Bill Text: NJ S3529 | 2016-2017 | Regular Session | Introduced
Bill Title: Provides for improved system for eligibility determination for Medicaid and NJ FamilyCare.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2017-11-30 - Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee [S3529 Detail]
Download: New_Jersey-2016-S3529-Introduced.html
Sponsored by:
Senator JOSEPH F. VITALE
District 19 (Middlesex)
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, in consultation with the Office of Information Technology, 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 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 accuracy of eligibility determinations; and corrective actions taken to correct errors in eligibility determination.
c. The Commissioner of Human Services shall establish a system of rewards and penalties for all entities responsible for intake and processing of 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 provide extended hours of operation for in-person intake of applications and information requests, and to provide in-person navigators to assist applicants with their applications when necessary. The system shall further provide incentive for the use of administrative renewals that do not require a beneficiary to file a renewal application, when such administrative renewals are permissible under State and federal law and can be completed with information from tax records and clinical and financial determinations made by other public entities.
d. The Commissioner of Human Services shall designate an ombudsperson, who shall be an employee of the Department of Human Services, to receive complaints that result from the eligibility application process. The ombudsperson 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 immediately.
STATEMENT
This bill provides for an improved system for eligibility determination for the Medicaid and NJ FamilyCare programs, implementing a recommendation of the New Jersey Health Care Quality Institute's report "Medicaid 2.0: Blueprint for the Future."
Specifically, the bill requires the Commissioner of Human Services, in consultation with the Office of Information Technology, 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 also 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 commissioner will establish a system of rewards and penalties for all entities responsible for intake and processing of applications that provides incentives for performance on these metrics. This system will provide incentives for county welfare agencies to provide extended hours of operation for in-person intake of applications and information requests, and to provide in-person navigators to assist applicants with their applications when necessary. The system will further provide incentive for the use of administrative renewals that do not require a beneficiary to file a renewal application, when such administrative renewals are permissible under State and federal law and can be completed with information from tax records and clinical and financial determinations made by other public entities.
Finally, the bill requires the commissioner to designate an ombudsperson to receive complaints that result from the eligibility application process. The ombudsperson 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.
