S 3463 — Makes certain changes to regulation of health care service firms.

S3463 1R [First Reprint] SENATE, No.

BUCCO District 25 (Morris and Passaic)  Assemblyman  Co-SponsoredROY by:FREIMAN District 16 (Hunterdon, Mercer, Middlesex and Somerset) Assemblyman  ALEXANDER "AVI" SCHNALL District 30 (Monmouth and Ocean) Assemblyman  CHRISTOPHER P.

SenatorsDEPHILLIPS McKnightDistrict and40 Mukherji(Bergen,  Essex  and  Passaic)   SYNOPSISCo-Sponsored     by: Makes certain changes to regulation of health care service firms.

Senators McKnight, Mukherji, Assemblyman Tully, Assemblywomen Murphy and Brennan   CURRENT  VERSION  OF  TEXTSYNOPSIS      AsMakes introduced.certain changes to regulation of health care service firms.

  CURRENT VERSION OF TEXT      As amended by the General Assembly on June 11, 2026.

     b.    (Deleted by amendment, P.L.2014, c.29)      c.    c.    As a condition of being registered under P.L.1989, c.331 (C.34:8-43 et al.), a health care service firm shall obtain within 12 months of registration accreditation from an accrediting body that is recognized by the Commissioner of Human Services as an accrediting body for homemaker agencies participating in the Medicaid program, as set forth at N.J.A.C.10:60-1.2.  For purposes of accreditation pursuant to this subsection, the accrediting body shall apply the standards set forth in N.J.A.C.13:37-14.1 et seq.

     (1)  (1)  All health care service firms shall annually submit to the director financial statements prepared by the firm, which shall be consistent with the firm's tax filing with the State for the year covered by the financial statements.       (2)  (2)  In addition to the financial statements required pursuant to paragraph (1) of this subsection, a health care service firm that receives more than [$250,000] $500,000 for the provision of New Jersey Medicaid Personal Care Assistance services shall submit to the director an audit the third calendar year after the date of registration or on December 30, 2022, whichever date is later, and every third year thereafter.  The audit shall be submitted no later than September 30th of the calendar year in which it is due.

     (3)  (3)  In addition to the financial statements required pursuant to paragraph (1) of this subsection, a health care service firm that generates $10 million or more in gross income in a year shall submit to the director an audit for that year, except that an audit required by this paragraph shall not be required to be submitted prior to December 30, 2022.  The audit shall be submitted no later than September 30th of the calendar year in which it is due.

     (i)   (i)   the health care service firm’s insurance coverages;

     (ii)  (ii)  any litigation the health care service firm is a party to and a list of all regulatory actions taken by the Division of Consumer Affairs in the Department of Law and Public Safety against the health care service firm, including any disposition of same for the previous three years;

     (iii) (iii) any independent contractors used by the health care service firm for the subject year;

and      (iv) (iv) transactions and liabilities that exceed 50 percent of the firm’s total billings or liabilities, as appropriate.

     (b)  (b)  If the division makes adverse findings against a firm upon review of a report submitted pursuant to subparagraph (a) of this paragraph, the director shall order such corrective action as the director deems appropriate, and, upon compliance with or completion of the corrective action, shall require the firm to obtain a separate review of the firm's data for that year, which shall be conducted by a different independent third-party practitioner than the one that furnished the original report, and shall be based on the standards and procedures developed by the director pursuant to subsection b.

     e.    e.    In addition to any other penalty provided by law, a person shall be liable for a penalty of $500 per day for each day that the person continues to operate a firm without registering as required under this section.  The penalty shall be collected by the Director of the Division of Consumer Affairs in a summary proceeding in accordance with the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.).

P.L.2020, c.132, s.1)             2.12.

TheSection Division2 of ConsumerP.L.2014, Affairsc.29 in(C. the Department of Law and Public Safety shall adopt rules and regulations, in accordance with the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), as are necessary to effectuate the provisions of this act.

 34:8-45.1a)     is 3.amended to read as follows:

This      act2.   shalla. take effect immediately.

 The  Director STATEMENTof  the     Division Thisof billConsumer makesAffairs variousin changesthe toDepartment theof regulationLaw and Public Safety shall enter into a memorandum of understanding with an accrediting body chosen by the director through appropriate procurement processes authorized to accredit a health care service firms.firm pursuant to subsection c.

    of section 1 of P.L.2002, c.126 (C.34:8-45.1).  The bill:memorandum of understanding shall establish the standards for accreditation and for reporting the results of audits performed pursuant to subsection d.

1)of raisessection the1 annualof MedicaidP.L.2002, reimbursementc.126 threshold for personal care assistance services that would trigger an audit for health care service firms from $250,000 to $500,000;the Division.

2)      requiresb.   the[The director shall, in consultation with representatives of health care service firms toregistered submitwith the auditdivision, nodevelop lateran thanagreed-upon Septemberset 30th of thestandards calendarand yearprocedures infor whichindependent itthird isparty due;practitioners to review health care service firm financial statements and records, general management, and internal controls pursuant to paragraph (4) of subsection d.

3)of revisessection the1 compensationof thresholdP.L.2002, forc.126 reporting(C.34:8-45.1).  requirementsAt fora healthminimum, carethe servicestandards firms from between $1 million and $10procedures million,developed pursuant to lessthis thansubsection $10shall million;address:

4)      revises(1) the informationminimum thateducational, istraining, toand beprofessional containedcertification inqualifications thefor independent third party practitioners performing reviews of health care service firm’sfirm report;financial statements and records;

5)      provides(2) forthe correctivedata actionpoints and metrics to be included in certaina cases;review of a health care service firm's financial statements and records, general management, and internal controls which shall include, at a minimum, verification of the accreditation and licensing status of the firm;

andreview 6)of permitsthe auditsfirm's toownership bestructure; performed by out-of-State accountants.

review of contracts and funding sources as well as payments, cash transactions, and reconciliation of account balances;

review of the adequacy of the firm's insurance coverage;

review of billing practices and invoices to ensure the adequacy of supporting documentation and the inclusion of appropriate authorizations;

review of any history of litigation involving the firm, regulatory actions taken against the firm, or past audits of the firm;

review of the use of independent contractors;

and review of large transactions and liabilities that exceed a specified percentage of the firm's total billings or liabilities, as appropriate;

and       (3) the thresholds and requirements for the division to make an adverse finding and take corrective action against a firm based upon a review of an independent third party report concerning the firm's financial statements and records.] (Deleted by amendment, P.L.   , c.   ) (pending before the Legislature as this bill).

1 (cf:

P.L.2020, c.132, s.2)        1[2.]  3.1 The Division of Consumer Affairs in the Department of Law and Public Safety shall adopt rules and regulations, in accordance with the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), as are necessary to effectuate the provisions of this act.

       1[3.]  4.1  This act shall take effect immediately.