Bill Text: NJ A5271 | 2020-2021 | Regular Session | Introduced
Bill Title: Requires DHS to establish two-year Regional Community Behavioral Health Pilot Program.
Spectrum: Partisan Bill (Democrat 5-0)
Status: (Introduced - Dead) 2021-01-25 - Introduced, Referred to Assembly Human Services Committee [A5271 Detail]
Download: New_Jersey-2020-A5271-Introduced.html
Sponsored by:
Assemblyman LOUIS D. GREENWALD
District 6 (Burlington and Camden)
Assemblyman DANIEL R. BENSON
District 14 (Mercer and Middlesex)
Assemblyman RAJ MUKHERJI
District 33 (Hudson)
Co-Sponsored by:
Assemblywoman Vainieri Huttle
SYNOPSIS
Requires DHS to establish two-year Regional Community Behavioral Health Pilot Program.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning the improved coordination of community-based behavioral health and support services and supplementing Title 30 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. As used in this act:
"Behavioral health" or "behavioral health care" means procedures or services rendered by a health care or mental health care provider for the treatment of mental illness, mental health or emotional disorders, or substance use disorders.
"Care transition" means the transfer or transition of a patient from one health care or behavioral health care provider to another.
"Commissioner" means the Commissioner of Human Services.
"Department" means the Department of Human Services.
"Eligible patient" means a patient with a severe mental illness or substance use disorder who is identified pursuant to paragraph (1) of subsection c. of section 2 of this act as being eligible to participate in the pilot program.
"Health information platform" means a Health Information Exchange (HIE) or other electronic platform that is used to run population-level analytics or exchange health information among various organizations.
"Managed care organization" means a Medicaid managed care organization, as that term is defined pursuant to 42 U.S.C. s.1396b(m)(1)(A).
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Participating provider" means a Certified Community Behavioral Health Clinic (CCBHC) or other community behavioral health provider that is contracted pursuant to paragraph (2) of subsection c. of section 2 of this act to participate in the pilot program.
"Pilot program" means the Regional Community Behavioral Health Pilot Program established pursuant to this act.
"Rapid referral" means the taking of appropriate steps by a participating provider, as soon as is practicable and not more than 48 hours after an eligible patient undergoes a needs assessment, as may be necessary to facilitate: the patient's referral or transfer to, prompt access to an appointment with, and timely receipt of services from, another appropriate health care or behavioral health care services provider; the patient's prompt and voluntary admission to an inpatient psychiatric facility; or the patient's prompt evaluation by a screening service or mental health screener to determine whether involuntary commitment to treatment is warranted pursuant to P.L.1987, c.116 (C.30:4-27.1 et seq.).
"Supportive contacts" means brief communications with a patient that occur during care transitions or when a patient misses an outpatient appointment or unexpectedly drops out of outpatient treatment, and which show support for the patient and are designed to promote a patient's feeling of connection to treatment and willingness to collaboratively participate in treatment. "Supportive contacts" may include the sending of postcards, letters, email messages, and text messages, the making of phone calls, or the undertaking of home visits either by the participating provider that is providing care to the patient or by an outside organization, such as a local crisis center, with which the participating provider has a contract or other agreement.
"Warm hand-off" means a safe care transition that connects a patient directly with a new health care or mental health care provider or interim contact, such as a crisis center worker or peer specialist, before the patient's first appointment with the new provider, or that connects a patient directly with a screening service or mental health screener for the purposes of determining whether involuntary commitment to treatment is warranted pursuant to P.L.1987, c.116 (C.30:4-27.1 et seq.).
2. a. The Department of Human Services shall establish a two-year Regional Community Behavioral Health Pilot Program in accordance with the provisions of this act.
b. Within 180 days after the effective date of this act, the department shall issue a request for proposals (RFP) and select one or more managed care organizations to administer the pilot program in each of the northern, central, and southern regions of the State.
c. The managed care organization or organizations selected to administer the pilot program shall:
(1) access and review Medicaid claims data, and work with primary care practitioners within the managed care network, to identify patients in the network who have a severe mental illness or substance use disorder. The patients identified pursuant to this paragraph shall be eligible to participate in the pilot program;
(2) enter into contracts with three community behavioral health providers, one in each of the northern, central, and southern regions of the State, and require each participating provider to promptly perform a behavioral health needs assessment for each eligible patient, identified under paragraph (1) of this section, who resides in the provider's region of operations. The needs assessment shall be performed using a standardized tool or methodology and shall be used by the provider to identify each eligible patient's behavioral health and social service needs, including, but not limited to, the need for medication-assisted treatment and other substance use disorder treatment, the need for mental health treatment, including voluntary or involuntary commitment, and the need for food, housing, financial, or other social assistance; and
(3) work with each participating provider, as well as with primary care providers, substance use disorder treatment providers, and social service providers in the State, to ensure that eligible patients in the participating provider's region of operations have access an intensive, coordinated support system to help them navigate the State's behavioral health care service system and timely identify and access necessary and appropriate behavioral health care services in the State and region. The coordinated support system utilized in each region shall incorporate: (a) the use, by participating providers, of warm hand-offs, rapid referrals, supportive contacts, and other efficient and supportive care transition methods; (b) the hiring, by participating providers, of service navigation specialists and advisors to guide eligible patients through the behavioral health care system and to direct, monitor, and keep a record of, the services received by each eligible patient; and (c) the use, by participating providers or the administering managed care organization or organizations, of any other means or methods deemed appropriate or necessary to facilitate behavioral health care coordination or care transitions for eligible patients in the State.
d. The department shall:
(1) in selecting one or more managed care organizations to administer the pilot program, give priority to those managed care organizations that have the ability to link to, and exchange relevant information and data through, a Statewide health information platform; and
(2) following the selection of an administering managed care organization or organizations, encourage the administering managed care organization or organizations to engage in the active and ongoing use of a Statewide health information platform and relevant information contained therein, as may be necessary to efficiently and effectively administer the pilot program. A portion of the funds provided to the administrating managed care organization or organizations, pursuant to section 3 of this act, may be used thereby, as deemed appropriate, to finance the costs associated with the use of the Statewide health information platform pursuant to this paragraph.
3. a. The pilot program established pursuant to this act shall be funded through the Medicaid program using a value-based payment system. The value-based payment system shall be modeled on, and be consistent with, the population-based payment methodology that is described under Category 4 of the alternative payment methodologies (APM) framework developed by the Health Care Payment Learning and Action Network. Specifically, the value-based payment system shall provide for a quarterly advanced bundled payment to be provided to the administering managed care organization or organizations for the purposes of financing the total cost of behavioral health care that is provided, by participating providers and other appropriate service providers, to eligible patients in the State, including, but not limited to, the costs associated with needs assessments performed pursuant to paragraph (2) of subsection c. of section 2 of this act and the costs associated with the provision of support and navigation services pursuant to paragraph (3) of subsection c. of section 2 of this act. The quarterly bundled payment rate shall be established by the Commissioner of Human Services, based on the commissioner's evaluation of the following factors:
(1) the number of eligible patients, identified pursuant to paragraph (1) of subsection c. of section 2 of this act, who are expected to be served by the pilot program;
(2) the average anticipated per-patient cost of care for eligible patients;
(3) the anticipated costs to participating providers of hiring and training staff to provide support and navigation services pursuant to paragraph (3) of subsection c. of section 2 of this act;
(4) the anticipated costs associated with ensuring the linkage to, and exchange of relevant health information through, a Statewide health information platform; and
(5) any other factors that may affect the cost of care for eligible patients.
b. The quarterly bundled payment provided under this section shall be limited to the bundled rate established by the commissioner under subsection a. of this section, and shall not be subject to increase, regardless of whether the actual costs of care received by patients in the pilot program exceed the bundled payment rate provided hereunder. If the administering managed care organization or organizations, in cooperation with participating providers in each region, are able to reduce the per-patient costs of care for patients engaged in the pilot program through the effective use of care coordination methodologies, including, but not limited to, the use of the service navigation and support systems described under paragraph (3) of subsection c. of section 2 of this act, the administering managed care organization or organizations may retain, and shall not be required to repay, any bundled payment funds that remain unexpended thereby. Any such savings achieved shall be shared by the managed care organization or organizations with the participating providers at a rate that is proportional to the rate of per-patient cost reduction savings achieved by each such provider. If the actual per-patient costs of care for patients engaged in the pilot program exceed the advanced bundled payment rate established by the commissioner under this section, the administering managed care organization or organizations shall ensure that all eligible patients continue to receive appropriate services and care from participating providers and other appropriate providers without being subject to an increase in out-of-pocket costs. Any financial loss suffered by the administering managed care organization or organizations as a result of an increase in the per-patient cost of care for patients in the pilot program shall be shared by the managed care organization or organizations with the participating providers at a rate that is proportional to the rate of per-patient cost increase attributed to each provider.
4. a. Within 90 days after the two-year pilot program is terminated, the department shall prepare and submit a written report of its findings and recommendations to the Governor and, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), to the Legislature.
b. At a minimum, the report shall:
(1) identify the managed care organization or organizations that were selected to administer the pilot program;
(2) identify the community behavioral health providers who were contracted by the administering managed care organization or organizations pursuant to paragraph (2) of subsection c. of section 2 of this act;
(3) identify the total number and percentage of patients in the managed care network, and the number and percentage of patients in each of the northern, central, and southern regions of the State, who were identified as having severe mental illness or substance use disorders pursuant to paragraph (1) of subsection c. of section 2 of this act;
(4) identify the number and percentage of patients identified in paragraph (3) of this subsection who were provided with rapid referrals and warm hand-offs to other appropriate service providers, or who received supportive contacts, following an individual needs assessment conducted pursuant to paragraph (2) of subsection c. of section 2 of this act;
(5) include recommendations as to whether and how the pilot program should be continued on a permanent basis; and
(6) include recommendations for executive, legislative, and other actions that can be undertaken by the State to better ensure and improve: (a) the effectiveness and coordinated provision of behavioral health care to patients with severe mental illness or substance use disorders; (b) the capacity of health care and behavioral health care providers and managed care organizations to both promptly identify patients who require coordinated behavioral health care services and assist those patients in navigating the State's behavioral health service system; and (c) the effectiveness and supportive nature of the State's behavioral health care referral and care transition processes.
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 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.), as may be necessary to implement the provisions of this act.
7. This act shall take effect immediately.
STATEMENT
This bill would require the Department of Human Services to establish a two-year Regional Community Behavioral Health Pilot Program.
Within 180 days after the bill's effective date, the DHS is to to issue a request for proposals (RFP) and select one or more managed care organization or organizations to administer the pilot program in the northern, central, and southern regions of the State.
The managed care organization or organizations selected to administer the pilot program will be required to:
1) review Medicaid claims data, and work with primary care practitioners in the managed care network, to identify patients in the network who have severe mental illness or substance use disorders. Such patients will be deemed to be eligible to participate in the pilot program;
2) contract with three community behavioral health providers, one in each of the northern, central, and southern regions of the State, and require each participating provider to promptly perform a behavioral health needs assessment for each eligible patient in the pilot program who resides in the provider's region of operations. The needs assessment is to be performed using a standardized tool or methodology and is to be used by the provider to identify each eligible patient's behavioral health and social service needs, including, but not limited to, the need for medication-assisted treatment and other substance use disorder treatment, the need for mental health treatment, including voluntary or involuntary commitment, and the need for food, housing, financial, or other social assistance;
3) work with each participating provider, as well as with primary care providers, substance use disorder treatment providers, and social service providers in the State, to ensure that eligible patients in the provider's region of operations have access to an intensive, coordinated support system to help them navigate the State's behavioral health care service system and timely identify and access necessary and appropriate behavioral health care services in the State and region. The coordinated support system utilized in each region will be required to incorporate: a) the use, by participating providers, of warm hand-offs, rapid referrals, supportive contacts, and other efficient and supportive care transition methods; b) the hiring, by participating providers, of service navigation specialists and advisors to guide eligible patients through the behavioral health care system and to direct, monitor, and keep a record of, the services received by each eligible patient; and c) the use, by participating providers or the administering managed care organization or organizations, of any other means or methods deemed appropriate or necessary to facilitate behavioral health care coordination or care transitions in the State.
In selecting one or more managed care organizations to administer the pilot program, the DHS will be required to give priority to those managed care organizations that have the ability to link to, and exchange relevant information and data through, a Statewide Health Information Exchange (HIE) or other health information platform. The DHS will further be required to encourage the administering managed care organization or organizations to engage in the active and ongoing use of the HIE or other platform, as may be necessary to efficiently and effectively administer the pilot program. A portion of the funding that is provided to the administering organization for the purposes of the pilot program may be used to finance the costs associated with use of the HIE or other platform.
The bill provides for the pilot program to be funded through the Medicaid program using a value-based payment system. The value-based payment system is to be modeled on, and consistent with, the population-based payment methodology that is described under Category 4 of the alternative payment methodologies (APM) framework developed by the Health Care Payment Learning and Action Network. Specifically, the value-based payment system is to provide for a quarterly advanced bundled payment to be provided to the administering managed care organization or organizations for the purposes of financing the total cost of behavioral health care that is provided, by participating providers and other appropriate service providers, to eligible patients in the State, including, but not limited to, the costs associated with needs assessments performed and support and navigation services provided pursuant to the bill and the costs associated with the managed care organization's linkage to, use of, and exchange of information and data through, a Statewide HIE or other health information platform. The quarterly bundled payment rate is to be established by the Commissioner of Human Services, based on the commissioner's evaluation of the following factors:
1) the number of eligible patients who are expected to be served by the pilot program;
2) the average anticipated per-patient cost of care for eligible patients;
3) the anticipated costs to participating providers of hiring and training staff to provide eligible patients with assistance and support in service navigation;
4) the anticipated costs associated with ensuring the linkage to, and exchange of relevant health information through, the HIE or other Statewide health information platform; and
5) any other factors that may affect the cost of care for eligible patients.
The quarterly bundled payment is to be limited to the bundled rate established by the commissioner under the bill, and may not be increased, regardless of whether the actual costs of care received by patients in the pilot program exceed the bundled payment rate provided under the bill. If the administering managed care organization or organizations, in cooperation with participating providers in each region, are able to reduce the per-patient costs of care for patients engaged in the pilot program through the effective use of care coordination methodologies, including, but not limited to, the use of the service navigation and support systems described under the bill, the administering managed care organization or organizations may retain, and will not be required to repay, any bundled payment funds that remain unexpended thereby. The managed care organization or organizations will be required to share any such savings with the providers participating in the pilot program at a rate that is proportional to the rate of per-patient cost reduction savings that was achieved by each such provider. If the actual per-patient costs of care for patients engaged in the pilot program exceed the advanced bundled payment rate established by the commissioner under bill, the administering managed care organization or organizations will be required to ensure that all eligible patients continue to receive appropriate services and care from participating providers and other appropriate providers without being subject to an increase in out-of-pocket costs. Any financial loss suffered by the managed care organization or organizations as a result of an increase in the per-patient cost of care for patients in the pilot program is to be shared by the managed care organization or organizations with the participating providers at a rate that is proportional to the rate of per-patient cost increase attributed to each provider.
The bill requires the DHS, within 90 days after the two-year pilot program is terminated, to prepare and submit a written report of its findings and recommendations to the Governor and Legislature.
The Commissioner of Human Services will be required to apply for any State plan amendments or waivers as may be necessary to implement the bill's provisions and secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
