Bill > A5977

Introduced Session

This bill would require the Department of Human Services (DHS) to establish a Regional Health Hub Program, and designate and certify Regional Health Hubs in appropriate areas of the State. The new Regional Health Hub Program will replace the Medicaid Accountable Care Organization Demonstration Project, established pursuant to P.L.2011, c.114 (C.30:4D-8.1 et seq.), which is now subject to expiration by law. Each Regional Health Hub will work to coordinate and improve the effectiveness and efficiency of health care and wrap-around services, and the engagement and cooperation of relevant stakeholders, in the region of the State in which it operates. The following certified accountable care organizations and accountable care look-alike organizations, which are operating in this State as of the bill's effective date, are to be grandfathered into the Regional Health Hub Program, and automatically designated and certified as Regional Health Hubs: 1) the Healthy Greater Newark ACO; 2) the Trenton Health Team; 3) the Camden Coalition of Health Care Providers; and 4) the Health Coalition of Passaic County. The DHS, in consultation with the Department of Health (DOH), will also be authorized to designate and certify additional non-profit organizations to operate as Regional Health Hubs under the Regional Health Hub Program, as determined to be appropriate. The bill requires the Commissioner of Human Services to designate and delineate the boundaries of each region of the State that is in need of a new Regional Health Hub. The commissioner's delineation of prospective service regions is to be based on the following factors: 1) the availability of State and federal funding necessary to support the new Regional Health Hub, and the State's ability to provide necessary funding without negatively impacting the operation and effectiveness of other Regional Health Hubs in the State; 2) the number and density of Medicaid beneficiaries in the region; 3) the existence, in the region, of multiple health and social service systems of care that are in need of convening and coordination; and 4) the volume, in the region, of avoidable inpatient hospital admissions and emergency department visits. Based on the analysis of these factors, the commissioner may designate any county, zip code, or group of zip codes in the State as a prospective service region. However, the boundaries of any prospective service region may not include any portion of a core region served by another Regional Health Hub. Once an area has been designated by the commissioner as a prospective service region, the commissioner will be required to solicit and review applications from qualified non-profit organizations that wish to be designated and certified as the new Regional Health Hub for the prospective region. The commissioner will only be authorized to designate and certify an organization as a new Regional Health Hub if the organization is a registered New Jersey non-profit organization exempt from federal taxation under 26 U.S.C. s.501(c)3, and the organization submits a request identifying the proposed boundaries of the Regional Health Hub's anticipated core region, and an additional request identifying the proposed boundaries of the Regional Health Hub's anticipated data catchment area. If more than one organization meets the criteria for designation as a Regional Health Hub in a prospective service region, the commissioner will be required to use his or her discretion to designate the organization that the commissioner determines will be best able to meet the needs of, and fulfill the bill's purposes within, the prospective service region. Within 180 days after an organization is approved to operate as a Regional Health Hub, the organization will be required to: 1) establish and maintain a headquarters within the boundaries of the core region; 2) establish and convene an advisory committee of persons who reside or work in the core region, which committee is to include community members and representatives from organizations that exemplify the diversity of geography, gender, disability, age, sexual orientation, veterans' status, and prevalent health conditions in the core region; 3) establish and convene a governing board that includes members from a majority of the following groups and entities, to the extent that such groups and entities are present in the core region: (a) hospitals or hospital systems; (b) Federally Qualified Health Centers; (c) private clinicians, including physicians and nurses; (d) community-based organizations such as behavioral health providers and social service agencies; (e) managed care organizations; (f) the Regional Health Hub's advisory committee, established pursuant to the bill; and (g) health care consumers; and 4) demonstrate, to the commissioner's satisfaction, the ability to perform the mandatory functions of a Regional Health Hub, as described in subsection a. of section 6 of this act. Each designated Regional Health Hub will be required to engage in the following mandatory activities: 1) establish, operate, and maintain a health information platform that allows for population-level views and analytics, and for patient-level health interventions, which platform is interoperable with all other Regional Health Hubs' platforms, and with any other Statewide health information project designated by the commissioner. (Hospitals and managed care organizations will be required, and State departments will be authorized, to submit health care data to the platforms that are maintained by the Regional Health Hubs); 2) convene and obtain relevant input from community stakeholders within the Regional Health Hub's core region. At a minimum, convening activities are to include quarterly opportunities for the active engagement and interaction of relevant stakeholders, including, but not limited to, managed care organizations, local and State government entities, health care and social service providers, community-based organizations, and local consumers of health care; 3) upon request, provide the DHS and other State agencies, including the Departments of Health, Children and Families, and Community Affairs, with information and feedback to assist the departments in program design, population analysis, strategic planning, and other appropriate functions; and 4) engage in any other activity that the Commissioner of Human Services deems necessary to achieve the bill's goals. Each designated Regional Health Hub will also be authorized to engage in the certain discretionary activities as necessary either to further the Regional Health Hub's goals or to comport with the provisions of an annual memorandum of understanding (MOU) voluntarily executed between, and espousing the joint goals, projects, and priorities, of, the Regional Health Hub and the department. Each MOU executed under the bill will be required to include, at a minimum: 1) a description of the joint goals, projects, and priorities agreed upon by the Regional Health Hub and the department for the upcoming fiscal year; 2) an indication of the amount of funding that will be needed to attain each joint goal, project, and priority, and an indication of the total amount of funding, overall, that will needed to execute the MOU; 3) a description of the clear deliverables and performance metrics that will be used to evaluate and measure success in relation to the achievement of the goals, projects, and priorities described in the MOU; and 4) a description of performance-based payments, representing at least 10 percent but not more than 25 percent of the total funding needed to execute the MOU, which payments will be tied to the achievement of the clear deliverables described in the MOU. The bill would authorize a designated Regional Health Hub to apply to the commissioner, at any time, for an expansion of its core region. The commissioner will be required to approve the requested expansion if: 1) the boundaries of the expanded core region will not overlap with the core region of another Regional Health Hub; 2) the area would otherwise qualify for designation as a prospective service region; and 3) the applicant demonstrates the ability to perform, in the requested expansion area, and within one year following submission of the application, the mandatory activities of a Regional Health Hub, as described in the bill. The commissioner will be authorized to revoke an organization's status as a Regional Health Hub if the organization fails to perform the mandatory activities required by the bill. After revoking an organization's status as a Regional Health Hub, the commissioner will be required to immediately determine whether a new Regional Health Hub is needed in the area and, if deemed appropriate, designate a new Regional Health Hub to serve the area. Any State department that implements a pilot program related to health care delivery will be encouraged to consult with the Regional Health Hubs operating in the regions of the State that will be affected by the pilot program, in order to ensure that all relevant considerations have been accounted for, and that the pilot program is effectively and efficiently implemented with the assistance of all relevant stakeholders.

Committee Categories

JoAnn Downey (D)*,  Lou Greenwald (D)*,  Troy Singleton (D)*,  Valerie Vainieri Huttle (D)*,  Joe Vitale (D)*, 

Approved P.L.2019, c.517. (on 01/21/2020)

Official Document