Bill Text: NJ A4569 | 2018-2019 | Regular Session | Introduced
Bill Title: Provides for improved system for eligibility determination for Medicaid and NJ FamilyCare.
Spectrum: Partisan Bill (Democrat 7-0)
Status: (Introduced - Dead) 2019-06-20 - Substituted by S499 (2R) [A4569 Detail]
Download: New_Jersey-2018-A4569-Introduced.html
Sponsored by:
Assemblywoman JOANN DOWNEY
District 11 (Monmouth)
SYNOPSIS
Provides for improved system for eligibility determination for Medicaid and NJ FamilyCare.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning eligibility determination for Medicaid 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 Commissioner of Human Services shall develop an information technology platform for use by the State, county welfare agencies, and State contractors for the purpose of intake, processing, and tracking of applications for benefits under the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) and the NJ FamilyCare program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.). The goals of the system shall be: to simplify the applications and eligibility determination processes for both applicants and eligibility determination staff; to standardize the application of eligibility policy across the various agencies responsible for eligibility determination; to allow for real-time tracking of the status of applications; to allow the rapid exchange of data relevant to applications among various State and county agencies and contractors; and to provide a platform to expand the system to encompass other social service program applications and eligibility determinations as the technology permits.
b. The Commissioner of Human Services shall establish a system to evaluate the performance of all entities responsible for intake and processing of applications for the Medicaid and NJ FamilyCare programs, including all county welfare agencies and the State's contracted health benefits coordinator. The system shall allow for the measurement of a set of relevant common metrics, including but not limited to: the number of complete and incomplete applications of each type received; the time between receipt of completed applications and the completion of the eligibility determination; the time between receipt of an application and the request for supporting documentation sent to the applicant; the number of applicants granted extensions; and the accuracy of eligibility determinations.
Nothing in this section shall be construed to permit a county welfare agency to deny an application for which an applicant requires additional time to provide information or documentation to a county welfare agency, and a county welfare agency shall grant extensions, as appropriate, when needed.
The Commissioner shall annually publish on the Department of Human Services website, the results, including those for each of the common metrics and by individual entity, of the performance evaluation system to be established pursuant to this section.
c. The Commissioner of Human Services shall establish a system of rewards and penalties for all entities responsible for intake, processing of applications, and processing of redetermination applications that provides incentives for performance on the metrics established pursuant to subsection b. of this section. This system shall include incentives for county welfare agencies to streamline their processes and utilize the information technology platform required by subsection a. of this section.
d. The Commissioner of Human Services shall designate a customer service liaison team, which shall be composed of employees of the Department of Human Services, to receive complaints that result from the eligibility application process. The customer service liaison team shall have authority to review all records of the cases about which complaints are submitted; to interview individuals who submit complaints, the individuals who have assisted with their applications, and the State and county staff who have worked on their cases; and to recommend corrective actions to State and county agencies to address specific complaints and reduce future complaints.
2. 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 expenditures under the federal Medicaid program or any other federal program.
3. 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.
4. This act shall take effect on the first day of the sixth month next following enactment.
STATEMENT
This bill requires the Commissioner of Human Services to develop an information technology platform for the intake, processing, and tracking of applications for benefits under the Medicaid and NJ FamilyCare programs. The goals of the system will be: to simplify the applications and eligibility determination processes for both applicants and eligibility determination staff; to standardize application of eligibility policy across the various agencies responsible for eligibility determination; to allow for real-time tracking of the status of applications; to allow the rapid exchange of data relevant to applications among various State and county agencies and contractors; and to provide a platform to expand the system to encompass other social service program applications and eligibility determinations as the technology permits.
The bill requires the commissioner to establish a system to evaluate the performance of all entities responsible for intake and processing of applications for the Medicaid and NJ FamilyCare programs, including all county welfare agencies and the State's contracted health benefits coordinator. The system will allow for the measurement of a set of relevant common metrics related to applications intake and eligibility determination.
The bill requires the commissioner to annually publish on the Department of Human Services website, the results, including those for each of the common metrics and by individual entity, of the performance system.
The commissioner is to establish a system of rewards and penalties for all entities responsible for intake, processing of applications, and processing of redetermination applications that provides incentives for performance on these metrics. This system will provide incentives for county welfare agencies to streamline their processes and utilize the information technology platform required by the bill.
The bill also requires the commissioner to designate a customer service liaison team, to be composed of employees of the department, to receive complaints that result from the eligibility application process. The customer service liaison team will have authority to review all records of the cases about which complaints are submitted; to interview individuals who submit complaints, the individuals who have assisted with their applications, and the State and county staff who have worked on their cases; and to recommend corrective actions to State and county agencies to address specific complaints and reduce future complaints.
The bill would take effect on the first day of the sixth month next following enactment.
