In New Jersey, Advocates Discuss "Care Coordination" Definition in CMS Medicaid Managed Care Rule

Across the country, different reactions are emerging to the massive proposal from CMS to overhaul regulations for Medicaid managed care for the first time since 2002.

But one group that sees hope is the band of reform advocates in New Jersey, where the state’s Medicaid program has been the subject of intense scrutiny. Several media outlets have reported how new Medicaid enrollees in New Jersey have face long delays in receiving proof of coverage and difficulty finding primary care physicians who accept Medicaid, in part due to outdated lists.

On Friday, the website NJ Spotlight, which focuses on state government and policy, reported on an aspect of the proposal that has received less attention thus far: according to one advocacy group, Medicaid’s definition of “care coordination” can include those outside the traditional healthcare system, such as social service agencies, housing, and legal services. The change was highlighted by the New Jersey Health Care Quality QI Collaborative.

“There’s a recognition in there that there’s a role for care coordination that goes beyond the traditional health system,” QI Director Jeff Brown told NJ Spotlight.

Brown told NJ Spotlight that CMS’ proposal recognizes that social services outside the health system, especially housing, contribute to whether a patient is a frequent visitor the hospital.

Care coordination has been a focus of CMS in the past year. As of January 1, 2015, primary care practices who care for Medicare patients with multiple chronic conditions can receive a $41 fee per patient per month for providing care coordinating subject to a number of requirements, including 24/7 availability and electronic health record (EHR) mandates.

In a briefing with reports on Tuesday, Acting CMS Administrator Andy Slavitt said the main aims of the regulatory proposal are to improve transparency and consumer protections, provide better care coordination, and allow states to pursue delivery system reforms that are well under way in Medicare Advantage and in commercial insurance. "A lot has changed in terms of best practices and the delivery of important health services in the managed care field over the last decade," he said.

Mark Humowiecki, general counsel of the Camden Coalition of Healthcare Providers, told NJ Spotlight that there could be benefits from aligning Medicaid regulations with those for federal marketplace plans, as well as for those in private Medicare Advantage plans.

It’s unclear what effect the CMS proposal will have on addressing the issue reported in December by NJ Advance Media, the state’s largest media outlet. That report chronicled the fallout of a failed contract with Hewlett Packard, which resulted in a backlog of 11,000 Medicaid applications a year after the Affordable Care Act took effect.