Will Create Oversight Mechanism to Monitor Christie Administration’s New Fee-For-Service Payment Model for Treatment Services
Legislation Assembly Democrats Valerie Vainieri Huttle, Daniel Benson, Pamela Lampitt, Gordon Johnson, Angela McKnight and Shavonda Sumter sponsored to ensure that the state does not recklessly limit access to health care treatment by changing the way it pays treatment service providers was signed into law on Thursday.
The new law (A-4146) was prompted by the state’s decision to begin transitioning most community-based health care treatment services from the traditionally-used cost reimbursement system to a fee-for-service reimbursement system this past summer. The Division of Mental Health and Addiction Services plans to require all providers to complete the transition by July 2017, while the Division of Developmental Disabilities is transitioning providers in a more gradual fashion.
The sponsors noted that health care 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), chair of the Assembly Human Services Committee. “We need to ensure that the administration is not recklessly toying with a system that could end up cutting off treatment for many people who suffer from severe mental illnesses or have developmental disabilities – those who need it most, but can least afford it.”
The law will establish two advisory boards, to be known as the Independent Mental Health and Addiction Fee-for-Service Transition Oversight Board and the Independent Developmental Disability Fee-for-Service Transition Oversight Board, to 1) oversee the transition by state-contracted health care providers to a fee-for-service reimbursement system, 2) determine the adequacy of fee-for-service reimbursement rates and 3) provide recommendations to better facilitate the transition.
“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 law is designed to keep a close eye on this transition so we can hopefully avoid this scenario.”
The Independent Mental Health and Addiction Fee-for-Service Transition Oversight Board would be comprised of 13 members, appointed by the governor, consisting of a wide range of stakeholders and experts in the fields of substance use and addiction treatment. Similarly, the Independent Developmental Disability Fee-for-Service Transition Oversight Board would be comprised of 11 members, appointed by the governor, consisting of a wide range of stakeholders and experts on developmental disabilities. Members of both boards must now be appointed within 45 days and the board must 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.”
“When a mental illness or substance use disorder goes untreated, the impact isn’t just limited to the individuals dealing with those issues,” said Johnson (D-Bergen). “Ensuring proper oversight of the transition to a fee-for-service system and uninterrupted access to services is a means of limiting the behavioral, physical and emotional problems that affect these individuals directly and the associated public safety concerns that may affect their communities.”
“Community mental health providers have made a difference in the lives of so many New Jersey residents at the greatest risk of crises due to mental illnesses and addiction. The possibility of vulnerable individuals no longer having these resources available is concerning,” said McKnight (D-Hudson). “An independent entity responsible for monitoring this transition will help ensure that these men and women continue to receive the high-quality care they need.”
“These new payment models will impact service delivery and allocation of resources to some of our most vulnerable populations,” Said Sumter (D-Bergen/Passaic). “It is imperative that this transition be monitored in order to identify and address problems at an early stage, and avoid disruptions that can affect the health of these individuals.”
The boards’ evaluation of the transition is to primarily focus on the transition’s effects on access to care, continuity of care and quality of care. The boards may make recommendations to the contracted evaluator with regard to its evaluation.
The law requires the boards to submit several written status reports to the legislature, the governor, and the Department of Human Services at various intervals.
The law 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 is required to issue periodic written reports to the legislature, the governor, the Department of Human Services and both of the aforementioned boards.