§1 - C.30:4D-3c
§2 - T&E
§§3,4 - Notes
An Act concerning eligibility determination for Medicaid and supplementing Title 30 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. The Commissioner of Human Services shall 2[, in consultation with the Office of Information Technology,]2 develop an information technology platform for use by the State, county welfare agencies, and State contractors for the purpose of intake, processing, and tracking of applications for benefits under the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) and the NJ FamilyCare program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.). The goals of the system shall be: to simplify the applications and eligibility determination processes for both applicants and eligibility determination staff; to standardize the application of eligibility policy across the various agencies responsible for eligibility determination; to allow for real-time tracking of the status of applications; to allow the rapid exchange of data relevant to applications among various State and county agencies and contractors; and to provide a platform to expand the system to encompass other social service program applications and eligibility determinations as the technology permits.
b. The Commissioner of Human Services shall establish a system to evaluate the performance of all entities responsible for intake and processing of applications for the Medicaid and NJ FamilyCare programs, including all county welfare agencies and the State’s contracted health benefits coordinator. The system shall allow for the measurement of a set of relevant common metrics, including but not limited to: the number of complete and incomplete applications of each type received; the time between receipt of completed applications and the completion of the eligibility determination; 1the time between receipt of an application and the request for 2[verification letters] supporting documentation2 sent to the applicant; the number of 2[ extensions granted to an applicant in order to permit the applicant an opportunity to provide additional documentation; the number of fair hearings requested, including the specific determination or action that gave rise to the request for a fair hearing;1] applicants granted extensions; and2 the accuracy of eligibility determinations 2[; and corrective actions taken to correct errors in eligibility determination]2.
1Nothing in this section shall be construed to permit a county welfare agency to deny an application for which an applicant requires additional time to provide information or documentation to a county welfare agency, and a county welfare agency shall 2[liberally]2 grant extensions 2, as appropriate,2 when needed 2[in the spirit of cooperation and assistance]2.
The Commissioner shall annually publish on the Department of Human Services website, the results, including those for each of the common metrics and by individual entity, of the performance evaluation system to be established pursuant to this section.1
c. The Commissioner of Human Services shall establish a system of rewards and penalties for all entities responsible for intake 2[and] ,2 processing of applications 2, and processing of redetermination applications2 that provides incentives for performance on the metrics established pursuant to subsection b. of this section. This system shall include incentives for county welfare agencies to 2[provide extended hours of operation for in-person intake of applications and information requests, and to provide in-person navigators to assist applicants with their applications when necessary. The system shall further provide incentive for the use of administrative renewals that do not require a beneficiary to file a renewal application, when such administrative renewals are permissible under State and federal law and can be completed with information from tax records and clinical and financial determinations made by other public entities] streamline their processes and utilize the information technology platform required by subsection a. of this section2.
d. The Commissioner of Human Services shall
designate 2[an
ombudsperson, who shall be an employee ]
a customer service liaison team, which shall be composed of
employees2
of the Department of Human Services, to receive complaints that result from the
eligibility application process. The 2[ombudsperson] customer
service liaison team2
shall have authority to review all records of the cases about which complaints
are submitted; to interview individuals who submit complaints, the individuals
who have assisted with their applications, and the State and county staff who
have worked on their cases; and to recommend corrective actions to State and
county agencies to address specific complaints and reduce future complaints.
2. 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 to secure federal financial participation for State expenditures under the federal Medicaid program or any other federal program.
3. 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.) to effectuate the purposes of this act.
4. This act shall take effect 2[immediately] on the first day of the sixth month next following enactment2.
Provides for improved system for eligibility determination for Medicaid and NJ FamilyCare.