N.J. Admin. Code § 8:33H-1.10

Current through Register Vol. 56, No. 11, June 3, 2024

Section 8:33H-1.10 - Comprehensive personal care homes

(a) In order to improve the utilization of readily available residential health care and "Class C" boarding home beds, to give current residents of these facilities the opportunity to age in place, and to improve access to care for many hospitalized patients and others who need long-term care placements, the Department shall give consideration to the conversion of residential health care facilities and "Class C" boarding homes to comprehensive personal care homes. The Department aims to preserve and promote the residential atmosphere of these settings, while enhancing the level of care and services they may provide, in accordance with the licensure standards at N.J.A.C. 8:36. Furthermore, in the case of hospice, the Department aims to promote the establishment of comprehensive personal care homes to serve terminally ill persons who lack adequate caregiving support to meet their needs while residing at home.

(b) The applicant for a comprehensive personal care home shall submit a Certificate of Need application for expedited review, in accordance with the applicable provisions of N.J.A.C. 8:33.

(c) Eligibility for the construction of new comprehensive personal care beds shall be open exclusively to the following:

1. Existing comprehensive personal care homes and existing facilities proposing conversion to a comprehensive personal care home that wish to add a limited number of beds. Within any five year period commencing at the time of licensure, the new construction of no more than 20 beds as an addition to an existing or proposed comprehensive personal care home may be considered for Certificate of Need approval.

i. Applicants who wish to add more than 20 beds shall apply for approval as an assisted living residence.

2. Hospice programs which have been Medicare-certified for at least 12 consecutive months.

i. As a condition of Certificate of Need approval, the facility shall be occupied exclusively by residents who are eligible for hospice services in accordance with 42 C.F.R. 418 of the Medicare Hospice Manual.

(d) 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.

(e) Certificate of Need applications submitted subsequent to the time that Medicaid reimbursement for comprehensive personal care homes becomes generally available beyond the limited number of slots authorized under the current 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 residents, including former psychiatric patients, who need nursing home level care.

(f) In converting to a comprehensive care home from a residential health care facility or Class C boarding home, the facility shall maintain its existing residents who are Supplemental Security Income-eligible recipients and former psychiatric patients. On an ongoing, annual basis, at least five percent of the facility's residents shall be Supplemental Security Income-eligible recipients, at least half of whom shall be former psychiatric patients. This percentage shall be computed based on the number of resident days per calendar year. The facility shall report this information to the Department's Office of Certificate of Need and Licensing Program by April 15 of each year for the prior calendar year.

1. In the event that the facility's Supplemental Security Income-eligible residents develop the need for nursing home level care, as defined at N.J.A.C. 8:33H-1.2 and determined by Medicaid's pre-admission screening process at N.J.A.C. 8:85, the facility shall maintain these residents in accordance with the licensing standards at N.J.A.C. 8:36, subject to the facility's discharge criteria in accordance with N.J.A.C. 8:36-4.1(d), provided that Medicaid reimbursement is available. However, if Medicaid reimbursement is not available, the facility shall make all necessary arrangements to transfer the person to a nursing home.

2. In the event that the Supplemental Security Income (SSI) payment rate for Comprehensive Personal Care Homes is set at a level below the SSI payment rate for Residential Health Care Facilities, the five percent occupancy requirement for SSI-eligible residents in (f) above shall not take effect. However, Comprehensive Personal Care Homes shall maintain their existing residents who are Supplemental Security Income-eligible, as required in (f) above.

(g) In accordance with 26:2H-12.1 6, a new facility licensed to operate as a comprehensive personal care home 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 comprehensive personal care home as private paying persons and subsequently become eligible for Medicaid, or through direct admission of Medicaid-eligible persons.

2. A comprehensive personal care home shall achieve this 10 percent Medicaid utilization within three years of licensure to operate and shall maintain this level of Medicaid utilization thereafter.

(h) Existing comprehensive personal care homes that add additional assisted living beds shall maintain, as a condition of licensure approval, where such approval was given on or after August 31, 2001, 10 percent of the additional beds for Medicaid-eligible persons through Medicaid conversion of persons who enter the comprehensive personal care home 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. A comprehensive personal care home shall achieve this 10 percent Medicaid utilization in the additional beds within three years of licensure to operate the 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 comprehensive personal care home 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 a comprehensive personal care home operated by a continuing care retirement community (CCRC), as defined at 8:36-1.3.

N.J. Admin. Code § 8:33H-1.10

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