Bill Text: NJ A1819 | 2016-2017 | Regular Session | Introduced
Bill Title: Establishes Medicaid Smart Card Pilot Program.
Spectrum: Partisan Bill (Democrat 8-0)
Status: (Introduced - Dead) 2016-01-27 - Introduced, Referred to Assembly Health and Senior Services Committee [A1819 Detail]
Download: New_Jersey-2016-A1819-Introduced.html
STATE OF NEW JERSEY
217th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2016 SESSION
Sponsored by:
Assemblyman HERB CONAWAY, JR.
District 7 (Burlington)
Assemblyman TIM EUSTACE
District 38 (Bergen and Passaic)
Assemblywoman VALERIE VAINIERI HUTTLE
District 37 (Bergen)
Assemblyman JOSEPH A. LAGANA
District 38 (Bergen and Passaic)
Assemblywoman NANCY J. PINKIN
District 18 (Middlesex)
Co-Sponsored by:
Assemblymen Diegnan, Wimberly and Assemblywoman Tucker
SYNOPSIS
Establishes Medicaid Smart Card Pilot Program.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act establishing the Medicaid Smart Card Pilot Program and supplementing P.L.1968, c.413 (C.30:4D-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. As used in this act:
"Abuse or fraud" means abuse or fraud as defined in section 3 of P.L.2007, c.58 (C.30:4D-55).
"Commissioner" means the Commissioner of Human Services.
"Designated recipient" means a recipient who is issued a Medicaid Smart Card.
"Division" means the Division of Medical Assistance and Health Services in the Department of Human Services.
"Health care facility" means a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).
"Health care professional" means a health care professional who is licensed or otherwise authorized to practice a health care profession pursuant to Title 45 or 52 of the Revised Statutes and is currently engaged in that practice.
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Medicaid Smart Card" means a Medicaid eligibility identification card that contains personal health information about the individual to whom it is issued, and which is distributed to designated recipients for use in the pilot program in lieu of their current Medicaid eligibility identification cards.
"Pilot program" means the "Medicaid Smart Card Pilot Program" established pursuant to this act.
"Provider" means a health care professional or health care facility providing health care services to a designated recipient.
"Recipient" means a recipient of Medicaid benefits.
"Transaction" means each occasion on which a designated recipient presents at a provider's premises for the receipt of health care services from that provider.
2. a. The Commissioner of Human Services shall establish a pilot program, to be known as the "Medicaid Smart Card Pilot Program," in the Division of Medical Assistance and Health Services of the Department of Human Services.
(1) The objective of the pilot program shall be to reduce the total amount of Medicaid expenditures, by reducing the average cost per designated recipient, relative to what would be expended in the absence of the pilot program. The pilot program shall be designed to reduce the average monthly cost to Medicaid for recipients within the pilot program area by an amount that is at least sufficient to recover the cost of implementing the pilot program.
(2) The commissioner shall determine the geographic area to be included in the pilot program and may contract with an independent entity as the commissioner determines appropriate for the purpose of developing and implementing the pilot program.
b. The pilot program shall include the following activities, at a minimum:
(1) enrollment of designated recipients as pilot program participants;
(2) distribution of Medicaid Smart Cards to those recipients;
(3) authentication of designated recipients at the point of transaction, at the onset and completion of each transaction, in order 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.
c. The commissioner shall develop such policies and procedures as necessary concerning the distribution and activation of Medicaid Smart Cards for designated recipients and the handling of lost, stolen, or otherwise unavailable Medicaid Smart Cards.
d. The pilot program may include the use of any of the following:
(1) a secure Internet-based information system for recording and reporting authenticated transactions;
(2) a secure Internet-based information system that interfaces with the appropriate State databases to determine the eligibility of designated recipients;
(3) a system that gathers analytical information to be provided to data‑mining companies in order to assist in data-mining processes for the purpose of facilitating compliance with the evaluation and reporting requirements in section 3 of P.L. , c. (C. ) (pending before the Legislature as this bill);
(4) a Medicaid Smart Card with the ability to store multiple recipients' information on one card;
(5) procedures that do not require pre-enrollment of designated recipients; and
(6) an image of the designated recipient stored on both the Medicaid Smart Card and the database with which it is matched.
e. In implementing the pilot program, the division may do any of the following:
(1) incorporate additional or alternative methods of authentication of designated recipients;
(2) enter and store billing codes, deductible amounts, and bill confirmations;
(3) allow electronic prescribing services and prescription database integration and tracking in order to prevent medical error through information sharing and to reduce prescription drug abuse and lower health care costs;
(4) implement quick-pay incentives for a provider when an electronic prescribing service, electronic health record, electronic patient record, or computerized patient record used by the provider automatically synchronizes with a designated recipient's Medicaid Smart Card and the provider electronically submits a claim; and
(5) allow elements of the pilot program, including, but not limited to, Medicaid Smart Cards, fingerprint scanners, and card readers, to be adapted for use by other State programs administered by the Department of Human Services in order to reduce costs associated with the use of multiple electronic benefit cards by a recipient.
f. The division shall collaborate with the New Jersey Motor Vehicle Commission to ensure that driver's license photographic and other identification data are utilized to reduce the cost of implementing the pilot program to the maximum extent practicable.
g. The commissioner shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure such federal financial participation through the federal Medicaid program as may be available for State expenditures made under this act.
3. a. The division shall evaluate the pilot program annually to:
(1) assess the impact of the pilot program on the average monthly Medicaid cost per recipient, including an assessment of how the Medicaid costs per recipient in geographic areas participating in the pilot program compare to the Medicaid costs per recipient in geographic areas not participating in the pilot program;
(2) distinguish the impact of the pilot program from other demographic, geographic, and health care factors that may affect the average monthly Medicaid costs per recipient;
(3) quantify the Medicaid savings attributable to the pilot program and identify those strategies necessary to achieve the highest rate of Medicaid savings from the pilot program;
(4) assess variations in the impact of the pilot program on the average monthly Medicaid cost per recipient and the Medicaid savings thereby generated, by provider type, by county, and by other geographic, demographic, or health care characteristics as identified by the division;
(5) assess the extent to which designated recipients receive health care services outside of the geographic area of the pilot program in order to avoid abuse or fraud detection; and
(6) survey a representative sample of recipients in the geographic area of the pilot program, prior to the start of the pilot program and at least annually thereafter, to collect data about health care services received, the frequency of those services, recipient satisfaction with services used, and recipient satisfaction with the pilot program.
The division may collect any additional data necessary to evaluate the scope, effectiveness, and impact of the pilot program including, but not limited to: Medicaid claims data; other health care data; demographic data; and geographic data.
b. The commissioner shall report to the Governor, and to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), no later than one year after the effective date of this act, and annually thereafter for such time as the pilot program remains in effect, on the results of the pilot program with regard to achieving its objective and the results of the annual evaluation conducted pursuant to subsection a. of this section. The report may include recommendations for appropriate legislative or administrative action necessary to further the purposes of this act.
c. The commissioner shall not extend the pilot program unless the commissioner has determined that the pilot program has achieved its objective and shall not expand the pilot program unless the annual evaluation conducted pursuant to subsection a. of this section indicates that the pilot program can be expanded through savings to Medicaid achieved by the pilot program. The commissioner's recommendations concerning whether to extend the pilot program or to expand the pilot program to encompass more recipients shall be included in the commissioner's second annual report pursuant to subsection b. of this section. The pilot program shall terminate two years after the effective date of this act unless extended by the commissioner.
4. a. The provisions of this act shall not be construed as affecting any person's obligation to comply with the requirements of federal and State law and regulations concerning the privacy of personal health information.
b. The commissioner, the Department of Human Services, and any employee thereof, if acting in good faith, shall not be held responsible for any action of any contractor or subcontractor in the event that the contractor or subcontractor is found to have violated any federal or State law or regulation concerning the privacy of personal health information.
5. If the division has reason to believe that abuse or fraud has been perpetrated in connection with the pilot program, the division shall refer any such matter to the Office of the State Comptroller pursuant to P.L.2010, c.33 (C.52:15C-20 et seq.).
6. The commissioner, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations necessary to effectuate the purposes of this act.
7. This act shall take effect on the first day of the fourth month next following the date of enactment, but the commissioner may take such anticipatory administrative action in advance thereof as shall be necessary for the implementation of this act.
STATEMENT
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.
