Provides for certain pediatric NJ FamilyCare beneficiaries to maintain private duty nursing hours when transitioning to Managed Long Term Services and Supports; codifies and expands appeals provisions for private duty nursing services.

This bill (A4080) ensures pediatric NJ FamilyCare beneficiaries transitioning from the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program to the Managed Long Term Services and Supports (MLTSS) program automatically retain their previous weekly private duty nursing hours, including carrying forward unused hours. It requires managed care organizations to justify any reduction in nursing hours only based on documented changes in medical need, not administrative reasons, and mandates continued coverage during appeals. Beneficiaries can appeal reductions within 30 days, with coverage maintained until the appeal concludes or is withdrawn. The bill also directs the state to review past transitions (last 5 years) to identify beneficiaries eligible for increased nursing hours. It directly affects children under 21 receiving nursing services through NJ FamilyCare.