Bill Text: NJ A4146 | 2016-2017 | Regular Session | Chaptered
Bill Title: Provides for monitoring and evaluation of transition of mental health and substance use disorder treatment service system and developmental disability system to fee-for-service reimbursement model; makes appropriation.*
Spectrum: Partisan Bill (Democrat 20-0)
Status: (Passed) 2017-05-11 - Approved P.L.2017, c.85. [A4146 Detail]
Download: New_Jersey-2016-A4146-Chaptered.html
T&E
An Act concerning the transition by 2certain2 community-based 2[mental health and substance use disorder] health care2 treatment service providers to a fee-for-service reimbursement model and making an appropriation.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. The Legislature finds the following:
(1) The Division of Mental Health and Addiction Services (DMHAS) 2and the Division of Developmental Disabilities (DDD)2 in the Department of Human Services 2[has] have2 historically used a cost reimbursement system to provide most State-level funding for community-based 2[mental health and substance use disorder treatment]2 services in New Jersey. 2[The DMHAS has] Both divisions have2 begun to transition most community-based 2[mental health and substance use disorder treatment]2 services from a cost reimbursement system to a fee-for-service reimbursement system 2[, beginning in July 2016, and]. The DMHAS2 plans to require all providers to complete the transition by July 2017 2, while the DDD is transitioning providers in a more gradual fashion2.
(2) Under the cost reimbursement system, community-based 2[mental health and substance use disorder treatment]2 providers 2in both divisions2 receive a monthly payment at a predetermined contracted rate, regardless of the actual services provided to consumers, and a close-out process is used at the end of the year to reconcile each provider's actual costs with the payments made. Under the new fee-for-service reimbursement model, monthly reimbursement will not be predetermined, and each provider will instead be required to submit a reimbursement claim for each specific unit of service that it has actually delivered to a consumer.
(3) The 2[DMHAS has] divisions have2 proposed new reimbursement rate schedules that would take effect as part of the transition to a fee-for-service model. The new rates cannot easily be compared to the cost reimbursement system, since the actual payments that providers will receive under the new fee-for-service model will be based on submitted claims, rather than on predetermined monthly amounts. While the Executive Branch estimates that the new rates will result in an overall increase in funding to providers, 1[those] for many1 providers 1[that have high overhead costs and low service volume may nonetheless find that]1 the new rates 1[are] may be1 insufficient to cover 1[their expenses] the costs of providing services1.
(4) 1[Because the] The1 new fee-for-service reimbursement system 1may negatively affect many providers' cash flow, particularly during the transition. The fee-for-service system1 will allow reimbursement only for 1[those] specific1 services that have 1[actually]1 been provided and claimed, 1[and will not allow community-based providers to be paid for vacant treatment slots or for lower service levels, the conversion to a fee-for-service reimbursement system may negatively affect provider cash flow during the transition and make revenue unpredictable, thereby reducing the] and may effectively pay less than providers had received in the past for delivering the same services. This reduced predictability of revenue may impede1 providers' ability to provide adequate services to persons in need. The conversion may simultaneously force providers to increase their marketing expenditures in an attempt to maximize billable services, while forcing them to maintain a greater reserve of cash on hand in order to ensure their ability to absorb costs when vacancies inevitably arise.
(5) Providers engaged in the transition to a fee-for-service reimbursement model will also be required to be approved by Medicaid, which will necessitate their compliance with extensive administrative regulations, and their use and administration of new billing systems and software, both of which may require additional and unanticipated financial expenditures.
b. The Legislature therefore declares that it is both reasonable and necessary, and in the public interest, for the State to establish procedures for monitoring the transition by community-based 2[mental health and substance use disorder treatment]2 providers to a fee-for-service reimbursement system, in order to ensure that reimbursement rates established under the new fee-for-service system are adequate, that 1[patient] client1 access to care is maintained, and that continuity of care and quality 2[or] of 2 care are not harmed as a result of the transition.
2. a. There 2[is] are2 hereby established 2[an] two2 advisory 2[board] boards2 to be known as the Independent 2Mental Health and Addiction2 Fee-for-Service Transition Oversight Board 2and the Independent Developmental Disability Fee-for-Service Transition Oversight Board2. The purpose of the 2[board] Independent Mental Health and Addiction Fee-for-Service Transition Oversight Board2 shall be to monitor and oversee the transition by 2[community-based mental health and substance use disorder treatment providers] DMHAS-contracted providers2 to a fee-for-service reimbursement system; determine the adequacy of fee-for-service reimbursement rates; and provide recommendations to better facilitate the transition. 2The purpose of the Independent Developmental Disability Fee-for-Service Transition Oversight Board shall be to monitor and oversee the transition by DDD-contracted providers to a fee-for-service reimbursement system; determine the adequacy of fee-for-service reimbursement rates; and provide recommendations to better facilitate the transition.2
b. The 2[board] Independent Mental Health and Addiction Fee-for-Service Transition Oversight Board2 shall be comprised of 3[1[11] 121] 133 members, appointed by the Governor, as follows:
(1) two representatives of provider entities that receive State funds for mental health services;
(2) two representatives of provider entities that receive State funds for substance use disorder treatment services;
(3) a certified public accountant, upon the recommendation of the New Jersey Society of Certified Public Accountants (NJCPA);
(4) a current consumer of State-funded mental health services, or the parent or guardian of such consumer;
(5) a current consumer of State-funded substance use disorder treatment services, or the parent or guardian of such consumer;
(6) 1one person upon the recommendation of the Mental Health Association in New Jersey;
(7)1 one person upon the recommendation of the New Jersey chapter of the National 1[Association] Alliance1 on Mental Illness (NAMI);
1[(7)] (8)1 one person upon the recommendation of the New Jersey Association of Mental Health and Addiction Agencies (NJAMHAA);
1[(8)] (9)1 one person upon the recommendation of the New Jersey Psychiatric Rehabilitation Association; 3[and]3
1[(9)] (10)1 one person upon the recommendation of the New Jersey Hospital Association 3; and
(11) a member of the New Jersey Association of County Mental Health Administrators3.
c. 2 The Independent Developmental Disability Fee-for-Service Transition Oversight Board shall be comprised of 11 members, appointed by the Governor, as follows:
(1) two representatives of provider entities that receive State funds for developmental disability services;
(2) a certified public accountant, upon the recommendation of the New Jersey Society of Certified Public Accountants (NJCPA);
(3) a current consumer of State-funded developmental disability services, or the parent or guardian of such consumer;
(4) one person on the recommendation of the Alliance for the Betterment of Citizens with Disabilities (ABCD);
(5) one person on the recommendation of the Arc of New Jersey;
(6) one person on the recommendation of Autism New Jersey;
(7) one person on the recommendation of the Developmental Disabilities Association of New Jersey;
(8) one person on the recommendation of the New Jersey Association of Community Providers (NJACP);
(9) one person on the recommendation of the New Jersey Council on Developmental Disabilities (NJCDD); and
(10) one person on the recommendation of the Boggs Center on Developmental Disabilities at Robert Wood Johnson Medical School.
d.2 The members of the 2[board] boards2 shall be appointed within 45 days after the effective date of this act, and 2[the] each2 board shall hold its initial organizational meeting as soon as practicable, but no later than 30 days, after the appointment of its members. 2[The] Each2 board shall select a chairperson from among its members, and shall meet and hold hearings at such places and times as the chairperson may designate. The chairperson may appoint a secretary who need not be a board member.
2[d.] e.2 The members of the 2[board] boards2 shall serve without compensation, but may be reimbursed for travel and other necessary expenses incurred in the performance of their duties, within the limits of funds appropriated or otherwise made available to 2[the] each2 board for its purposes.
2[e.] f.2 The Department of Human Services shall provide professional and clerical staff to the 2[board] boards2 as may be necessary for 2[the] each2 board's purposes. 2[The] Each2 board shall also be entitled to call upon the services of any other State, county, or municipal department, board, commission, or agency, as may be available to it for its purposes.
2[f.] g.2 In executing its duties under this act, 2[the] each2 board shall consult with the 2[community-based mental health and substance use disorder treatment]2 providers and their clients who are being affected by the transition to a fee-for-service reimbursement model.
2[g. The] h. Each2 board may solicit and receive grants or other funds that are made available for its purposes by any governmental, public, private, not-for-profit, or for-profit agency, including funds that are made available under any federal or State law, regulation, or program.
3. a. 2[The] Each2 board shall evaluate and report on the status and effects of the transition by community-based 2[mental health and substance use disorder treatment]2 providers to a fee-for-service reimbursement model, in accordance with the provisions of this section. 2[The]Each2 board's evaluation of the transition shall primarily focus on its effects on access to care, continuity of care, and quality of care. In order to determine the relationship between the transition to fee-for-service on these measures, 2[the] each2 board shall consider information included in reports issued by the selected contractor pursuant to subsection c. 2of 2 section 4 of this act, and may also independently evaluate providers' costs, revenues, revenue shortfalls, and other needs including technical assistance, training, and business infrastructure needs that are affected by the transition, and how these factors affect providers' ability to serve their 1[patients] clients1. 2[The] Each2 board may make recommendations to the contractor selected pursuant to section 4 of this act with regard to its evaluation.
b. 2[The] Each2 board shall submit a written status report to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), to the Governor, and to the 2[Division of Mental Health and Addiction Services in the]2 Department of Human Services, at the following intervals: (1) an initial status report shall be submitted six months after the board's organizational meeting; (2) an interim status report shall be submitted one year after the board's organizational meeting; and (3) a final status report shall be submitted two years after the board's organizational meeting.
Each written report prepared pursuant to this subsection shall:
(1) evaluate the adequacy of fee-for-service reimbursement rates as of the time of the reporting;
(2) identify the positive and negative effects revealed during the reporting period that have been associated with the transition to a fee-for-service reimbursement system;
(3) identify the number and percentage of community-based mental health 2[and] ,2 substance use disorder 2, and developmental disability2 treatment providers that are having difficulties with the transition;
(4) identify any specific problems that are hampering the transition;
(5) identify any actions that have been undertaken by any entity during the reporting period to counteract or remedy the negative effects identified pursuant to paragraph (2) of this subsection, or the specific problems identified pursuant to paragraph (4) of this subsection;
(6) indicate the number and percentage of consumers who have been served by community mental health 2[and] ,2 substance use disorder 2, and developmental disability2 treatment providers during the course of the reporting period; identify whether the number or frequency of consumer contacts has been reduced as a result of the transition; and approximate the number and percentage of consumers who have been unable to obtain service as a result of the transition to a fee-for-service model; and
(7) provide recommendations for the modification of applicable reimbursement rate schedules, and recommendations for other actions that could be undertaken to better facilitate the transition or otherwise ease the burden on 2[community-based mental health and substance use disorder treatment]2 providers, and to avoid or redress any unintended lapses in service provision or reductions in service quality or capabilities that may result from the transition.
c. 2[The] Each2 board shall dissolve 30 days after it submits its final report pursuant to paragraph (3) of subsection b. of this section.
4. a. The Division of Purchase and Property in the Department of the Treasury, in consultation with the Department of Human Services 2[and the New Jersey Association of Mental Health and Addiction Agencies] 2, shall issue a request for proposals to perform 2[an] two separate2 independent 2[evaluation] evaluations2 of the 2[transition] transitions2 of the mental health and substance use disorders treatment service system 2and the developmental disability services system2 to fee-for-service. The 2[evaluation] evaluations2 shall assess the impact of 2[the] each2 transition to fee-for-service and the particular rates adopted in the fee-for-service system on the financial sustainability of provider agencies, and on 1[patients'] clients'1 access to care, continuity of care, and quality of care. Proposals shall be submitted no later than April 1, 2017. The criteria for selection shall include, but need not be limited to, demonstrated competence in developing and evaluating reimbursement systems for state health care programs. The division shall review all submissions and select one proposal, with the contract to begin no later than July 1, 2017.
b. The selected contractor shall be responsible for evaluating, on a continual basis, the impact of the transition of the community-based mental health and substance use disorder treatment services system 2and the community-based developmental disabilities service system2 to a fee-for-service reimbursement model and the particular rates adopted in the fee-for-service system on the financial sustainability of provider agencies, and on 1[patients'] clients'1 access to care, continuity of care, and quality of care. The contractor shall conduct its evaluation in accordance with its contract and, to the maximum extent practicable, with the recommendations of the Independent 2Mental Health and Addiction2 Fee-for-Service Transition Oversight Board
2and the Independent Developmental Disability Fee-for-Service Transition Oversight Board2 established pursuant to section 2 of this act.
c. The contractor shall issue periodic written reports 2, separately for each of its evaluations,2 to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), the Governor, the 2[Division of Mental Health and Addiction Services in the]2 Department of Human Services, 2[and]2 the Independent 2Mental Health and Addiction2 Fee-for-Service Transition Oversight Board 2, and the Independent Developmental Disability Fee-for-Service Transition Oversight Board2. At a minimum, the contractor shall issue written reports evaluating the 2[transition] transitions2 for the following reporting periods: (1) the start of the transition through September 30, 2017; (2) October 1, 2017 through December 31, 2017; (3) January 1, 2018 through June 30, 2018; and (4) July 1, 2018 through June 30, 2019. Each report shall be submitted no later than one month following the end of each reporting period. The contract will terminate after the submission of the final report.
5. There 2[is] are2 appropriated from the General Fund 2to the Department of Human Services2 such 2[fund] amounts as are determined by the Director of the Division of Purchase and Property as are2 necessary for the 2[execution] performance of the independent evaluation contracts pursuant to2 of section 4 of this act 2subject to the approval of the Director of the Division of Budget and Accounting in the Department of the Treasury2 .
6. This act shall take effect immediately, and shall expire on the later of: (1) the 30th day after 2[the] each2 board submits its final report pursuant to subsection b. of section 3 of this act 2, 2 or (2) the 30th day after the contractor submits its final report pursuant to subsection c. of section 4 of this act.
Provides for monitoring and evaluation of transition of mental health and substance use disorder treatment service system and developmental disability system to fee-for-service reimbursement model; makes appropriation.
