Requires DHS to establish two-year Regional Community Behavioral Health Pilot Program.

A1788

ASSEMBLY, No. 1788

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblyman ANTHONY S. VERRELLI

District 15 (Hunterdon and Mercer)

Assemblywoman ELLEN J. PARK

District 37 (Bergen)

Co-Sponsored by:

Assemblyman Danielsen and Assemblywoman Carter

SYNOPSIS

���� Requires DHS to establish two-year Regional Community
Behavioral Health Pilot Program.

CURRENT VERSION OF TEXT

���� Introduced Pending Technical Review by Legislative
Counsel.

��

An Act

concerning the improved coordination of
community-based behavioral health and support services and supplementing Title
30 of the Revised Statutes.

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

���� 1.��� As used in this act:

���� �Behavioral health� or
�behavioral health care� means procedures or services rendered by a health care
or mental health care provider for the treatment of mental illness, mental
health or emotional disorders, or substance use disorders.�

���� �Care transition� means the
transfer or transition of a patient from one health care or behavioral health
care provider to another.

���� �Commissioner� means the
Commissioner of Human Services.

���� �Department� means the
Department of Human Services.

���� �Eligible patient� means a
patient with a severe behavioral health disorder who is identified pursuant to
paragraph (1) of subsection c. of section 2 of this act as being eligible to
participate in the pilot program.

���� �Health information platform�
means a Health Information Exchange (HIE) or other electronic platform that is
used to run population-level analytics or exchange health information among
various organizations.

���� �Managed care organization�
means a Medicaid managed care organization, as that term is defined pursuant to
42 U.S.C. s.1396b(m)(1)(A).

���� �Medicaid� means the Medicaid
program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).

���� �Participating provider� means
a Certified Community Behavioral Health Clinic (CCBHC) or other community
behavioral health provider that is contracted pursuant to paragraph (2) of
subsection c. of section 2 of this act to participate in the pilot program.

���� �Pilot program� means the
Regional Community Behavioral Health Pilot Program established pursuant to this
act.

���� �Rapid referral� means the
taking of appropriate steps by a participating provider, as soon as is
practicable and not more than 48 hours after an eligible patient undergoes a
needs assessment, as may be necessary to facilitate:� the patient�s referral or
transfer to, prompt access to an appointment with, and timely receipt of
services from, another appropriate health care or behavioral health care
services provider; the patient�s prompt and voluntary admission to an inpatient
psychiatric facility; or the patient�s prompt evaluation by a screening service
or mental health screener to determine whether involuntary commitment to
treatment is warranted pursuant to P.L.1987, c.116 (C.30:4-27.1 et seq.).�

���� �Supportive contacts� means
brief communications with a patient that occur during care transitions or when
a patient misses an outpatient appointment or unexpectedly drops out of
outpatient treatment, and which show support for the patient and are designed
to promote a patient�s feeling of connection to treatment and willingness to
collaboratively participate in treatment.� �Supportive contacts� may include
the sending of postcards, letters, email messages, and text messages, the
making of phone calls, or the undertaking of home visits either by the
participating provider that is providing care to the patient or by an outside
organization, such as a local crisis center, with which the participating
provider has a contract or other agreement.

���� �Warm hand-off� means a safe
care transition that connects a patient directly with a new health care or
mental health care provider or interim contact, such as a crisis center worker
or peer specialist, before the patient�s first appointment with the new
provider, or that connects a patient directly with a screening service or
mental health screener for the purposes of determining whether involuntary
commitment to treatment is warranted pursuant to P.L.1987, c.116 (C.30:4-27.1
et seq.).�

���� 2.� a.� The Department of
Human Services shall establish a two-year Regional Community Behavioral Health
Pilot Program in accordance with the provisions of this act.

���� b.��� Within 180 days after
the effective date of this act, the department shall issue a request for
proposals (RFP) and select one or more managed care organizations to administer
the pilot program in each of the northern, central, and southern regions of the
State.�

���� c.���� The managed care
organization or organizations selected to administer the pilot program shall:

���� (1)�� access and review
Medicaid claims data, and work with primary care practitioners within the
managed care network, to identify patients in the network who have a severe
behavioral health disorder.� The patients identified pursuant to this paragraph
shall be eligible to participate in the pilot program;�

���� (2)�� enter into contracts
with three community behavioral health providers, one in each of the northern,
central, and southern regions of the State, and require each participating
provider to promptly perform a behavioral health needs assessment for each eligible
patient, identified under paragraph (1) of this section, who resides in the
provider�s region of operations.� The needs assessment shall be performed using
a standardized tool or methodology and shall be used by the provider to
identify each eligible patient�s behavioral health and social service needs,
including, but not limited to, the need for medication-assisted treatment and
other substance use disorder treatment, the need for mental health treatment,
including voluntary or involuntary commitment, and the need for food, housing,
financial, or other social assistance; and

���� (3)�� work with each
participating provider, as well as with primary care providers, substance use
disorder treatment providers, and social service providers in the State, to
ensure that eligible patients in the participating provider�s region of
operations have access to an intensive, coordinated support system to help them
navigate the State�s behavioral health care service system and identify and
access, in a timely manner, necessary and appropriate behavioral health care
services in the State and region.� The coordinated support system utilized in
each region shall incorporate:� (a) the use, by participating providers, of
warm hand-offs, rapid referrals, supportive contacts, and other efficient and
supportive care transition methods; (b) the hiring, by participating providers,
of service navigation specialists and advisors to guide eligible patients
through the behavioral health care system and to direct, monitor, and keep a
record of, the services received by each eligible patient; and (c) the use, by
participating providers or the administering managed care organization or
organizations, of any other means or methods deemed appropriate or necessary to
facilitate behavioral health care coordination or care transitions for eligible
patients in the State.

���� d.��� The department shall:�

���� (1)�� in selecting one or more
managed care organizations to administer the pilot program, give priority to
those managed care organizations that have the ability to link to, and exchange
relevant information and data through, a Statewide health information platform;
and

���� (2)�� following the selection
of an administering managed care organization or organizations, encourage the
administering managed care organization or organizations to engage in the
active and ongoing use of a Statewide health information platform and relevant
information contained therein, as may be necessary to efficiently and
effectively administer the pilot program.� A portion of the funds provided to
the administrating managed care organization or organizations, pursuant to
section 3 of this act, may be used thereby, as deemed appropriate, to finance
the costs associated with the use of the Statewide health information platform
pursuant to this paragraph.

���� 3.��� a.� The pilot program
established pursuant to this act shall be funded through the Medicaid program
using a value-based payment system.� The value-based payment system shall be
modeled on, and be consistent with, the population-based payment methodology that
is described under Category 4 of the alternative payment methodologies (APM)
framework developed by the Health Care Payment Learning and Action Network.�
Specifically, the value-based payment system shall provide for a quarterly
advanced bundled payment to be provided to the administering managed care
organization or organizations for the purposes of financing the total cost of
behavioral health care that is provided, by participating providers and other
appropriate service providers, to eligible patients in the State, including,
but not limited to, the costs associated with needs assessments performed
pursuant to paragraph (2) of subsection c. of section 2 of this act and the
costs associated with the provision of support and navigation services pursuant
to paragraph (3) of subsection c. of section 2 of this act.� The quarterly
bundled payment rate shall be established by the Commissioner of Human
Services, based on the commissioner�s evaluation of the following factors:�

���� (1)�� the number of eligible
patients, identified pursuant to paragraph (1) of subsection c. of section 2 of
this act, who are expected to be served by the pilot program;

���� (2)�� the average anticipated
per-patient cost of care for eligible patients;

���� (3)�� the anticipated costs to
participating providers of hiring and training staff to provide support and
navigation services pursuant to paragraph (3) of subsection c. of section 2 of
this act;

���� (4) the anticipated costs
associated with ensuring the linkage to, and exchange of relevant health
information through, a Statewide health information platform; and

���� (5)�� any other factors that
may affect the cost of care for eligible patients.

���� b.��� The quarterly bundled
payment provided under this section shall be limited to the bundled rate
established by the commissioner under subsection a. of this section, and shall
not be subject to increase, regardless of whether the actual costs of care
received by patients in the pilot program exceed the bundled payment rate
provided hereunder. If the administering managed care organization or
organizations, in cooperation with participating providers in each region, are
able to reduce the per-patient costs of care for patients engaged in the pilot
program through the effective use of care coordination methodologies,
including, but not limited to, the use of the service navigation and support
systems described under paragraph (3) of subsection c. of section 2 of this
act, the administering managed care organization or organizations may retain,
and shall not be required to repay, any bundled payment funds that remain
unexpended thereby.� Any such savings achieved shall be shared by the managed
care organization or organizations with the participating providers at a rate
that is proportional to the rate of per-patient cost reduction savings achieved
by each such provider.� If the actual per-patient costs of care for patients
engaged in the pilot program exceed the advanced bundled payment rate
established by the commissioner under this section, the administering managed
care organization or organizations shall ensure that all eligible patients
continue to receive appropriate services and care from participating providers
and other appropriate providers without being subject to an increase in
out-of-pocket costs.� Any financial loss suffered by the administering managed
care organization or organizations as a result of an increase in the
per-patient cost of care for patients in the pilot program shall be shared by
the managed care organization or organizations with the participating providers
at a rate that is proportional to the rate of per-patient cost increase
attributed to each provider.�

���� 4.��� a.� Within 90 days after
the two-year pilot program is terminated, the department shall prepare and
submit a written report of its findings and recommendations to the Governor
and, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), to the Legislature.�

���� b.��� At a minimum, the report
shall:

���� (1)�� identify the managed
care organization or organizations that were selected to administer the pilot
program;

���� (2)�� identify the community
behavioral health providers who were contracted by the administering managed
care organization or organizations pursuant to paragraph (2) of subsection c.
of section 2 of this act;

���� (3)�� identify the total
number and percentage of patients in the managed care network, and the number
and percentage of patients in each of the northern, central, and southern
regions of the State, who were identified as having severe behavioral health
disorders pursuant to paragraph (1) of subsection c. of section 2 of this act;

���� (4)�� identify the number and
percentage of patients identified in paragraph (3) of this subsection who were
provided with rapid referrals and warm hand-offs to other appropriate service
providers, or who received supportive contacts, following an individual needs
assessment conducted pursuant to paragraph (2) of subsection c. of section 2 of
this act;

���� (5)�� include recommendations
as to whether and how the pilot program should be continued on a permanent
basis; and

���� (6)�� include recommendations
for executive, legislative, and other actions that can be undertaken by the
State to better ensure and improve:� (a) the effectiveness and coordinated
provision of behavioral health care to patients with severe behavioral health disorders;
(b) the capacity of health care and behavioral health care providers and
managed care organizations to both promptly identify patients who require
coordinated behavioral health care services and assist those patients in
navigating the State�s behavioral health service system; and (c) the
effectiveness and supportive nature of the State�s behavioral health care
referral and care transition processes.

���� 5.��� The Commissioner of
Human Services shall apply for such State plan amendments or waivers as may be
necessary to implement the provisions of this act and secure federal financial
participation for State Medicaid expenditures under the federal Medicaid program.

���� 6.��� The Commissioner of
Human Services shall adopt rules and regulations, pursuant to the
�Administrative Procedure Act,� P.L.1968, c.410 (C.52:14B-1 et seq.), as may be
necessary to implement the provisions of this act.

���� 7.��� This act shall take
effect immediately.

STATEMENT

����� Within 180 days after the bill�s effective date, the
DHS is to issue a request for proposals (RFP) and select one or more managed
care organization or organizations to administer the pilot program in the
northern, central, and southern regions of the State.

����� The managed care organization or organizations
selected to administer the pilot program will be required to:

����� 1)�� review Medicaid claims data, and work with
primary care practitioners in the managed care network, to identify patients in
the network who have severe behavioral health disorders.� Such patients will be
deemed to be eligible to participate in the pilot program;�

����� 2)�� contract with three community behavioral health
providers, one in each of the northern, central, and southern regions of the
State, and require each participating provider to promptly perform a behavioral
health needs assessment for each eligible patient in the pilot program who
resides in the provider�s region of operations.� The needs assessment is to be
performed using a standardized tool or methodology and is to be used by the
provider to identify each eligible patient�s behavioral health and social service
needs, including, but not limited to, the need for medication-assisted
treatment and other substance use disorder treatment, the need for mental
health treatment, including voluntary or involuntary commitment, and the need
for food, housing, financial, or other social assistance;

����� 3)�� work with each participating provider, as well
as with primary care providers, substance use disorder treatment providers, and
social service providers in the State, to ensure that eligible patients in the
provider�s region of operations have access to an intensive, coordinated
support system to help them navigate the State�s behavioral health care service
system and to identify and access, in a timely manner, necessary and
appropriate behavioral health care services in the State and region.� The
coordinated support system utilized in each region will be required to
incorporate:� a) the use, by participating providers, of warm hand-offs, rapid
referrals, supportive contacts, and other efficient and supportive care
transition methods; b) the hiring, by participating providers, of service
navigation specialists and advisors to guide eligible patients through the
behavioral health care system and to direct, monitor, and keep a record of, the
services received by each eligible patient; and c) the use, by participating
providers or the administering managed care organization or organizations, of
any other means or methods deemed appropriate or necessary to facilitate
behavioral health care coordination or care transitions in the State.

����� In selecting one or more managed care organizations
to administer the pilot program, the DHS will be required to give priority to
those managed care organizations that have the ability to link to, and exchange
relevant information and data through, a Statewide Health Information Exchange
(HIE) or other health information platform.� The DHS will further be required
to encourage the administering managed care organization or organizations to
engage in the active and ongoing use of the HIE or other platform, as may be
necessary to efficiently and effectively administer the pilot program.� A
portion of the funding that is provided to the administering organization for
the purposes of the pilot program may be used to finance the costs associated
with use of the HIE or other platform.

����� The bill provides for the pilot program to be funded
through the Medicaid program using a value-based payment system.� The
value-based payment system is to be modeled on, and consistent with, the
population-based payment methodology that is described under Category 4 of the
alternative payment methodologies (APM) framework developed by the Health Care
Payment Learning and Action Network.� Specifically, the value-based payment
system is to provide for a quarterly advanced bundled payment to be provided to
the administering managed care organization or organizations for the purposes
of financing the total cost of behavioral health care that is provided, by
participating providers and other appropriate service providers, to eligible
patients in the State, including, but not limited to, the costs associated with
needs assessments performed and support and navigation services provided
pursuant to the bill and the costs associated with the managed care
organization�s linkage to, use of, and exchange of information and data
through, a Statewide HIE or other health information platform.� The quarterly
bundled payment rate is to be established by the Commissioner of Human
Services, based on the commissioner�s evaluation of the following factors:�

����� 1)�� the number of eligible patients who are expected
to be served by the pilot program;

����� 2)�� the average anticipated per-patient cost of care
for eligible patients;

����� 3)�� the anticipated costs to participating providers
of hiring and training staff to provide eligible patients with assistance and
support in service navigation;

����� 4)�� the anticipated costs associated with ensuring
the linkage to, and exchange of relevant health information through, the HIE or
other Statewide health information platform; and

����� 5)�� any other factors that may affect the cost of
care for eligible patients.

����� The quarterly bundled payment is to be limited to the
bundled rate established by the commissioner under the bill, and may not be
increased, regardless of whether the actual costs of care received by patients
in the pilot program exceed the bundled payment rate provided under the bill.�
If the administering managed care organization or organizations, in cooperation
with participating providers in each region, are able to reduce the per-patient
costs of care for patients engaged in the pilot program through the effective
use of care coordination methodologies, including, but not limited to, the use
of the service navigation and support systems described under the bill, the
administering managed care organization or organizations may retain, and will
not be required to repay, any bundled payment funds that remain unexpended
thereby.� The managed care organization or organizations will be required to
share any such savings with the providers participating in the pilot program at
a rate that is proportional to the rate of per-patient cost reduction savings
that was achieved by each such provider.� If the actual per-patient costs of
care for patients engaged in the pilot program exceed the advanced bundled
payment rate established by the commissioner under bill, the administering
managed care organization or organizations will be required to ensure that all
eligible patients continue to receive appropriate services and care from
participating providers and other appropriate providers without being subject
to an increase in out-of-pocket costs.� Any financial loss suffered by the
managed care organization or organizations as a result of an increase in the
per-patient cost of care for patients in the pilot program is to be shared by
the managed care organization or organizations with the participating providers
at a rate that is proportional to the rate of per-patient cost increase
attributed to each provider.�

����� The bill requires the DHS, within 90 days after the
two-year pilot program is terminated, to prepare and submit a written report of
its findings and recommendations to the Governor and Legislature.�

���� The Commissioner of Human Services will be required to
apply for any State plan amendments or waivers as may be necessary to implement
the bill�s provisions and secure federal financial participation for State
Medicaid expenditures under the federal Medicaid program.