number of additional beds is less than 10, at least one of the additional beds shall be reserved for a Medicaid-eligible person.

2. An assisted living residence shall achieve this 10 percent Medicaid utilization in the additional beds within three years of licensure to operate these beds and shall maintain this level of Medicaid utilization thereafter.

3. For the purposes of this subsection, "Medicaid-eligible person" means an individual who has been determined as satisfying the financial eligibility criteria for medical assistance under the Medicaid program, has been assessed as being in need of nursing facility level of care as specified at N.J.A.C. 8:85-2.1, and has been approved by the Department for participation in the Federally approved Comprehensive Medicaid waiver program for assisted living services. "Medicaid-eligible person" includes:

i. Persons who were admitted to the facility as private paying residents and subsequently became eligible for Medicaid; and

ii. Persons who were admitted directly to the facility as Medicaid-eligible.

4. The Commissioner or his or her designee may waive or reduce this 10 percent Medicaid occupancy requirement for some or all regions of the State if it is determined that sufficient numbers of licensed beds are available in the State to meet the needs of Medicaid-eligible persons within the limits of the Federally approved Comprehensive Medicaid waiver as it pertains to assisted living services.

i. The Commissioner or his or her designee shall waive this 10 percent Medicaid occupancy requirement if limitations on funding result in the Department establishing a waiting list for Medicaid-eligible persons requesting assisted living services through the Comprehensive Medicaid waiver.

ii. A licensed assisted living residence may submit a written request for a waiver of the 10 percent Medicaid occupancy requirement in accordance with 8:36-2.7.

5. In accordance with 26:2H-12.1 6 et seq., this subsection shall not apply to an assisted living residence operated by a continuing care retirement community (CCRC), as defined at 8:36-1.3.

N.J. Admin. Code § 8:33H-1.7

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