Bill Text: NJ A3598 | 2022-2023 | Regular Session | Introduced
Bill Title: Establishes pilot program for 24-hour urgent care for behavioral health.
Spectrum: Partisan Bill (Democrat 8-0)
Status: (Introduced - Dead) 2022-03-14 - Introduced, Referred to Assembly Human Services Committee [A3598 Detail]
Download: New_Jersey-2022-A3598-Introduced.html
Sponsored by:
Assemblyman LOUIS D. GREENWALD
District 6 (Burlington and Camden)
Assemblywoman VERLINA REYNOLDS-JACKSON
District 15 (Hunterdon and Mercer)
SYNOPSIS
Establishes pilot program for 24-hour urgent care for behavioral health.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning behavioral health and substance use disorders and supplementing Title 30 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. As used in this act:
"Behavioral health" or "behavioral health care" means procedures or services rendered by a health care or mental health care provider for the treatment of a mental illness, a mental health or emotional disorder, or a substance use disorder.
"Care transition" means the transfer or transition of a patient from an urgent care facility to a health care or behavioral health care provider.
"Commissioner" means the Commissioner of Human Services.
"Community health center" means a federally qualified health center (FQHC), an ambulatory care facility, a certified community behavioral health clinic (CCBHC), a behavioral health program, and a substance use disorder facility.
"Department" means the Department of Human Services.
"Hospital" means a general acute care hospital licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).
"Managed care organization" means a Medicaid managed care organization, as that term is defined pursuant to 42 U.S.C. s.1396b (m)(1)(A).
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Pilot program" means the Urgent Care Facility Behavioral Health Pilot Program established pursuant to this act.
"Rapid referral" means the taking of appropriate steps by an urgent care facility as may be necessary to facilitate: a patient's referral or transfer to, prompt access to an appointment with, and timely receipt of services from, another appropriate health care or behavioral health care services provider; a patient's prompt and voluntary admission to an inpatient psychiatric facility; or a patient's prompt evaluation by a screening service or mental health screener to determine whether involuntary commitment to treatment is warranted pursuant to P.L.1987, c.116 (C.30:4-27.1 et seq.).
"Supportive contacts" means brief communications with a patient that occur during care transitions, and which show support for the patient and are designed to promote a patient's feeling of connection to treatment and willingness to collaboratively participate in treatment. "Supportive contacts" may include, but shall not be limited to, sending the patient postcards, letters, email messages, and text messages, as well as calling the patient on the phone or using video chat.
"Warm hand-off" means a safe care transition that connects a patient directly with a health care or mental health care provider or interim contact, such as a crisis center worker or peer specialist, before the patient's first appointment with the new provider, or that connects a patient directly with a screening service or mental health screener for the purposes of determining whether involuntary commitment to treatment is warranted pursuant to P.L.1987, c.116 (C.30:4-27.1 et seq.).
"Urgent care facility" means a health care facility that offers episodic, walk-in care for the treatment of acute, but not life-threatening, health conditions 24 hours per day, seven days per week.
2. a. The Department of Human Services shall establish a two-year Urgent Care Facility Behavioral Health Pilot Program, commencing upon the selection of the managed care organizations pursuant to subsection b. of this section, in accordance with the provisions of sections 1 through 4 of this act. The goal of the pilot program shall be to provide behavioral health care at certain hospital urgent care facilities to stabilize individuals experiencing behavioral health crises in a way that reduces unnecessary hospital emergency department and inpatient admissions.
b. Within 180 days after the effective date of this act or, if the department submits State plan amendments or waivers pursuant to section 6 of this act, within 30 days of the receipt of any necessary federal approvals, the department shall issue a request for proposals and select one or more managed care organizations to participate in the pilot program. The managed care organizations selected pursuant to this subsection shall demonstrate the ability to meet the requirements of the pilot program and shall operate in each of the northern, central, and southern regions of the State.
c. The managed care organizations selected to participate in the pilot program shall contract with six hospitals, with two in each of the northern, central, and southern regions of the State, to provide integrated behavioral health care within one of the hospital's urgent care facilities. To be eligible to contract with a managed care organization pursuant to this subsection, a hospital shall demonstrate the ability to coordinate patients with primary care providers, outpatient behavioral health and substance abuse providers, community health centers, and social service providers, and shall not receive funding from the department to provide Early Intervention Support Services. In determining which hospitals to contract with, the selected managed care organizations shall prioritize hospitals that specialize in pediatric care if feasible.
d. Each participating urgent care facility shall integrate behavioral health care with the facility's existing physical health care services, which shall, at a minimum, include: employing a behavioral health team of at least one licensed behavioral clinician and one licensed clinical social worker; partnering with one or more licensed psychiatrists to provide services, as needed, via telemedicine and telehealth; providing behavioral health awareness and intervention training to staff; and using warm hand-offs, rapid referrals, supportive contacts, and other efficient and supportive care transition methods.
3. a. The pilot program established pursuant to section 2 of this act shall be funded through the Medicaid program using a value-based payment system. The value-based payment system shall be modeled on, and be consistent with, the population-based payment methodology that is described under Category 4 of the alternative payment methodologies (APM) framework developed by the Health Care Payment Learning and Action Network. Specifically, the value-based payment system shall provide for a quarterly advanced bundled payment to be provided to the managed care organization for the purposes of financing the total cost of behavioral health care that is provided by participating urgent care facilities. The quarterly bundled payment rate shall be established by the Commissioner of Human Services and shall be based on the commissioner's evaluation of the following factors:
(1) an assessment of claims data indicating the cost to provide behavioral health care in hospital emergency departments and inpatient settings, absent the pilot program;
(2) the number of patients who are expected to be served by the pilot program;
(3) the average anticipated per-patient cost of care under the pilot program;
(4) the anticipated costs to participating urgent care facilities of complying with the provisions of subsection d. of section 2 of this act; and
(5) any other factors that may affect the cost of care.
b. The quarterly bundled payment provided under this section shall be limited to the bundled rate established by the commissioner under subsection a. of this section, and shall not be subject to increase, regardless of whether the actual costs of care received by patients in the pilot program exceed the bundled payment rate provided hereunder. If the managed care organization, in cooperation with participating urgent care facilities, is able to reduce the per-patient costs of care for patients receiving care and services under the pilot program, the managed care organization may retain, and shall not be required to repay, any remaining unexpended bundled payment funds. Any such savings achieved shall be shared by the managed care organization with participating urgent care facilities at a rate that is proportional to the rate of per-patient cost reduction savings achieved by each such facility. If the actual per-patient costs of care for patients receiving care and services under the pilot program exceed the advanced bundled payment rate established by the commissioner under this section, the managed care organization shall ensure that all patients continue to receive appropriate services and care from participating urgent care facilities without being subject to an increase in out-of-pocket costs. Any financial loss incurred by the managed care organization as a result of an increase in the per-patient cost of care for patients receiving care and services under the pilot program shall be shared by the managed care organization with participating urgent care facilities at a rate that is proportional to the rate of per-patient cost increase attributed to each facility.
4. a. Within 90 days after the two-year pilot program established pursuant to section 2 of this act is terminated, the department shall prepare and submit a written report of its findings and recommendations to the Governor and, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), to the Legislature.
b. At a minimum, the report shall:
(1) identify the managed care organizations that were selected to participate in the pilot program;
(2) identify the hospitals who were contracted by the managed care organizations pursuant to subsection c. of section 2 of this act, as well as the urgent care facilities participating in the pilot program;
(3) identify the total number and percentage of patients in each managed care network and the number and percentage of patients in each of the northern, central, and southern regions of the State who received behavioral health care from a participating urgent care facility under the pilot program;
(4) a summary of patient outcomes following an urgent care visit under the pilot program, including follow-up care regarding behavioral health;
(5) a comparison of costs of behavioral health care provided in hospital emergency departments and inpatient settings against costs of behavioral health care provided under the pilot program; and
(6) include recommendations as to whether and how the pilot program should be continued on a permanent basis.
5. The Commissioner of Health, the Commissioner of Human Services, and the Director of the Division of Consumer Affairs in the Department of Law and Public Safety shall each adopt rules and regulations, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), as shall be necessary to implement the provisions of this act.
6. The Commissioner of
Human Services shall apply for such State plan amendments or waivers as may be
necessary to implement the provisions of sections 1 through 4 of this act and
secure federal financial participation for State Medicaid expenditures under
the federal Medicaid program.
7. This act shall take effect immediately.
STATEMENT
This bill seeks to expand access to behavioral health care services by requiring the Department of Human Services (DHS) to establish a two-year Urgent Care Facility Behavioral Health Pilot Program.
The goal of the program will be to provide behavioral health care at hospital urgent care facilities to stabilize individuals experiencing behavioral health crises in a way that reduces unnecessary emergency department and inpatient admissions. In doing so, it is the sponsor's goal to provide quality, timely behavioral health care in a setting that offers positive patient outcomes, addresses the stigma associated with behavioral health issues, reduces the burden on hospital emergency room departments, and minimizes costs. Under the bill, "behavioral health" or "behavioral health care" means procedures or services rendered by a health care or mental health care provider for the treatment of a mental illness, a mental health or emotional disorder, or a substance use disorder.
Within 180 days after the effective date of the bill or, if the DHS submits State plan amendments or waivers to receive federal reimbursement under Medicaid for services provided under the bill, within 30 days of the receipt of any necessary federal approvals, the DHS is required to issue a request for proposals and select one or more Medicaid managed care organizations to participate in the pilot program. Under the bill, the two-year pilot program is to commence upon the selection of the managed care organizations. The managed care organizations selected are to demonstrate the ability to meet the requirements of the pilot program and are required to operate in each of the northern, central, and southern regions of the State.
The selected managed care organizations are required to contract with six hospitals, with two in each of the northern, central, and southern regions of the State, to provide integrated behavioral health care within one of the hospital's urgent care facilities. In determining which hospitals to contract with, the selected managed care organizations are to prioritize hospitals that specialize in pediatric care if feasible. Under the bill, a participating urgent care facility is required to provide services 24 hours per day, seven days per week. Furthermore, to be eligible, a hospital is to demonstrate the ability to coordinate a patient's care with primary care providers, outpatient behavioral health and substance abuse providers, community health centers, and social service providers, and may not receive funding from the DHS to provide Early Intervention Support Services.
Each participating urgent care facility is required to integrate behavioral health care with the facility's existing physical health services, which will, at a minimum, include: employing a behavioral health team of at least one licensed behavioral clinician and one licensed clinical social worker; partnering with one or more licensed psychiatrists to provided services, as needed, via telemedicine and telehealth; providing behavioral health awareness and intervention training to staff; and using warm hand-offs, rapid referrals, supportive contacts, and other efficient and supportive care transition methods.
The pilot program is to be funded in part through the Medicaid program using a value-based payment system. The value-based payment system is to be modeled on, and be consistent with, the population-based payment methodology that is described under Category 4 of the alternative payment methodologies (APM) framework developed by the Health Care Payment Learning and Action Network. Specifically, the value-based payment system is required to provide for a quarterly advanced bundled payment to be provided to the managed care organization for the purposes of financing the total cost of behavioral health care that is provided by participating urgent care facilities.
The quarterly bundled payment rate is to be established by the Commissioner of Human Services and is required to be based on the commissioner's evaluation of the following factors:
(1) an assessment of claims data indicating the cost to provide behavioral health care in hospital emergency departments and inpatient settings, absent the pilot program;
(2) the number of patients who are expected to be served by the pilot program;
(3) the average anticipated per-patient cost of care under the pilot program;
(4) the anticipated costs to participating urgent care facilities of complying with the provisions of the bill; and
(5) any other factors that may affect the cost of care.
Once established, the quarterly bundled payment may not be increased, regardless of whether the actual costs of care received by patients under the pilot program exceed the bundled payment rate provided. If the managed care organization, in cooperation with participating urgent care facilities, is able to reduce the per-patient costs of care for patients receiving care and services under the pilot program, the managed care organization may retain, and will not be required to repay, any remaining unexpended bundled payment funds. The managed care organization will be required to share any savings achieved with participating urgent care facilities at a rate that is proportional to the rate of per-patient cost reduction savings achieved by each such facility. If the actual per-patient costs of care for patients receiving care and services under the pilot program exceed the advanced bundled payment rate established by the commissioner, the managed care organization is to ensure that all patients continue to receive appropriate services and care from participating urgent care facilities without being subject to an increase in out-of-pocket costs. Any financial loss incurred by the managed care organization as a result of an increase in the per-patient cost of care for patients in the pilot program is to be shared by the managed care organization with participating urgent care facilities at a rate that is proportional to the rate of per-patient cost increase attributed to each facility.
The bill requires the DHS, within 90 days after the two-year pilot program is terminated, to prepare and submit a written report of its findings and recommendations to the Governor and Legislature.
The Commissioner of Human Services will be required to apply for any State plan amendments or waivers as may be necessary to implement the bill's provisions and secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
