ASSEMBLY, No. 2024

STATE OF NEW JERSEY

INTRODUCED MAY 13, 1996

By Assemblywomen ALLEN and VANDERVALK

An Act establishing the Medicaid Asthma Education Pilot Project.

    Be It Enacted by the Senate and General Assembly of the State of New Jersey:

    1. This act shall be known and may be cited as the "Medicaid Asthma Education Pilot Project."

    2. a. The Commissioner of Human Services shall establish the Medicaid Asthma Education Pilot Project in the Division of Medical Assistance and Health Services in the Department of Human Services, in consultation with the New Jersey Pharmacists Association and an accredited college of pharmacy and science. The purpose of the pilot project is to significantly improve the quality of life and ability to work for Medicaid recipients with moderate to severe asthma by testing the efficacy of a health care delivery and provider reimbursement model which should increase quality of care and reduce health care costs by ensuring continuity of care through enhanced linkages between primary care physicians and pharmacists and preventing excessive utilization of health care services.

    b. The pilot project shall utilize the services of specially trained pharmacists to care for Medicaid recipients with moderate to severe asthma who are enrolled in a health maintenance organization and who are identified by their health maintenance organization as high users of health care resources.

    c. A pharmacist participating in the pilot project, working in conjunction with a participating patient's primary care physician, shall provide asthma education intervention services to each participating patient in accordance with the following phases of care, which shall be documented by the pharmacist in the patient's record:

    (1) Clarify the patient's diagnosis and treatment goals with the patient's primary care physician; assess the patient's medical history, understanding of the disease, barriers to treatment and ability to use asthma-associated devices; and perform a patient regimen review;

    (2) Develop an educational care plan for the patient, including the establishment of a health-related behavioral contract with the patient which includes measurable goals that the patient agrees to achieve, and schedule follow-up visits as necessary which complement the primary care physician's treatment schedule and plan; and

    (3) Review the patient contract; review and assess the patient's use of asthma-associated devices and correct as necessary; review and adjust the education care plan for the patient as necessary; review and adjust the treatment plan for the patient as necessary, in consultation with the primary care physician; and assess patient adherence to the health-related behavioral contract and revise the contract as necessary.

    d. The commissioner shall provide for appropriate rates of reimbursement to participating pharmacists for education intervention services provided to patients under the pilot project.

    3. The Commissioner of Human Services shall obtain such waivers from the United States Secretary of Health and Human Services as may be necessary to effectuate the purposes of this act.

    4. The Commissioner of Human Services shall report to the Governor and the Legislature no later than 24 months after the implementation of the pilot project on its success in meeting its objectives and shall present such recommendations as the commissioner wishes to make for legislative or administrative action as a follow-up to this pilot project.

    5. This act shall take effect on the 120th day after the date of enactment, subject to federal approval, except that the Commissioner of Human Services may take such anticipatory administrative action in advance as shall be necessary for the implementation of the act, and shall expire upon the submission of the report required pursuant to section 4 of this act.

STATEMENT

    This bill establishes the Medicaid asthma education pilot project to provide education intervention services to Medicaid recipients with moderate to severe asthma through specially trained pharmacists working in concert with a patient's primary care physician. The Medicaid recipients shall be enrolled in health maintenance organizations and shall have been identified as high users of health care services.

    This pilot project is intended to create a model for future reimbursement for health care services that are shown to reduce costs and deliver quality care, and will test the assumption that self-care for asthma (and by implication other chronic diseases) is the best approach to providing care. A successful project of this kind could lead to expanded funding for asthma education throughout the country and lay the groundwork for other pilot projects that address high-cost chronic diseases.

"Medicaid Asthma Education Pilot Project Act".