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  • NJ A1819
  • Establishes Medicaid Smart Card Pilot Program.
In Committee
Crossed OverPassedSignedDead/Failed/Vetoed
2016-2017 Regular Session
This bill requires the Commissioner of Human Services to establish the Medicaid Smart Card Pilot Program in the Division of Medical Assistance and Health Services in the Department of Human Services. The objective of the pilot program is to reduce the total amount of Medicaid expenditures, by reducing Medicaid costs relative to what would be expended in the absence of the program, through activities intended to reduce waste, fraud, and abuse. The bill requires the program to be designed to reduce the average monthly cost to the State Medicaid program for recipients within the pilot program's geographic area by an amount that is at least sufficient to recover the cost of implementing the program. Under the bill, the commissioner is required to determine the geographic area to be included in the pilot program, and is permitted to contract with an independent entity to develop and implement the program. At a minimum, the program must include the following activities: (1) enrollment of designated recipients as program participants; (2) distribution of Medicaid Smart Cards to those recipients, to be used by them in lieu of their current Medicaid eligibility identification cards; (3) authentication of designated recipients at the point of transaction, at the onset and completion of each transaction, to prevent card sharing and other forms of abuse or fraud; (4) denial of ineligible persons at the point of transaction; (5) authentication of providers at the point of transaction to prevent improper billing practices and other forms of abuse or fraud; and (6) any efforts necessary to secure and protect the personal identity and information of designated recipients. The bill authorizes the division to include various features in the pilot program to streamline data gathering activities, expedite determinations of recipient eligibility, facilitate the processing of recipient transactions, and reduce the costs of implementing the program by coordinating, to the extent possible, with other State agencies. The bill requires the commissioner to apply for such Medicaid State plan amendments or waivers necessary to implement the bill and to secure federal Medicaid funding as may be available for State expenditures made under the bill. The bill requires the division to perform an annual evaluation of the pilot program, assessing: the average monthly Medicaid costs of recipients in the program and the Medicaid savings attributable to the program; the strategies necessary for the program to achieve the highest rate of Medicaid savings; trends in the use of health care services by participating Medicaid recipients; and recipient satisfaction with the program. The bill requires the commissioner to report to the Governor and the Legislature, no later than one year after the effective date of the bill and annually thereafter while the pilot program remains in effect, on the results of the program with regard to achieving its objective and the results of the annual evaluation. The report may include recommendations for appropriate legislative or administrative action necessary to further the purposes of the bill. The bill prohibits the commissioner from extending the pilot program unless the commissioner determines that it has achieved its objective, and similarly prohibits the commissioner from expanding the scope of the program unless the commissioner determines that expansion can be achieved through cost savings that would be equal to or greater than the costs of implementing the expansion. The bill provides that the commissioner's findings and recommendations concerning whether to extend the pilot program or expand it to encompass more recipients must be included in the commissioner's second annual report. The bill provides for the program to terminate two years after the effective date of the bill unless the program is extended by the commissioner. The bill authorizes the commissioner to adopt rules and regulations necessary to effectuate the purposes of the bill. The bill takes effect on the first day of the fourth month following enactment, but permits the commissioner to take anticipatory administrative actions in advance of the bill's effective date.
Health and Senior Services
Introduced, Referred to Assembly Health and Senior Services Committee  (on 1/27/2016)
Date Chamber Action Description
1/27/2016 A Introduced, Referred to Assembly Health and Senior Services Committee
Date Motion Yea Nay Other
None specified