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Vitale-Whelan Bill To Ensure Quality, Accessible Care For Medicaid Population Now Law

Law Creates Three-Year Pilot Program in Department of Human Services

TRENTON – A bill sponsored by Senators Joseph F. Vitale and Jim Whelan which would establish a three-year pilot program in the Department of Human Services in order to make sure Medicaid recipients have access to quality health care is now law.

“I am pleased to have helped lead the effort to create a new model of care in NJ, which will encourage partnerships between providers and the government to efficiently provide effective, high quality and cost effective care to New Jersey’s most vulnerable populations,” said Senator Vitale, D-Middlesex. “By using Medicaid to lead this effort, we hope to demonstrate to private insurance companies and employers that a more cost effective way to deliver services exists. Fortunately, with the support of private organizations like the Nicholson Foundation, New Jersey’s ACO pilot will serve as a national model.”

“Access to health care isn’t a privilege for the ultra-rich, but should be a right for all Americans, regardless of personal income or health insurance status,” said Senator Whelan, D-Atlantic. “As we live up to our responsibility of ensuring everyone has access to appropriate, affordable health care, we have to be open to exploring newer, more cost-efficient modes of providing that care. The ACO model will incorporate cost-efficiency standards, results-based review and objective metrics to not only track our progress, but build a better health care system for the future.”

The law, S-2443, creates the “Medicaid Accountable Care Organization Demonstration Project” to ensure that Medicaid recipients in New Jersey have access to high-quality, cost-effective medical care. The law establishes a demonstration project within the Department of Human Services to increase access to primary care, behavioral health care, and dental care by Medicaid recipients in a particular region. The law will also improve the quality of health care by establishing objective metrics and relying on patient experience, and will reduce unnecessary and inefficient care without interfering with a patients’ access to the health care providers and services they need to stay healthy.

The bill would authorize Accountable Care Organizations (ACOs), defined as nonprofit corporations, to provide coordinated, high-quality care to Medicaid recipients in a municipality or defined geographic region with more than 5,000 Medicaid recipients. If the program proves successful in lowering costs and improving care, the sponsors said they would consider working with the Department to establish a permanent program.

“ACOs have the potential to improve patient outcomes and reduce out-of-pocket health care costs – in this case, the cost of providing care through the State and federal Medicaid partnership,” said Senator Vitale. “Given the chronic budgetary shortfalls, and the fact that health care is usually among the first things on the chopping block, improving cost efficiency in Medicaid is necessary to get the most for our health care investment. I look forward to seeing what sort of savings and positive patient outcomes we can achieve by implementing ACOs.”

“While the United States excels in a number of areas, our health care system is among the most inefficient in the entire industrialized world,” said Senator Whelan. “There simply has to be a better way of administering health care and making sure everyone has access to the services they need to get and stay healthy. If the ACO demonstration project proves to be effective, I hope we’ll give serious thought to adopting ACOs systemwide.”

The bill was signed into law by the Governor Friday.

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