Bill Text: NJ S1055 | 2022-2023 | Regular Session | Introduced
Bill Title: Establishes Medicaid Enrollee Encounter Database as part of iPHD Project.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2022-01-31 - Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee [S1055 Detail]
Download: New_Jersey-2022-S1055-Introduced.html
Sponsored by:
Senator JOSEPH F. VITALE
District 19 (Middlesex)
SYNOPSIS
Establishes Medicaid Enrollee Encounter Database as part of iPHD Project.
CURRENT VERSION OF TEXT
As introduced.
An Act establishing the Medicaid Enrollee Encounter Database 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 Department of Human Services shall establish a Medicaid Enrollee Encounter Database to ensure the transparency of the provision of health care services to individuals who are enrolled in the Medicaid program and receive services through the fee-for-service program or through Medicaid managed care organizations.
b. The Medicaid Enrollee Encounter Database shall contain the enrollee encounter data for each service delivered to an individual through the Medicaid program pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) or the NJ FamilyCare program pursuant to P.L.2005, c.156 (C.30:4J-8 et al.).
c. The department shall coordinate with the Rutgers Center for State Health Policy to develop and implement the Medicaid Enrollee Encounter Database as part of the iPHD Project, established pursuant to P.L.2015, c.193 (C.30:4D-65 et seq.).
d. The database shall contain enrollee encounter data that indicates the date, type of service, units of service, provider location, rate charged by the provider for the service, and reimbursement received for the service. Claims-level data indicating the date, type of service, units of service, and location of provider shall be reported in datasets and in a map indicating where the service was provided. Claims data indicating the reimbursement received by the provider for the service shall be reported by service by geographic district.
e. The Medicaid Enrollee Encounter Database shall be publicly available on a State Internet website. Information included shall be presented in a user-friendly database which allows researchers, as well as the general public, to research, query, and view the enrollee encounter data provided throughout the State.
f. As used in this section:
"De-identified data" means information that does not identify an individual and for which there is no reasonable basis to believe that the information can be used to identify an individual, and which meets the requirements for de-identification of protected health information under the "Health Insurance Portability and Accountability Act of 1996," Pub.L.104-191, and any regulations promulgated thereunder by the Secretary of the U.S. Department of Health and Human Services.
"Enrollee encounter data" means the information concerning services received by each Medicaid beneficiary reported by the department to the Centers for Medicare and Medicaid Services on a quarterly basis pursuant to 42 C.F.R. Parts 431, 433, 438, or any subsequently adopted regulations promulgated with the intent of requiring states and their contracted entities to provide Medicaid enrollee data to the federal government. "Enrollee encounter data" also means the identical information on each service delivered to an individual who receives Medicaid services but is not enrolled in a Medicaid managed care organization, and the service is reimbursed by the State through the fee-for-service reimbursement system. The information shall be accessible to the public as de-identified data.
"Geographic district" means each of the following regional groupings of counties: Northeastern which shall include Bergen, Hudson and Passaic counties; Northwestern which shall include Hunterdon, Morris, Somerset, Sussex and Warren counties; Central which shall include Essex, Union, Middlesex, and Mercer counties; South Central which shall include Burlington, Camden, Monmouth and Ocean counties; and Southern which shall include Atlantic, Cape May, Cumberland, Gloucester, and Salem counties.
2. Notwithstanding the provisions of P.L.2015, c.193 (C.30:4D-65 et seq.), the iPHD Project Governing Board established pursuant to section 3 of P.L.2015, c.193 (C.30:4D-67) shall:
a. create and administer the Medicaid Enrollee Encounter Database established pursuant to section 1 of P.L. c. (C. ) (pending before the Legislature as this bill);
b. receive, maintain, and transmit data for the Medicaid Enrollee Encounter Database; and
c. adopt and publish policies and procedures for the efficient and transparent operation of the Medicaid Enrollee Encounter Database. Data access policies and procedures for the database shall ensure that the information in the database is accessible to the general public in a user-friendly format on the Internet and the information shall be searchable as provided in section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill).
3. The Commissioner of Human Services, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations as the commissioner determines necessary to effectuate the purposes of this act.
4. This act shall take effect immediately.
STATEMENT
This bill would establish a Medicaid Enrollee Encounter Database. The database will include de-identified information on each Medicaid enrollee encounter service provided in the State. The information will include the date, type of service, units of service, provider location, and reimbursement received for each service.
Newly adopted federal regulations require Medicaid managed care organizations to provide much of this information to the State on a quarterly basis, and the State is required to share the information with the Centers for Medicare and Medicaid Services (CMS). CMS will then make the information publicly available, but in an aggregated manner.
This legislation is intended to require New Jersey to provide the information in a more detailed manner to the general public and is based on similar projects in other states that have begun to make this information publicly available. The sharing of the information leads to improved health outcomes and transparency on the provision of publicly funded health care.
Notwithstanding current law, the iPHD Governing Board will be responsible for: creating and administering the Medicaid Enrollee Encounter Database; receiving, maintaining, and transmitting data for the database; and adopting and publishing policies and procedures for the efficient and transparent operation of the database. Data access policies and procedures for the database are required to ensure the information in the database is accessible to the general public in a user-friendly format on the Internet.
The database will include de-identified claims-level data indicating the date, type of service, units of service and location of provider which will be reported in a database and as a map indicating where the service was provided. Claims data indicating the reimbursement received by the provider for the service will be reported by service by geographic district.
The geographic districts are defined in the bill as regional groupings of counties as follows: Northeastern, which will include Bergen, Hudson and Passaic counties; Northwestern, which will include Hunterdon, Morris, Somerset, Sussex and Warren counties; Central, which will include Essex, Union, Middlesex, and Mercer counties; South Central, which will include Burlington, Camden, Monmouth and Ocean counties; and Southern, which will include Atlantic, Cape May, Cumberland, Gloucester, and Salem counties.
