Bill Would Create Oversight Mechanism to Monitor Christie Administration’s New Fee-For-Service Payment Model for Treatment Services
An Assembly panel has approved legislation sponsored by Assembly Democrats Valerie Vainieri Huttle, Daniel Benson and Pamela Lampitt to ensure that the state does not recklessly limit access to mental health and addiction treatment by changing the way it pays treatment service providers.
The bill (A-4146) was prompted by the state’s decision to begin transitioning most community-based mental health and substance use disorder treatment services from the traditionally used cost reimbursement system to a fee-for-service reimbursement system this past summer, with plans to require all providers to complete the transition by July 2017.
The sponsors noted that mental health providers across the state have expressed concern that the new payment model will result in substantial revenue losses that could force many to reduce or eliminate community-based treatment services.
“Our primary concern is to ensure that the transition to a fee-for-service payment system doesn’t end up having a negative impact on the delivery of treatment by forcing service providers out of business and effectively limiting treatment options,” said Vainieri Huttle (D-Bergen). “We need to ensure that the administration is not recklessly toying with a system that could end up cutting off treatment for many people suffering from severe mental illnesses – those who need it most, but can least afford it.”
The bill would establish a formal system of oversight for the planned transition that would establish two mechanisms: (1) an Independent Fee-for-Service Transition Oversight Board and (2) a contracted evaluator with demonstrated competence in developing and evaluating reimbursement systems for state health care programs.
“For a governor who has focused heavily on substance abuse treatment and eschewed stricter gun safety measures in favor of greater mental health treatment, it seems somewhat precarious to toy with a system that could eventually limit treatment options,” said Benson (D-Mercer/Middlesex). “This bill is designed to keep a close eye on this transition so we can hopefully avoid this scenario.”
The Independent Fee-for-Service Transition Oversight Board would be comprised of 12 members, appointed by the Governor, consisting of a wide-range of stakeholders and experts in the fields of substance use and addiction treatment. Members of the board are to be appointed within 45 days after the bill’s effective date, and the board is to hold its initial organizational meeting as soon as practicable, but no later than 30 days after the appointment of its members.
“We need proper oversight of this transition because one of the biggest concerns is that it will eventually deny treatment to tens of thousands of our most vulnerable residents,” said Lampitt (D-Camden/Burlington). “Without access to treatment, the state could wind up paying more in the long run when those suffering from mental illness or addiction end up in emergency rooms, psychiatric hospitals or, worse, jail.”
The board’s evaluation of the transition would be to primarily focus on the transition’s effects on access to care, continuity of care, and quality of care. The board may make recommendations to the contracted evaluator with regard to its evaluation.The bill would require the board to submit written several status reports to the Legislature, the Governor, and DMHAS at various intervals.
The bill also requires an independent evaluation of the transition to a fee-for-service system in order to assess its impact, particularly the impact of the new rates on the financial sustainability of provider agencies and on patients’ access to care, continuity of care, and quality of care.
The contractor hired to conduct the independent evaluation would be required to issue periodic written reports to the Legislature, the Governor, DMHAS, and the Independent Fee-for-Service Transition Oversight Board.
The bill was approved Monday by the Assembly Human Services Committee chaired by Vainieri Huttle.