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Bill

A 4559

Eliminates 16 hour per 24-hour period coverage limit on private duty nursing services for certain Medicaid enrollees who are 21 years of age or older.

2026-2027 Regular Session Introduced by Al Barlas and 1 co-sponsor

Allows up to 24 hours of private duty nursing per day for certain NJ Medicaid adults if illness severity requires it, via plan waivers and rules.

Introduced, Referred to Assembly Aging and Human Services Committee
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Bill Summary · A 4559

Summary of Bill A 4559 (Session 222) – New Jersey

Purpose and intent

  • The bill eliminates the current 16-hour-per-24-hour-period cap on private duty nursing services for a specific group of Medicaid enrollees.
  • Target group: individuals aged 21 or older who are eligible for private duty nursing services under Medicaid managed long-term support services (MLTSS) in New Jersey.
  • Goal: allow up to 24 hours of private duty nursing services in a single 24-hour period when the severity of the individual’s illness requires such care.

Key provisions

  1. Eligibility and service limit change

    • Replaces the existing 16-hour-per-24-hour limit with a 24-hour-per-24-hour limit for eligible individuals 21+.
    • The 24-hour level is conditional: it applies if the severity of the illness necessitates such services, as determined by the New Jersey Department of Human Services (the Commission of Human Services).

  2. Administrative actions and federal compliance

    • The Commissioner of Human Services must pursue any required State plan amendments or waivers to implement the bill and to secure federal financial participation for Medicaid expenditures.
    • This ensures alignment with federal Medicaid programs and funding mechanisms.

  3. Rulemaking authority

    • The Commissioner is authorized to adopt rules and regulations under the Administrative Procedure Act to effectuate the bill’s purposes.

  4. Effective date and implementation

    • The act would take effect on the first day of the seventh month after enactment.
    • The Commissioner may take anticipatory administrative actions in advance as necessary to implement the measure.

Who is affected

  • Medicaid beneficiaries in New Jersey who are:

    • 21 years of age or older, and
    • enrolled in the Medicaid managed long-term support services program (MLTSS) and eligible for private duty nursing services under N.J.A.C. 10:60-5.1 et seq. (or successor regulations).

  • Carriers/providers of private duty nursing services serving this population, and the Department of Human Services, which oversees program administration and funding.

Practical impact

  • Beneficiaries who require more intensive private duty nursing due to illness severity could receive up to 24 hours of private duty nursing within a single day, rather than being limited to 16 hours.
  • Could affect care planning, staffing, and reimbursement for homes or facilities providing private duty nursing services.
  • The change depends on determinations of illness severity by the Department of Human Services and on approved federal waivers/State plan amendments to fund the expanded hours.

Procedural/timeline considerations

  • Introduction: March 10, 2026.
  • Referred to Assembly Aging and Human Services Committee.
  • Implementation hinges on:
    • Approval of State plan amendments or waivers with federal Medicaid participation.
    • Rulemaking under the Administrative Procedure Act.
    • Effective date: first day of the seventh month after enactment, with possible pre-enactment administrative steps as needed.

Sponsorship

  • Primary sponsor: (not specified in the text)
  • Co-sponsors: Al Barlas, Mike Venezia

Notes

  • The bill does not specify a funding amount or budget impact beyond enabling federal participation; actual costs would be determined through state plan amendments and evolving Medicaid enrollment and service utilization.
  • The determination of “severity of illness” remains a key implementing criterion, to be defined by regulations and associated guidance.

Compiled from official sources — confirm details with the bill’s official record.

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