Bill Text: NJ S667 | 2010-2011 | Regular Session | Introduced
Bill Title: Directs DHS to prepare plan to establish primary care case management pilot program.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2010-01-12 - Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee [S667 Detail]
Download: New_Jersey-2010-S667-Introduced.html
STATE OF NEW JERSEY
214th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2010 SESSION
Sponsored by:
Senator BARBARA BUONO
District 18 (Middlesex)
SYNOPSIS
Directs DHS to prepare plan to establish primary care case management pilot program.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel
An Act concerning the delivery of health care services to certain Medicaid recipients.
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 develop a plan to implement a pilot program for alternative approaches to the delivery of health care services through a system of primary care case management.
The plan shall be developed no later than June 30, 2010, and shall be submitted to the Senate Health, Human Services and Senior Citizens and Budget and Appropriations committees and the Assembly Human Services and Appropriations committees for their review and comment. The committees may hold hearings on the plan and may recommend modifications to the plan.
b. The plan shall provide, at a minimum, for the following:
(1) voluntary enrollment in the primary care case management pilot program by at least 1,000 Medicaid recipients as an alternative to enrollment in a managed care plan;
(2) primary care providers participating in the primary care case management system, who shall provide program beneficiaries with primary care medical services and arrange for specialty care as needed;
(3) payment to participating primary care providers of a per member, per month coordination-of-care payment, to enable the providers to hire case managers;
(4) a process for primary care providers to apply for participation in the pilot program and requirements for participation as a provider;
(5) a mechanism for primary care providers to report to the division; and
(6) the services that the division shall "carve out" from the pilot program and arrange to coordinate and provide through other means.
c. The division shall consult with primary care provider organizations and such other organizations as it deems appropriate in developing the plan.
d. Subject to the availability of federal matching funds, the division shall begin implementing the plan no later than January 1, 2011.
2. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
3. This act shall take effect on the 30th day following enactment.
STATEMENT
This bill directs the State Medicaid program to develop a plan to implement a pilot program for alternative approaches to the delivery of health care services through a system of primary care case management. The plan shall be developed no later than June 30, 2010, and shall be submitted to the Senate Health, Human Services and Senior Citizens and Budget and Appropriations committees and the Assembly Human Services and Appropriations committees for their review and comment.
The Medicaid program shall consult with primary care provider organizations and such other organizations as it deems appropriate in developing the plan. The plan shall provide, at a minimum, for the following:
· primary care providers participating in the primary care case management system, who shall provide program beneficiaries with primary care medical services and arrange for specialty care as needed;
· payment to participating primary care providers of a per member, per month coordination-of-care payment, to enable the providers to hire case managers;
· voluntary enrollment by Medicaid recipients as an alternative to enrollment in a managed care plan;
· a process for primary care providers to apply for participation in the pilot program and requirements for participation as a provider;
· a mechanism for primary care providers to report to the division; and
· the services that the division shall "carve out" from the pilot program and arrange to coordinate and provide through other means.
Subject to the availability of federal matching funds, the division shall begin implementing the plan no later than January 1, 2011.
The bill directs the Commissioner of Human Services to apply for such State plan amendments or waivers as may be necessary for implementation of the bill and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
The bill takes effect on the 30th day following enactment.
