Bill Text: NJ A4583 | 2024-2025 | Regular Session | Introduced
Bill Title: Requires DHS to review, and implement certain improvements to, Medicaid Managed Long-Term Services and Supports Program and to establish public-facing report card of managed care organization's coordination of program.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced) 2024-06-13 - Introduced, Referred to Assembly Aging and Human Services Committee [A4583 Detail]
Download: New_Jersey-2024-A4583-Introduced.html
Sponsored by:
Assemblyman CHRIS TULLY
District 38 (Bergen)
Assemblyman REGINALD W. ATKINS
District 20 (Union)
SYNOPSIS
Requires DHS to review, and implement certain improvements to, Medicaid Managed Long-Term Services and Supports Program and to establish public-facing report card of managed care organization's coordination of program.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning the Medicaid Managed Long-Term Services and Supports Program and supplementing Title 30 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. The Division of Medical Assistance and Health Services in the Department of Human Services shall conduct a review of the Medicaid Managed Long-Term Services and Support Program and the managed care organizations contracted with the division to administer and coordinate that program. The review, at a minimum, shall include:
(1) a survey and evaluation of the quality oversight measures in place upon the effective date of this act and used to assess the performance of each Medicaid managed care organization in administering and coordinating the Managed Long-Term Services and Supports Program;
(2) an assessment of the State's barriers to transitioning Medicaid members enrolled in the Managed Long-Term Services and Supports Program from nursing home to community settings, when clinically appropriate and desired by the member; and
(3) a nationwide study of Medicaid Managed Long-Term Services and Supports Program payment models that have high rates of success in transitioning members from nursing home to community settings.
b. Following the completion of the review pursuant to subsection a. of this section, the division shall identify and implement improvements to the Medicaid Managed Long-Term Services and Supports Program based upon the division's findings pursuant to paragraphs (1), (2), and (3) of subsection a. of this section. The improvements under this subsection shall also include requiring each managed care organization to:
(1) reduce care management caseloads for nursing home residents;
(2) more frequently visit nursing home residents on a face-to-face basis, during which visit a representative from the managed care organization shall ask members directly about, and document members' responses regarding, the quality of the facility and satisfaction with the facility's services;
(3) annually review the preferences and clinical needs of members residing in nursing homes and transition any member, when clinically appropriate and desired by the member, to a community setting; and
(4) establish a process, that includes reporting requirements and dedicated transition teams, for complex transitions from nursing home to community care.
c. No later than 18 months after the effective date of this act, the division shall submit a report to the Legislature, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), that summarizes the division's findings regarding the Medicaid Managed Long-Term Services and Supports Program pursuant subsection a. of this section and describes the improvements made to the program pursuant to subsection b. of this section.
2. a. The Division of Medical Assistance and Health Services in the Department of Human Services shall establish a public-facing report card for each Medicaid managed care organization's administration and coordination of the Medicaid Managed Long-Term Services and Support Program. Each report card shall be accessible on the department's website and shall provide user-friendly performance and quality rating information, such that members of the public are able to easily compare managed care organizations and to make an informed decision when choosing a managed care organization for the coordination of long-term services and supports under the Medicaid program. Any Medicaid Managed Long-Term Services and Supports Program reports prepared by the department shall also be included on the same webpage as the report cards established pursuant to this section.
b. For each managed care organization, the report card shall include:
(1) the number of members enrolled in the Medicaid Managed Long-Term Services and Supports Program, disaggregated by service setting;
(2) monthly disenrollment data within the Medicaid Managed Long-Term Services and Supports Program, disaggregated by service setting;
(3) data on performance, quality, and compliance within the Medicaid Managed Long-Term Services and Supports Program, including access to services across different member populations;
(4) available member feedback and reviews; and
(5) any additional information deemed appropriate by the Commissioner of Human Services.
c. The division shall update each managed care organization's report care annually.
3. This act shall take effect immediately and section 1 shall expire after the submission of the report to the Legislature pursuant to subsection c. of section 1 of this act.
STATEMENT
This bill requires the Division of Medical Assistance and Health Services (division) in the Department of Human Services (department) to identity and implement certain improvements to the Medicaid Managed Long-Term Services and Supports (MLTSS) Program, and to report to the Legislature on those activities no later than 18 months after the effective date of the bill. The bill also requires the division to establish a public-facing report card for each of the managed care organizations (MCOs) that administer and coordinate the program under the Medicaid program. The MLTSS program uses MCOs to coordinate all long-term services and supports under Medicaid - whether at home, in an assisted living facility, in community residential services, or in a nursing home.
Under the bill, the division is directed to conduct a review of the MLTSS Program. The review, at a minimum, is to include: 1) a survey and evaluation of the existing quality oversight measures in place used to assess the performance of MCOs; 2) an assessment of the State's barriers to transitioning Medicaid members enrolled in the MLTSS Program from nursing home to community settings; and 3) a nationwide study of MLTSS Program payment models that have high rates of success in transitioning members from nursing home to community settings.
Following the completion of this review, the division is required to identify and implement improvements to the MLTSS Program based upon the division's findings. The improvements are also to include requiring managed care organizations to: 1) reduce care management caseloads for nursing home residents; 2) more frequently visit nursing home residents on a face-to-face basis; 3) annually review the preferences and clinical needs of members residing in nursing homes and to transition any member, as appropriate, to a community setting; and 4) establish a process for complex transitions from nursing home to community care.
The bill also directs the division to establish, and update annually, a public-facing report card on the department's website for each MCO's administration and coordination of the MLTSS Program. Each report card is to provide user-friendly performance and quality rating information for use by the public. Any MLTSS Program reports prepared by the department are also be included on the same webpage as the report cards.
The bill provides that the report card is to include the following information for each MCO: 1) the number of members enrolled in the MLTSS Program; 2) monthly disenrollment data within the MLTSS Program; 3) data on performance, quality, and compliance; 4) available member feedback and reviews; and 4) any additional information deemed appropriate by the Commissioner of Human Services.
