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New Jersey’s governor signed P.L. 2010, c.74 into law in September 2010 to establish a three-year medical home demonstration. The legislation, unanimously passed by the legislature, directed the Division of Medical Assistance and Health Service (DMAHS) to develop the demonstration in partnership with the state’s Medicaid managed care organizations (MCOs).
 
In accordance with that legislative requirement, New Jersey’s contracts with each of the state’s four Medicaid managed care organizations (MCOs) now include several requirements related to building medical homes. These requirements took effect on July 1, 2011 and are to last until June 30, 2014. According to the contract, medical home services include:
  1. “Care-coordination through multi-disciplinary teams;
  2. Care of enrollees with chronic diseases and the elderly;
  3. Patient or family education for enrollees with chronic diseases;
  4. Home-based services;
  5. Telephonic communication;
  6. Group care;
  7. Oral health examinations; and
  8. Culturally and linguistically appropriate care.”
New Jersey’s Medicaid MCOs are required to develop medical home payment models and then seek approval from DMAHS. They are also required to use National Committee for Quality Assurance (NCQA) medical home recognition criteria to qualify practices and to regularly evaluate their programs. The medical home projects are to be guided by the Joint Principles of the Patient Centered Medical Home. New Jersey anticipates that approximately 25,000 Medicaid beneficiaries will receive medical home services under the pilots from a diverse array of provider types. The state is encouraging MCOs to focus on practices that care for frail elderly beneficiaries and others with chronic health conditions, behavioral health conditions, and/or developmental disabilities.
 
Other activity of note in New Jersey, as detailed in this report, includes:
  • The establishment of behavioral health home pilot sites for Medicaid beneficiaries (pages 74-75)
  • Legislation and planning related to the establishment of accountable care organizations for Medicaid beneficiaries (pages 76-83)
Federal Support: New Jersey has received a planning grant from the Centers for Medicare & Medicaid Services (CMS) to develop a state plan amendment to implement Section 2703 of the Affordable Care Act (ACA), establishing health homes for Medicaid enrollees with chronic conditions.
 
New Jersey has also been selected to participate in the CMS's upcoming Comprehensive Primary Care Initiative. In this multi-payer initiative, Medicare will collaborate with public and private insurers in the selected regions with the goal of strengthening primary care.
 
Last updated: May 2012
 
Forming Partnerships P.L. 2010, c.74 directed Medicaid to consult with Medicaid managed care organizations (MCOs) in establishing a medical home demonstration.
Defining & Recoginizng a Medical Home
Definition: P.L. 2010, c.74 defined the medical home model as, at a minimum, including, “a multi-disciplinary team that provides patient-centered care coordination through the use of health information technology and chronic disease registries across the patient’s life-span and across all domains of the health care system and the patient’s community.”  The legislation further specified that health centers may be considered primary care providers.
 
New Jersey’s contract with Medicaid managed care organizations (MCOs) specifies that the MCO demonstration projects are to be executed in accordance with the Joint Principles of the Patient Centered Medical Home.
 
Recognition: The Medicaid MCO medical home pilots must use the National Committee for Quality Assurance (NCQA) standards for practice recognition. All practices must achieve NCQA Level 1 recognition by the end of year 1 and NCQA Level 2 recognition by the end of year 2. See page 440 of the MCO contract for further details.
Aligning Reimbursement & Purchasing
Each of the four New Jersey Medicaid managed care organizations (MCOs) is administering its own medical home pilot, and information is not available on the specific payment methodologies that each MCO will use to pay medical home-recognized practices. The MCO contract states that each MCO must submit its proposed reimbursement methodology to the state for approval. It also requires the methodologies to “support care coordination and reward quality and improved patient outcomes.”
Measuring Results
According to New Jersey’s Medicaid managed care contract, Medicaid managed care organizations (MCOs) are to evaluate their medical home demonstrations using the following criteria:
  1. "Whether cost savings are achieved and supporting documentation;
  2. Types and rates of health screening;
  3. Health outcome measures including but not limited to:
    • emergency room visit rates;
    • hospitalization rates; and
    • avoidable hospital readmission rates, comparing medical home cohorts;
  4. At a minimum, two clinical measures; and
  5. Satisfaction measures, e.g., CAHPS [Consumer Assessment of Healthcare Providers and Systems] measures.”

Reports are to be made to the Division of Medical Assistance and Health Service (DMAHS) annually.