Reform proposal stresses 'coordinated care'
A New Jersey health care reform proposal that will emphasize the use of coordinated care systems over expensive hospital and emergency department treatment for low-income individuals has been approved by the Health Care Financing Administration (HCFA). Under the Medicaid 1115 waiver for the Managed Charity Care Demonstra tion (MCCD), hospitals will be required to develop "hospital-centered managed care networks," HCFA administrator Nancy-Ann Min DeParle said in a prepared statement.
New Jersey hopes to serve more uninsured low-income residents through the more efficient use of disproportionate-share hospital funds and by using less costly and intensive care settings, according to HCFA. Participation in the new program is voluntary. Uninsured individuals with family incomes of up to 200% of the federal poverty level are entitled to fully subsidized inpatient and outpatient care under the state's current program, while those whose incomes fall between 200% and 300% of the poverty level are eligible for partial subsidies.
Rather than offering a specific benefit package, hospitals will offer services that are tailored to the needs of their own patients, according to the HCFA statement. However, substance abuse and mental health services, as well as services for any other conditions that would benefit from care coordination, such as diabetes, hypertension and prenatal care, must be offered by the MCCD.
Hospitals are required to establish a quality assessment program that will monitor availability, accessibility, continuity, and quality of care on an ongoing basis, the statement said.
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