Bill > A2064

Introduced Session

This bill requires Medicaid and NJ FamilyCare beneficiaries managed care organizations to offer patient-centered medical home models or other alternative payment models to primary care providers. As defined under the bill, a "patient-centered medical home model" means a type of alternative payment model that supports a clinical model of team-based health care, led by a health care provider, to provide comprehensive, person-centered, and continuous medical care to patients in order to achieve maximal health outcomes. An "alternative payment model" means a payment approach that gives providers financial incentives to deliver high-quality and cost-efficient care and may apply to a specific clinical condition, care episode, or population. Under the bill, a managed care organization that provides benefits to persons who are eligible for Medicaid under P.L.1968, c.413 (C.30:4D-1 et seq.) or NJ FamilyCare under P.L.2005, c.156 (C.30:4J-8 et al.) is to offer a patient-centered medical home model to primary care providers in the managed care organization's network. The Division of Medical Assistance and Health Services in the Department of Human Services (division), in its sole discretion, may waive this requirement if a managed care organization can demonstrate that the managed care organization offers an alternative payment model to primary care providers that is not a patient-centered medical home model but that similarly incentivizes high quality, efficient, and holistic care. The bill provides that a managed care organization is to submit annually to the division a description of the managed care organization's patient-centered medical home model or, if waived by the division to offer a patient-centered medical home model, the other alternative payment model offered to primary care providers, which description is to include, but not be limited to: 1) the basic financial structure of the model, which is to include incentive or population management payments which may be available to providers participating in the model; 2) whether participating providers are required to obtain any certifications to participate in the model; 3) quality or other performance metrics which affect provider payment under the model; 4) the requirements for a provider to be eligible to participate in the model, including but not limited to the number of unique patients seen by a provider or past quality performance; 5) whether the model qualifies as an "Other Payer Advanced APM" as defined in 42 CFR 414.1305; 6) a list of all providers participating in the model; and 7) the number of enrollees provided services by providers participating in the model, listed by county. Under the bill, the division is to establish standardized quality metrics for patient-centered medical home models and other alternative payment models offered to primary care providers. The division is to develop, through a public stakeholder process, standardized quality metrics for patient-centered medical home models and other alternative payment models offered to primary care providers and request public comment on such standardized quality metrics. Following the public comment period, and periodically thereafter, the division is to identify a list of standardized quality metrics and is to mandate that managed care organizations utilize only those standardized quality metrics when determining or calculating payments to providers under the managed care organization's patient-centered medical home model or other alternative payment offered to primary care providers. To the extent practicable, the standardized quality metrics are to promote alignment with other non-Medicaid payers. The bill provides that the division is to specify a format and methodology through which managed care organizations are to submit patient-level and provider-level data on participation and performance in a patient-centered medical home model or other alternative payment model in order to facilitate the division's evaluation of the performance of such patient-centered medical home models and alternative payment models offered to primary care providers.

AI Summary

Committee Categories

Eliana Pintor Marin (D)*,  Verlina Reynolds-Jackson (D)*, 

Introduced, Referred to Assembly Health Committee (on 01/09/2024)

Official Document