New Jersey-2018-A2398-Introduced

An Act concerning a pilot program for incentive-based value payments for nursing homes and supplementing Title 30 of the Revised Statutes.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. a. The Division of Medical Assistance and Health Services in the Department of Human Services shall establish a pilot program to adopt a new, incentive-based value payment system for nursing homes providing services to Medicaid and NJ FamilyCare recipients. The incentive-based value payment system shall reward participating nursing homes for achieving improved performance outcomes in at least four core measurements of quality improvement and cost savings. The division shall implement the incentive-based value payment system established under the pilot program no later than January 1, 2017.

b. The Commissioner of Human Services, in consultation with Nursing Home Value Payment System Advisory Board established pursuant to section 2 of this act, shall adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), establishing:

(1) eligibility requirements for participation in the pilot program;

(2) core measurements to be considered when determining quality improvement and cost savings, including, but not limited to: preventable hospital admissions and readmissions; medication reconciliation; adverse events; discharge planning during hospitalization; and collaboration with primary care and other health care providers;

(3) performance targets for improvements in the core measurements;

(4) a formula for determining the baseline data against which the core measurements shall be compared when determining the level of improvement and cost savings achieved by a participating nursing home;

(5) the amount of the incentive payments, which may include payment amounts scaled to the level of improvement achieved in each core measurement; and

(6) a schedule for making incentive payments, including one payment no later than 60 days after the start of the pilot program to assist participating nursing homes with implementation and reporting costs, the option of a second payment during the course of the pilot program, and a final payment to be made upon completion of the pilot program.

c. A nursing home participating in the pilot program shall:

(1) for each resident, designate a single health care professional who is responsible for establishing a plan of care for that resident and for coordinating person-centered services throughout the continuum of care;

(2) develop protocols for immediate follow up after discharge from a hospital, including a comprehensive risk assessment;

(3) establish protocols to facilitate collaboration with hospitals and other health care providers to coordinate resident care throughout the continuum of services;

(4) establish protocols and procedures to reconcile resident medications; and

(5) establish standards, requirements, and programs to educate residents and their families regarding individualized plans of care and goals to address the unique needs of each resident.

d. No later than one year after the effective date of this act, the Department of Human Services shall report to the Legislature, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), on the projected costs and benefits of the incentive-based value payment system established under the pilot program. In determining the costs and benefits of the new system, the department shall cooperate with and consider input from nursing homes and provider associations.

Commencing two years after the effective date of this act, and annually thereafter for the duration of the pilot program, the Department of Human Services shall report to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1) on the status of the pilot program, including the number of participating nursing homes, the costs of implementation, the cost savings realized, the department's recommendations with regard to expanding the incentive-based value payment system Statewide, and any other information as may be necessary to evaluate the results of the pilot program.

2. a. There is established in the Department of Human Services the Nursing Home Value Payment System Advisory Board, which shall make recommendations to the Commissioner of Human Services concerning the regulations which are to be adopted pursuant to subsection b. of section 1 of this act.

b. The board shall comprise five public members, to be appointed one each by the Governor, the Senate President, the Senate Minority Leader, the Speaker of the General Assembly, and the Assembly Minority Leader. The public members shall have experience with, possess a background in, or demonstrate a specialized knowledge of, the legal, policy, or social aspects of the nursing home industry and the provision of nursing home services to Medicaid and NJ FamilyCare recipients.

c. The board shall organize as soon as practicable following the appointment of its members, and the members shall select a chairperson from among themselves. The chairperson shall appoint a secretary who need not be a member of the board. The board shall meet at such times as the chairperson shall designate.

d. Members of the board shall serve without compensation, but may be reimbursed for necessary expenses incurred in the performance of their duties within the limits of funds appropriated or otherwise made available to the commission for its purposes.

e. The Department of Human Services shall provide staff services and other necessary support to the board.

f. The board shall expire upon the adoption of regulations pursuant to subsection b. of section 1 of this act.

3. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.

4. This act shall take effect immediately.

STATEMENT

This bill requires the Division of Medical Assistance and Health Services in the Department of Human Services to establish a pilot program to adopt a new, incentive-based value payment system for nursing homes providing services to Medicaid and NJ FamilyCare recipients. The incentive-based value payment system, which is required to commence no later than January 1, 2017, will reward participating nursing homes for achieving improved performance outcomes in at least four core measurements of quality improvement and cost savings, including, but not limited to: preventable hospital admissions and readmissions; medication reconciliation; adverse events; discharge planning during hospitalization; and collaboration with primary care and other health care providers. The goal of the system will be to reduce the costs associated with long-term care by improving the coordination of long-term health care services.

The Commissioner of Human Services will establish, in consultation with the Nursing Home Value Payment System Advisory Board established under the bill, regulations concerning the eligibility requirements for participation in the pilot program, the core measurements and performance targets for the system, a formula for establishing baseline data for comparison, the amount of the incentive payments, and a schedule for making payments. The advisory board will comprise five public members, to be appointed one each by the Governor, the Senate President, the Senate Minority Leader, the Speaker of the General Assembly, and the Assembly Minority leader. The public members are to have experience with, possess a background in, or demonstrate a specialized knowledge of, the legal, policy, or social aspects of the nursing home industry and the provision of nursing home services to Medicaid and NJ FamilyCare recipients. The advisory board will expire upon the adoption of regulations by the commissioner.

Nursing homes participating in the pilot program will be required to designate a single health care professional for each resident to establish a plan of care and coordinate person-centered services for the resident, develop protocols for immediate follow up after discharge from a hospital, develop protocols for medication reconciliation, establish protocols to facilitate collaboration with hospitals and other health care providers, and establish standards, requirements, and programs to educate residents and their families regarding individualized plans of care and goals to address the unique needs of each resident.

The Department of Human Services will be required to submit an initial report to the Legislature on the projected costs and benefits of the incentive-based value payment system and to thereafter submit annual reports on the status of the program, including the number of participating nursing homes, the costs of implementation, the cost savings realized, the department's recommendations with regard to expanding the incentive-based value payment system Statewide, and any other information as may be necessary to evaluate the results of the pilot program.