Bill > A3623

Introduced Session

This bill requires the Division of Medical Assistance and Health Services in the Department of Human Services (DHS) to establish an incentive-based value payment system to reward home health agencies and health care service firms for achieving improved performance outcomes in providing services to NJ FamilyCare recipients enrolled in a Fully Integrated Dual Eligible Special Needs Plan. Participation in the incentive-based value payment system will be mandatory for any home health agency or health care service firm providing services to these individuals. The division will be required to establish a system to measure improved performance outcomes and rank participating home health agencies and health care service firms based on how well the agencies or firms meet performance targets and realize improvements in certain "Outcome and Assessment Information Set" measures, including: acute care hospitalization and emergent care; patient bathing; patient ambulation or locomotion; patient transfers, including discharge planning and maintaining continuity of care; collaboration between primary care providers and other health care providers; medication management; status of surgical wounds; and adverse events. The division will establish performance targets, a formula for determining the baseline data for making performance comparisons, and the amount of the incentive payments, which may include payments scaled to absolute performance level and to the level of improvement achieved in each measurement. The performance targets, formula for determining baseline data, amounts of incentive payments and ranks of participating home health agencies and health care service firms will be made publicly available on the division's Internet website. Home health agencies and health care service firms participating in the incentive-based value payment system will be required to: designate, for each patient, a single health care professional who is responsible for establishing a plan of care for that patient and for coordinating person-centered services throughout the continuum of care; develop protocols for immediate follow up after discharge from a hospital, including a comprehensive risk assessment; establish protocols to facilitate collaboration with hospitals and other health care providers to coordinate patient care throughout the continuum of services; establish protocols and procedures to reconcile patient medications; and establish standards, requirements, and programs to educate patients, families, and caregivers regarding individualized plans of care and goals to address the unique needs of each patient, family member, and caregiver. The incentive-based value payment system is to be administered by managed care organizations (MCO) that have contracted with home health agencies and health care service firms to provide home health services to Medicaid and NJ FamilyCare recipients. The DHS and each MCO in the State will be required to provide the division with any data necessary for the purpose of establishing and evaluating the incentive-based value payment system. The division will be permitted to authorize an administrative fee to be paid to MCOs to offset the cost of reporting any data that is in addition to data the MCO currently reports to the State. The division will provide these data and any data reported by home health agencies and health care service firms concerning their participation in the system to the Rutgers Center for State Health Policy for the purposes of evaluating the system with regard to patient outcomes, quality of patient care, cost savings, and such other metrics as the division requires. The division will be required to report to the Legislature concerning the status of the incentive-based value payment system, including: the costs of implementation; the number and size of participating home health agencies and health care service firms; the number of clients served by each agency and firm; the total cost savings realized and the proportion of cost savings attributable to each agency and firm; the individual amounts and the proportion of total incentive-based value payments made to each agency and firm; an analysis of quality improvement and cost savings by type of service; the division's recommendations, if any, concerning revisions to the incentive-based value payment system; and any other information as may be necessary to evaluate the system. Commencing two years after the effective date of the bill, an annual audit of the incentive-based value payment system by an independent third party auditor will be required. The results of the audit will be included in the annual report. The DHS may appropriate up to $10 million for the purposes of establishing and making payments under the incentive-based value payment system. Less any administrative costs to the division, 60 percent of the appropriated funds are to be distributed to home health agencies and health care service firms which are ranked by the division in the top 20 percent for absolute performance level, and 40 percent of the appropriated funds are to be distributed to those home health agencies and health care service firms which are ranked in the top 20 percent for improvement in performance relative to base year. The bill establishes the Home Health Services Value Payment System Advisory Board, which is to provide the Director of the Division of Medical Assistance and Health Services with recommendations concerning the regulations which are to be adopted under the bill. The board will comprise eight public members appointed by the Governor. The members will serve without compensation, and the board will submit its recommendations no later than six months after the effective date of the bill. The division will be required to adopt regulations to implement the incentive-based value payment system, consistent with the advisory board's recommendations, within one year after the effective date of the bill. The board will expire upon the adoption of those regulations.

Committee Categories

Carol Murphy (D)*, 

Introduced, Referred to Assembly Health Committee (on 02/12/2024)

Official Document