Sponsored by:
Assemblyman TROY SINGLETON
District 7 (Burlington)
SYNOPSIS
Establishes payment incentive program for home health agencies and health care service firms.
CURRENT VERSION OF TEXT
As introduced.
An Act establishing an incentive program for home health agencies and health care service firms 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 pay-for-performance program for licensed home health agencies and registered health care service firms providing services to NJ FamilyCare recipients enrolled in a Fully Integrated Dual Eligible Special Needs Plan. Participation in the pay-for-performance program shall be mandatory for home health agencies and health care service firms providing services to NJ FamilyCare recipients enrolled in a Fully Integrated Dual Eligible Special Needs Plan, and shall reward the home health agencies and health care service firms for achieving improved performance outcomes.
b. The division shall establish a system to measure improved performance outcomes for Fully Integrated Dual Eligible Special Needs Plan beneficiaries and rank participating home health agencies and health care service firms as determined by how well the agencies or firms meet seven "Outcome and Assessment Information Set" measures, as follows: 1) Incidence of Acute Care Hospitalization; 2) Incidence of Any Emergent Care; 3) Improvement in Bathing; 4) Improvement in Ambulation or Locomotion; 5) Improvement in Transferring; 6) Improvement in Management of Oral Medications; and 7) Improvement in Status of Surgical Wounds.
c. The division shall rank participating home health agencies and health care service firms by each Outcome and Assessment Information Set measure, as delineated in subsection b. of this section, in terms of absolute performance level and percentage improvement in performance relative to the base year. Base year shall be defined as the 12 month period immediately prior to the start of the pay for performance program.
d. Each Medicaid managed care organization in the State that is under contract with the Division of Medical Assistance and Health Services to participate in the Fully Integrated Dual Eligible Special Needs Plan Program and contracts with home health agencies and health care service firms to provide home health services to NJ FamilyCare recipients enrolled in a Fully Integrated Dual Eligible Special Needs Plan shall provide to the division all such data concerning home health services provided in the State as the division determines to be necessary for the purposes of establishing and evaluating the pay-for-performance program, including all such data as may be required to develop base year data and to compare outcomes among home health agencies and health care service firms throughout the State.
2. The Department of Human Services shall appropriate $5 million for distribution to home health agencies and health care service firms for the pay-for-performance program established pursuant to section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill). The pay-for-performance appropriations shall be distributed as follows:
a. 75 percent of the appropriation for the pay-for-performance program shall be distributed to those home health agencies and health care service firms which are ranked by the division in the top 20 percent for absolute performance level, as determined by the division pursuant to section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill).
b. 25 percent of the appropriation for the pay-for-performance program shall be distributed to those home health agencies and health care service firms which are ranked in the top 20 percent for improvement in performance relative to base year, as determined by the division pursuant to section 1 of P.L. c. (C. ) (pending before the Legislature as this bill).
3. The division shall provide the data received pursuant to section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill) and data reported by home health agencies and health care service firms concerning their participation in the pay-for-performance system to the Rutgers Center for State Health Policy for the purposes of evaluating the program with regard to patient outcomes, quality of patient care, cost savings, and such other metrics as the division shall require.
4. No later than three years after the effective date of this act, the division shall report to the Legislature, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), on the projected benefits and costs of the pay-for-performance program.
5. 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.
6. The Commissioner of
Human Services shall adopt rules and regulations pursuant to the
"Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.),
to effectuate the purposes of this act.
7. This act shall take effect on the first day of the sixth month next following enactment, except the commissioner may take any anticipatory administrative action in advance as shall be necessary for the implementation of this act.
STATEMENT
This bill will require the Division of Medical Assistance and Health Services in the Department of Human Services to establish a pay-for-performance program, which will be mandatory for licensed home health agencies and registered health care service firms providing services to NJ FamilyCare recipients enrolled in a Fully Integrated Dual Eligible Special Needs Plan.
The division will establish a system to measure improved performance outcomes for Fully Integrated Dual Eligible Special Needs Plan beneficiaries, and rank participating home health agencies and health care service firms as determined by how well the agencies or firms meet seven "Outcome and Assessment Information Set" measures. The measures include: 1) Incidence of Acute Care Hospitalization; 2) Incidence of Any Emergent Care; 3) Improvement in Bathing; 4) Improvement in Ambulation or Locomotion; 5) Improvement in Transferring; 6) Improvement in Management of Oral Medications; and 7) Improvement in Status of Surgical Wounds.
The division will rank participating home health agencies and health care service firms by each Outcome and Assessment Information Set measure, in terms of absolute performance level and percentage improvement in performance relative to the base year. Base year is defined as the 12 month period before the start of the program.
The requires the Department of Human Services to appropriate $5 million for distribution to home health agencies and health care service firms for the pay-for-performance program. Furthermore, the bill instructs that the pay-for-performance appropriations are distributed as follows: 75 percent of the appropriation will be distributed to those home health agencies and health care service firms which are ranked by the division in the top 20 percent for absolute performance level; and 25 percent of the appropriation will be distributed to those home health agencies and health care service firms which are ranked in the top 20 percent for improvement in performance relative to base year.
The bill also provides for an evaluation of the program and an annual report to be submitted to the Legislature on the program no later than three years after the start of the program.