Bills were inspired by recent State Auditor reports that found mismanagement & deficiencies in Medicaid, FamilyCare & behavior health services
An Assembly panel on Thursday approved two bills sponsored by Assembly Democrats Valerie Vainieri Huttle and Daniel Benson to address deficiencies identified recently by the State Auditor in the way the Department of Human Services delivers critical services to some of New Jersey’s most vulnerable populations.
The first bill (A-4769) is designed to ensure that New Jersey’s Medicaid and FamilyCare programs have adequate networks to meet the needs of participants and the second bill (A-4654) would revamp the system used to access services and resources for people with persistent behavioral health issues.
“The Auditor’s report brought to light some glaring deficiencies in the way the state manages critical health services for children, low-income families and residents who struggle with behavioral health issues,” said Vainieri Huttle (D-Bergen). “We need to make sure that residents who need these services aren’t harmed by bureaucratic failures and instead can concentrate on getting themselves or their loved ones the services they need.”
“When you’re struggling to put food on the table for your family or trying to cope with behavioral issues, the state should be helping you overcome these hurdles, not throwing more up in your way,” said Benson (D-Mercer/Middlesex). “These bills will institute the proper oversight to ensure these programs run much more efficiently and in the best interest of the people they’re designed to serve.”
In 2011, the administration of health care benefits for the majority of New Jersey Medicaid and FamilyCare recipients was shifted from the Department of Human Services to managed care organizations (MCOs) contracted with the department.
In January, the State Auditor released a report, which found that the Division of Medical Assistance and Health Services (DMHAS) does not effectively monitor the adequacy of the MCO provider networks regarding access to care and provider availability. Some of the more notable deficiencies included providing the wrong location for doctors’ offices or misreporting facilities as acute care hospitals, giving the appearance that Medicaid beneficiaries had access to hospital services when they did not.
To rectify these shortcomings, the first bill (A-4769), sponsored by Vainieri Huttle and Benson, would require DMAHS to establish a Medicaid Managed Care Organization Oversight Program to ensure the availability of accessible health care for individuals who are enrolled in the NJ FamilyCare and Medicaid programs. The program would be responsible for monitoring provider and beneficiary data, creating an independent verification system to monitor networks, and overseeing reporting and penalties for MCOs that fail to comply.
The second bill (A-4654), sponsored by Benson and Vainieri Huttle, is designed to improve the performance of the Integrated Case Management Services (ICMS) program, which is supposed to assist adults with persistent behavioral health issues in obtaining access to needed behavioral health, medical, social, educational, vocational, housing, and other services and resources needed to successfully integrate into the community of their choice upon discharge from a state or county hospital or short-term care facility.
In January, the State Auditor released a five-year audit of the Department of Human Services, Division of Mental Health and Addiction Services (DMHAS), which found that the procedures for monitoring and evaluating the performance of the ICMS program were not adequate. Most notably, it found that DMHAS did not establish specific regulations for the program, was not able to identify consumers receiving services, and found consumers that did not necessarily require case management services.
To address these deficiencies, the bill would require the Division of Mental Health and Addiction Services (DMHAS) to develop and implement procedures, and utilize appropriate tools as necessary to administer, monitor, and evaluate the ICMS program, including developing a comprehensive database that identifies all consumers receiving integrated case management services through the program.
Both bills were approved by the Assembly Human Services Committee chaired by Vainieri Huttle.