SENATE HEALTH, HUMAN SERVICES AND SENIOR CITIZENS COMMITTEE

STATEMENT TO

SENATE, No. 3365

with committee amendments

STATE OF NEW JERSEY

DATED:  MARCH 4, 2019

      The Senate Health, Human Services and Senior Citizens Committee reports favorably and with committee amendments Senate Bill No. 3365.

      As amended by the committee, this bill implements a three-year perinatal episode of care pilot program in Medicaid, to be developed by the perinatal episode of care learning network, which will be established under the bill by the Division of Medical Assistance and Health Services in the Department of Human Services.

      The learning network is to consist of 10 or more members with knowledge regarding alternative payment methodologies for pregnancy-related services within Medicaid, including, but not limited to: the Director of the Division of Medical Assistance and Health Services in the Department of Human Services, or the director’s designee; representatives from each of the current Medicaid managed care organizations (MCOs) contracted with the division to provide Medicaid benefits; at least two representatives of federally-qualified health centers, with at least one from a center located in northern New Jersey and at least one from a center located in southern New Jersey; and at least three maternity healthcare providers, representing northern, central, and southern New Jersey, approved to participate in Medicaid.  The learning network may be administered by the division or, at the division’s discretion, by a designated entity that is well-versed in alternative payment models.  Any entity designated by the division to administer the learning network is to enter into a data sharing agreement with the division in order to fulfill the provisions of this act.

      The learning network will be required to develop the parameters for a three-year perinatal episode of care pilot program within Medicaid.  The purpose of this pilot program is to improve perinatal healthcare outcomes and to reduce the cost of perinatal care.  To effectuate the goals of the program, the learning network is to design a perinatal episode of care payment model, also known as a bundle payment model, in which provider reimbursement is based on target total cost of care for services provided within a perinatal episode of care, rather than on individual services provided within the episode of care.  The bill defines a “perinatal episode of care” as all pregnancy-related care, including prenatal care, labor and birth, and postpartum care, provided to a mother and infant, beginning 40 weeks prior to the delivery and ending 60 days after the delivery of the infant.  The perinatal episode of care payment model is subject to approval by the division and will be implemented by MCOs.  

      Subject to the approval of the division, the learning network will be required to:

      (1) Identify the services to be covered under each episode, including wraparound patient support services, such as childbirth education and community doula services for the mother; 

      (2) Establish patient volume minimums for participating providers;

      (3) Identify quality metrics and quality metric targets to be included in the episode;

      (4) Establish a methodology to calculate the target total cost of care for an episode and the distribution of any shared savings between a MCO and a participating provider.  The methodology for shared savings is to align payments to a participating provider with the quality metrics and quality metric targets, as determined by the learning network, regarding the provider’s provision of care; and

      (5) Establish additional episode parameters including the episode trigger, duration, principal accountable provider, exclusions, adjustments, and quality reporting methodology between providers and MCOs.

      The learning network is also required to report to the Governor and to the Legislature, no later than four years after the commencement of the pilot program, on the effectiveness of the pilot program in improving the quality and reducing the cost of maternity and infant care.  The report is to include any recommendations that learning network deems appropriate to continue, revise, restrict, or expand the program.  The division is also directed to make copies of the learning network’s report available to the public on the Department of Human Services’ website.

      As amended, the bill requires any MCO that has contracted with the division to provide benefits under the Medicaid program to enter into a provider agreement with an obstetrical provider or group of obstetrical providers to implement the perinatal episode of care payment model. 

      As amended, the bill directs participating providers to submit all information required to fulfill the provisions of the bill to the learning network, in a format and at a frequency to be determined by the learning network and approved division.  The bill also requires a participating provider to conduct a risk assessment for all episodes using the Perinatal Risk Assessment form, as used by the division, to determine each mother’s level of need for State-sponsored support services.  With the mother’s consent, the provider is to forward the completed risk assessment form to the appropriate county central intake agency, which will review the form and, if the form indicates a need for services, contact the mother to provide her with information and referrals to appropriate services.  The services to which mothers may be referred will include, but will not be limited to: home visitation programs; mental health and substance use disorder treatment; domestic violence support and intervention; transportation and housing assistance; and group prenatal counseling.

      The bill will take effect immediately upon enactment, with the pilot program commencing no later than January 1, 2020, and will expire upon the submission of the report required under the bill.

COMMITTEE AMENDMENTS:

      The committee amendments revise the membership of the learning network to include at least two representatives from federally qualified health centers, with at least one each from centers located in northern and southern New Jersey.

      The committee amendments revise the requirements concerning the risk assessment tool, to provide that the completed tool is to be forwarded, with the mother’s consent, by her obstetrical provider to the appropriate county central intake agency.  The agency will review the form and, if the form indicates a need for services, contact the mother to provide information and referrals to appropriate services.

      The committee amendments make various technical changes involving punctuation, capitalization, grammar, and syntax, and to eliminate redundant language.