Bill Text: NJ A4706 | 2014-2015 | Regular Session | Introduced
Bill Title: Establishes pilot program for incentive-based value payment system for long-term care provided by home health agencies.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2015-11-16 - Introduced, Referred to Assembly Health and Senior Services Committee [A4706 Detail]
Download: New_Jersey-2014-A4706-Introduced.html
Sponsored by:
Assemblyman GARY S. SCHAER
District 36 (Bergen and Passaic)
SYNOPSIS
Establishes pilot program for incentive-based value payment system for long-term care provided by home health agencies.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning a pilot program for incentive-based value payments for home health agencies 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 licensed home health agencies providing services to Medicaid and NJ FamilyCare recipients. The incentive-based value payment system shall reward participating home health agencies 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 Director of the Division of Medical Assistance and Health Services, in consultation with representatives of the home health agency industry, 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 the 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 home health agencies;
(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 within 60 days after the start of the pilot program to assist participating home health agencies 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 home health agency participating in the pilot program shall:
(1) for each patient, designate a single health care professional who is responsible for establishing a plan of care for that patient 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 patient care throughout the continuum of services;
(4) establish protocols and procedures to reconcile patient medications; and
(5) establish standards, requirements, and programs to educate patients, families, and caregivers regarding individualized plans of care and goals to address the unique needs of each patient, family member, and caregiver.
d. No later than one year 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 incentive-based value payment system established under the pilot program. In determining the costs and benefits of the new system, the division shall cooperate with and consider input from the home health agencies and provider associations.
Commencing two years after the effective date of this act, and annually thereafter for the duration of the pilot program, the division 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 home health agencies, the costs of implementation, the cost savings realized, the division'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. 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.
3. 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 licensed home health agencies 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 home health agencies 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 Director of the Division of Medical Assistance and Health Services will establish, in consultation with representatives of the home health agency industry, 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.
Home health agencies participating in the pilot program will be required to designate a single health care professional for each patient to establish a plan of care and coordinate person-centered services for the patient, 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 patients, families, and caregivers regarding individualized plans of care and goals to address the unique needs of each patient, family member, and caregiver.
The division will be required to submit an initial report to the Legislature on the projected benefits and costs of the incentive-based value payment system and to thereafter submit annual reports on the status of the program, including the number of participating home health agencies, the costs of implementation, the cost savings realized, the division'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.
