New Jersey Gov. Mikie Sherrill has signed legislation sponsored by Senate Republican Leader Anthony M. Bucco that eases several regulatory requirements for New Jersey home health care service firms (HCSFs).
The new law, S-3463, updates audit and reporting requirements for health care service firms that provide personal care assistance services through Medicaid.
“Families depend on home care providers to help their loved ones live safely and comfortably, and those providers should be able to spend their time caring for patients,” said Bucco (R-35). “By signing this bill into law, we are maintaining necessary accountability and oversight while helping ensure patients receive the quality care they deserve. It will also give families the peace of mind they need and allow small health care providers to focus on doing what they do best.”
The legislation raises the annual Medicaid reimbursement threshold that triggers an audit for health care service firms providing personal care assistance services from $250,000 to $500,000. The law also requires health care service firms to submit required audits by Sept. 30 of the calendar year in which they are due.
In addition, the measure revises reporting requirements by changing the compensation threshold from firms with compensation between $1 million and $10 million to firms with compensation of less than $10 million. It also updates the information that must be included in required reports, establishes a process for corrective action in certain cases, and allows audits to be conducted by qualified out-of-state accountants.
Audit and Reporting Updates
- Medicaid Audit Threshold: Raises the annual Medicaid reimbursement limit that requires an independent audit from $250,000 to $500,000 for personal care assistance services.
- Gross Income Rule: Requires an annual audit for any firm with a gross income of $10 million or more.
- Submission Deadline: Sets a fixed due date of September 30th of the calendar year for required audits to be submitted.
- Detailed Reports: Replaces third-party practitioner reviews with a detailed report for smaller firms (under $500,000 in Medicaid personal care services and under $10 million in gross income) covering insurance, litigation, and independent contractors.
Operational Adjustments
- Out-of-State Accountants: Permits qualified out-of-state accountants to perform the required financial audits.
- Corrective Actions: Introduces provisions for corrective action plans when specific regulatory issues arise.
The new legislation significantly alters the renewal timeline for home care agencies operating as HCSFs, tying mandatory financial filings directly to your annual registration renewal.
While it leaves the core licensing and accreditation structure intact, it introduces stricter deadlines and enforcement parameters.
New Renewal Timelines
- Shifted Expiration Date: All HCSF registrations now expire on Sept. 30 instead of June 30.
- Hard Submission Deadline: Renewal applications are due before Oct. 1 each year.
- Conditional Renewal: The New Jersey Division of Consumer Affairs (DCA) will not approve your registration renewal unless your required audit or detailed financial report is submitted concurrently.
Licensing Adjustments & Rules
- Explicit Registration Caps: The law establishes clear, official penalties for operating without an active registration.
- Platform Model Oversight: It formally extends the DCA’s regulatory authority to cover internet-based referral and digital platform business models, meaning digital home care matchmakers must now register fully as HCSFs.
- Accreditation Mandate Maintained: Agencies must still obtain formal accreditation from an approved body within 12 months of initial registration to maintain compliance.
Financial Compliance Changes
- Audit Triggers: Your firm only needs to submit a full independent audit if it crosses $500,000 in Medicaid Personal Care Assistance revenue or $10 million in gross income.
- Detailed Disclosures: If your agency falls below those metrics, you are no longer required to hire a third-party practitioner for a financial review. Instead, you must fill out a detailed report disclosing insurance, pending litigation, regulatory actions, and use of independent contractors directly on your renewal application.
Specific tier requirements and guidelines can be checked on the New Jersey Division of Consumer Affairs Portal.