In September, 2010 a state law (NJ P.L. 2010, Chapter 74) was passed directing Medicaid to establish a three-year pilot demonstration for medical homes focusing on the frail elderly and those with chronic diseases. In response to the legislation, the Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) wrote a Memorandum of Agreement (MOA) requesting that the four Medicaid contracted managed care organizations (MCOs) in NJ participate in a pilot to enhance or create infrastructure, within their networks, for medical home services.
All four MCOs agreed to participate, signed the MOA, and are presently in various stages of developing patient centered medical homes (Patient-Centered Medical Home) within their network. Additionally, the language from the Memorandum of Agreement was incorporated into the Managed Care Contract; thus making it a required program for all contracted NJ Medicaid MCOs to participate in developing and supporting Patient-Centered Medical Home practices within their networks. According to the contract, medical home services include: Care-coordination through multi-disciplinary teams; Care of enrollees with chronic diseases and the elderly; Patient or family education for enrollees with chronic diseases; Home-based services; Telephonic communication; Group care; Oral health examinations; and Culturally and linguistically appropriate care.
Each of the four New Jersey Medicaid managed care organizations (MCOs) is administering its own medical home pilot. Information is not available on the specific payment methodologies that each MCO will use to pay medical home-recognized practices. The MCO contract requires the methodologies to “support care coordination and reward quality and improved patient outcomes.” Premium: Health and demographic based, risk adjustment is used for all of these groups except ABD with Medicare and other dual eligibles. The ABD with Medicare and other dual eligibles, are risk adjusted using demographic characteristics, DDD, and HIV/AIDS indicators.
