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Bill

S 1951

Establishes requirements for sanctions and other actions involving low-performing nursing homes.

2024-2025 Regular Session Introduced by Joe Cryan and 2 co-sponsors

NJ bill requires DMAS to impose escalating sanctions on Medicaid nursing homes with consecutive CMS one-star ratings, including improvement plans and possible Medicaid removal.

Referred to Senate Budget and Appropriations Committee
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Bill Summary · S 1951

Summary — S.1951 (Introduced June 4, 2025)

Establishes requirements for sanctions and other actions involving low‑performing nursing homes (those rated “one star” by CMS).

Main purpose

Require the Division of Medical Assistance and Health Services (DMAS) in the NJ Department of Human Services (DHS) to take graduated actions — warnings, evaluations for sanctions, mandatory improvement plans, and potential removal of Medicaid participation — when a nursing home receives low CMS quality ratings for consecutive quarters, and to report annually on actions taken.

Key provisions

  • Triggering events

    • 1 one‑star quarter following a prior 2+ star quarter: DMAS must issue a warning urging improvement and notifying the facility that further one‑star ratings may prompt required corrective action or sanctions.
    • Two consecutive one‑star quarters: DMAS must evaluate whether to impose sanctions (examples listed).
    • Three or more consecutive one‑star quarters: DMAS must evaluate and may impose additional, more severe sanctions and require an improvement plan.

  • Possible sanctions (non‑exclusive examples)

    • Prohibit admitting new Medicaid enrollees or new residents
    • Limit the number of Medicaid enrollees admitted
    • Reduce or stop quality‑incentive payments under DHS programs
    • Remove current Medicaid residents and stop QIP payments
    • Decline, revoke, or restrict owner/operator participation in Medicaid
    • In consultation with the Department of Health (DOH), bar owners/operators from acquiring interests in or contracting with other state nursing homes

  • Improvement plan process (for 3+ consecutive one‑star quarters)

    • Facility must submit an 18‑month improvement plan (format as determined by DMAS).
    • DMAS (with DOH consultation) approves or returns plan with deficiencies; facility has 30 days to resubmit a revised plan.
    • After completion, facility must file a report within 60 days documenting implementation and outcomes.
    • Noncompliance can lead to ineligibility for Medicaid reimbursement (payments continue only until all Medicaid beneficiaries are relocated). Facilities must provide written notice to Medicaid residents and a patient‑centered discharge plan within 30 days of a noncompliance determination.

  • Oversight, procedures & protections

    • DMAS must consult DOH and review DOH’s nursing‑home data dashboard when considering sanctions; if DMAS declines action it must document reasons.
    • DMAS may act at any time to protect residents and staff.
    • DMAS must promulgate regulations defining sanction criteria (minimum factors include resident preferences and regional availability of other homes) and establish an appeals process for facilities.
    • “Nothing in this act” limits DOH or other regulators’ existing authorities; penalties under this law are additional.

Reporting and timing

  • DMAS must submit an annual report to the Governor and Legislature beginning one year after the act’s effective date describing quarterly sanctions, reasons for not imposing authorized sanctions, improvement plan outcomes, and actions against noncompliant homes.

Fiscal and operational impact

  • Office of Legislative Services: indeterminate State cost and revenue impacts. Costs depend on how many homes qualify for sanctions and which sanctions are applied.
  • Potential administrative cost increase for DHS and DOH to monitor compliance, review plans, and prepare reports.
  • Potential Medicaid savings from reduced payments (e.g., quality incentive reductions — historically $3.00–$23.25 per diem adjustments), offset by federal matching fund effects and relocation or alternate placement costs.
  • OLS notes there are dozens of one‑star facilities in the State historically (OSC reports referenced), making fiscal outcomes unpredictable.

Who is affected

  • Primary: nursing homes participating in Medicaid with CMS one‑star ratings.
  • Residents (particularly Medicaid beneficiaries) — may be relocated if a facility is found noncompliant.
  • DHS/DMAS and DOH — increased review, enforcement, and reporting responsibilities.
  • Medicaid program budgets and potentially federal match revenues.

Status

  • Introduced 6/4/2025; referred to Senate Budget and Appropriations Committee (reported favorably out of Senate Health, Human Services & Senior Citizens Committee 6/9/2025). Legislative Fiscal Note issued 7/29/2025.

(Provided metadata lists sponsors and some cross‑jurisdictional text that appear inconsistent with the primary bill materials; the above summary focuses on the New Jersey nursing‑home provisions in the official bill and committee/report documents.)

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

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