Bill Text: NJ A4776 | 2016-2017 | Regular Session | Introduced
Bill Title: Establishes certain requirements and conditions concerning changes to DHS reimbursement system for mental health and substance use disorder treatment services; appropriates $10 million.
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Introduced - Dead) 2017-05-11 - Introduced, Referred to Assembly Human Services Committee [A4776 Detail]
Download: New_Jersey-2016-A4776-Introduced.html
Sponsored by:
Assemblywoman VALERIE VAINIERI HUTTLE
District 37 (Bergen)
SYNOPSIS
Establishes certain requirements and conditions concerning changes to DHS reimbursement system for mental health and substance use disorder treatment services; appropriates $10 million.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning State reimbursement for mental health and substance use disorder treatment services, supplementing Title 30 of the Revised Statutes, and making an appropriation.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. A contract between a licensed provider of mental health or substance use disorder treatment services and the Division of Mental Health and Addiction Services or the Division of Medical Assistance and Health Services in the Department of Human Services that provides fee-for-service reimbursement for the provider to provide mental health or substance use disorder treatment services shall include provisions allowing for the provider to be reimbursed for the following services and activities:
a. providing an initial intake assessment of a patient, and separately for providing an initial psychiatric evaluation. Reimbursement for both services shall be available if both an assessment and an evaluation are performed on the same day;
b. outreach services after a consumer fails to appear for a scheduled appointment to determine the cause of the missed appointment;
c. transportation for staff traveling to visit a consumer at the consumer's residence or another appropriate remote location;
d. transitional planning and other engagement for a consumer who is preparing to transition, or who has recently transitioned, between an institutional setting and a community setting; and
e. assistance with applications for public benefits for which a consumer may be eligible, including, but not limited to, medical assistance, nutrition assistance, and home energy assistance programs.
2. Notwithstanding any law or regulation to the contrary, neither the Division of Mental Health and Addiction Services nor the Division of Medical Assistance and Health Services in the Department of Human Services shall require prior authorization for partial care services for treatment of a substance use disorder in order to provide reimbursement for those services.
3. The Department of Human Services shall provide in-person technical support to any licensed provider of mental health or substance use disorder treatment services that, on June 30 2017, holds a contract with the Division of Mental Health and Addiction Services or the Division of Medical Assistance and Health Services in the Department of Human Services that provides cost-based reimbursement for the provider to provide mental health or substance use disorder treatment services, and that subsequently transitions to a fee-for-service reimbursement system, upon the provider's request.
4. a. There is established in the Department of Human Services a one-year Fee for Service Transition Assistance Grant Program, to be effective for State Fiscal Year 2018. The purpose of the program shall be to provide grants to eligible providers to aid in the transition from a cost-based reimbursement system to a fee-for-service reimbursement system.
b. To be eligible for a grant, a provider must:
(1) be a licensed provider of mental health or substance use disorder treatment services; and
(2) be actively preparing to transition from a cost-based reimbursement system to a fee-for-service reimbursement system, or have completed such a transition within one year preceding the application.
c. Applications shall be filed in a form and manner determined by the department. Grants shall be awarded on a competitive basis to those providers that can demonstrate the need for specific equipment or business or technical assistance in order to establish financial stability and continue services to consumers under the fee-for-service system. No applicant shall be eligible to receive more than one grant under this section.
5. There is appropriated from the General Fund to the Department of Human Services the sum of $10,000,000 to effectuate the Fee for Service Transition Assistance Grant Program established pursuant to section 4 of this act.
6. This act shall take effect immediately. Sections 3 through 5 shall expire on June 30, 2018.
STATEMENT
This bill places certain requirements and conditions on the implementation of the Department of Human Services (DHS) plan to reform its system for providing State reimbursement to providers of mental health and substance use disorder treatment services to low-income New Jersey residents. The bill would apply to any such services funded through the Division of Mental Health and Addiction Services or the Division of Medical Assistance and Health Services (Medicaid) in the Department of Human Services. The DHS is in process of transitioning its contracted providers of community-based mental health and substance use disorder treatment services from a cost-based reimbursement model to a fee-for-service model. Under the current plan, providers will be required to transition their contracts no later than July 1, 2017.
The bill requires a fee-for-service provider contract to include provisions allowing for the provider to be reimbursed for the following services and activities:
· providing an initial intake assessment of a patient, and separately for providing an initial psychiatric evaluation, even if both services are performed on the same day;
· outreach services after a consumer fails to appear for a scheduled appointment to determine the cause of the missed appointment;
· transportation for staff traveling to visit a consumer at the consumer's residence or another appropriate remote location;
· transitional planning and other engagement for a consumer who is preparing to transition, or who has recently transitioned, between an institutional setting and a community setting; and
· assistance with applications for public benefits for which a consumer may be eligible, including, but not limited to, medical assistance, nutrition assistance, and home energy assistance programs.
The bill also prohibits the department from requiring prior authorization for partial care services for treatment of a substance use disorder. This provision of the bill is intended to preempt a proposed change to Medicaid regulations (noticed in the New Jersey Register at 48 N.J.R.2737(a), but not yet adopted as of March 2017) that would extend current prior authorization requirements to substance use disorder services. According to providers, the proposed $6,000 limit on services that may be provided without prior authorization would cover approximately 85 days of care, while more severe cases may require as much as 240 days to provide necessary treatment.
The bill requires the DHS to provide in-person technical support to any provider that is planning to transition or in process of transitioning from a cost-based reimbursement system to a fee-for-service reimbursement system, upon the provider's request. This provision would be effective until June 30, 2018.
Finally, the bill establishes a grant program for licensed providers transitioning from the cost-based reimbursement system to the fee-for-service system. Grants would be awarded on a competitive basis to those providers that can demonstrate the need for specific equipment or business or technical assistance in order to establish financial stability and continued services to consumers under the fee-for-service system. No applicant would be eligible to receive more than one grant under this section. The bill appropriates from the General Fund $10 million in FY 2018 to effectuate this grant program.
