New Jersey Administrative Code › Title 8 - HEALTH › Chapter 33H - CERTIFICATE OF NEED: POLICY MANUAL FOR LONG TERM CARE SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 8:33H-1.15 - Utilization requirements for Medicaid-eligible residents and former psychiatric patients

Current through Register Vol. 56, No. 14, July 15, 2024
(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.