NJ A2150

Medicaid and NJ FamilyCare managed care organizations must offer patient-centered medical home models to primary care providers in their networks, with the Division of Medical Assistance and Health Services able to grant waivers for organizations offering alternative payment models that similarly incentivize high-quality, efficient care.

Managed care organizations must submit annual descriptions of their payment models to the Division, including financial structure, provider certification requirements, quality metrics, eligibility requirements, participating provider lists, and county-level enrollee data.

The Division must establish standardized quality metrics for patient-centered medical home and alternative payment models through a public stakeholder process, and managed care organizations must use only these approved metrics when calculating provider payments.

Managed care organizations must submit patient-level and provider-level data on participation and performance to enable Division evaluation of payment model effectiveness.

The bill takes effect one year after enactment, contingent on receipt of necessary federal waivers and approvals for Medicaid program compliance.