
In New Jersey, Advocates Discuss "Care Coordination" Definition in CMS Medicaid Managed Care Rule
CMS' Medicaid managed care proposal broadens the definition of "care coordination," according to healthcare advocates in New Jersey, where the state's Medicaid program has been under fire.
Across the country, different reactions are emerging to the massive proposal from CMS to overhaul regulations for Medicaid managed care for the first time since 2002.
But one group that sees hope is the band of reform advocates in New Jersey, where the state’s Medicaid program has been the subject of intense scrutiny. Several media outlets have reported how new Medicaid enrollees in New Jersey have face long delays in receiving proof of coverage and difficulty finding primary care physicians who accept Medicaid, in part due to outdated lists.
On Friday, the website
“There’s a recognition in there that there’s a role for care coordination that goes beyond the traditional health system,” QI Director Jeff Brown told NJ Spotlight.
Brown told NJ Spotlight that CMS’ proposal recognizes that social services outside the health system, especially housing, contribute to whether a patient is a frequent visitor the hospital.
Care coordination has been a focus of CMS in the past year. As of January 1, 2015, primary care practices who care for Medicare patients with multiple chronic conditions can receive a $41 fee per patient per month for providing care coordinating subject to a number of requirements, including 24/7 availability and electronic health record (EHR) mandates.
In a briefing with reports on
Mark Humowiecki, general counsel of the Camden Coalition of Healthcare Providers, told NJ Spotlight that there could be benefits from aligning Medicaid regulations with those for federal marketplace plans, as well as for those in private Medicare Advantage plans.
It’s unclear what effect the CMS proposal will have on addressing the issue reported in December by
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