New Jersey plans to take advantage of the technical assistance (TA) afforded by the BIP in accordance with Section 10202 of the Patient Protection and Affordable Care Act from the Centers for Medicare & Medicaid Services (CMS). During this period and beyond, New Jersey will also be operating a statewide reform effort that will expand existing managed care programs to include managed long term services and supports (LTSS) and expand home and community based services (HCBS) to some populations.
Through the federal government’s approval of the Comprehensive Medicaid Waiver, the state is be better positioned to serve more individuals with HCBS and meet the BIP’s conditions. It is within the context of the BIP coupled with New Jersey’s move to managed LTSS that the state would best benefit from TA.
With regards to the BIP’s structural changes, data collection and reporting requirements, New Jersey will use CMS’ TA to ensure that the state meets the program’s mandate. It is in New Jersey’s best interest to benefit from the nation’s best practices and lessons learned—in terms of increasing access to non-institutionally based LTSS. First, it will be important to receive guidance on developing the state’s work plan for the BIP prior to implementation.
46 State
Agency Name Quarter Ended
Year of Service (1-4) INSTRUCTIONS: PLEASE COMPLETE ONLY THE NON-SHADED CELLS - BLUE CELLS WILL AUTO-CALCULATE.
Total Service Expenditures Regular FEDERAL Portion Regular STATE Portion Amount Funded By Balancing Incentive Program (4 year total) Year 1 FFY 2012 Year 2 FFY 2013 (4/1/13- 9/30/13) Year 3 FFY 2014 Year 4 FFY 2015 (A) (B) (C (D) (E) (F) (G) (H) Home Health Services Total $ 96,403,485 $ 48,201,742 $ 48,201,742 $ 1,928,070 $ - $ 16,959,904 $ 37,650,986 $ 41,792,595 Home and Community Total $ 2,977,289,369 $ 1,488,644,684 $ 1,488,644,684 $ 59,545,787 $ - $ 523,783,359 $ 1,162,799,057 $ 1,290,706,953 PACE Total $ 35,055,977 $ 17,527,989 $ 17,527,989 $ 701,120 $ - $ 6,167,267 $ 13,691,332 $ 15,197,378 Personal Care Services Total $ 1,306,368,828 $ 653,184,414 $ 653,184,414 $ 26,127,377 $ - $ 229,824,571 $ 510,210,548 $ 566,333,708 Targeted Case Management Total $ 76,069,037 $ 38,034,519 $ 38,034,519 $ 1,521,381 $ - $ 13,382,541 $ 29,709,240 $ 32,977,257 Private Duty Nursing - EPSDT Total $ 151,563,196 $ 75,781,598 $ 75,781,598 $ 3,031,264 $ - $ 26,663,945 $ 59,193,958 $ 65,705,293 Medical Day Care Total $ 781,768,510 $ 390,884,255 $ 390,884,255 $ 15,635,370 $ - $ 137,533,604 $ 305,324,600 $ 338,910,306 Personal Care IADLs Total $ - $ - $ - $ - $ - $ - $ - $ -
Personal Care Health-Related Total $ - $ - $ - $ - $ - $ - $ - $ -
Personal Care Adult Companion Total $ - $ - $ - $ - $ - $ - $ - $ -
Personal Care PERS Total $ - $ - $ - $ - $ - $ - $ - $ -
Pers. Care Assistive Technology Total $ - $ - $ - $ - $ - $ - $ - $ - Habilitation Day Total $ - $ - $ - $ - $ - $ - $ - $ - Habilitation Behavioral Total $ - $ - $ - $ - $ - $ - $ - $ - Habilitation Prevocational Total $ - $ - $ - $ - $ - $ - $ - $ -
Hab. Supported Employment Total $ - $ - $ - $ - $ - $ - $ - $ -
Hab. Educational Services Total $ - $ - $ - $ - $ - $ - $ - $ -
Respite Care Total $ - $ - $ - $ - $ - $ - $ - $ -
Day Treatment / Partial Hosp. Total $ - $ - $ - $ - $ - $ - $ - $ - Psychosocial Rehabilitation Total $ - $ - $ - $ - $ - $ - $ - $ - Clinic Services Total $ - $ - $ - $ - $ - $ - $ - $ - Other HCBS Services Service 1 $ - $ - $ - $ - $ - $ - $ - $ - Service 2 $ - $ - $ - $ - $ - $ - $ - $ - Service 3 $ - $ - $ - $ - $ - $ - $ - $ - Total $ - $ - $ - $ - $ - $ - $ - $ - Health Homes Total $ - $ - $ - $ - $ - $ - $ - $ - CFC Total $ - $ - $ - $ - $ - $ - $ - $ -
Money Follows the Person*
Total $ 81,391,542 $ 40,695,771 $ 40,695,771 $ - $ 13,129,409 $ 33,322,196 $ 34,939,937
TOTALS* $ 5,505,909,944 $ 2,752,954,972 $ 2,752,954,972 $ 108,490,368 $ - $ 967,444,598 $ 2,151,901,918 $ 2,386,563,428
*MFP does not receive enhanced FMAP through BIP, but the expenditures do count towards the state's target spending of 50% or 25%. *Total for Federal and State share for MFP reflect regular state share; does not calculate MFP enhanced FMAP.
LTSS
DHS Extra Balancing Incentive Program Portion (2 or 5 %) 2.00% FFY 2012 - FFY 2015
Projected LTSS Spending
NJ State FMAP Rate 50.00%
Attachment B
DEPARTMENT OF HEALTH & HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES
BALANCING INCENTIVE PAYMENTS PROGRAM (Balancing Incentive Program) APPLICANT FUNDING ESTIMATES LONG TERM SERVICES AND SUPPORTS
47
Abbreviation/ Acronym
Term
Act Independence, Dignity and Choice in Long Term Care Act
AAA Area Agencies on Aging
ADL Activity of Daily Living
ADRC Aging and Disability Resource Centers AID Automatic Interactions Detections ASO Administrative Services Organization
BH Behavioral Health
BHI Behavioral Health Initiative
BHO Behavioral Health Organization
CAP Clinical Assessment Protocol
CASS Consolidated Assistance Support System CSOC Children’s System of Care
CWA County Welfare Agencies
DoAS Division of Aging Services
DCF Department of Children and Families
DD Developmentally Disabled
DDD Division of Developmental Disabilities
DHS Department of Human Services
DHSS Department of Health and Senior Services
DMAHS Division of Medical Assistance and Health Services
EHR Electronic Health Records
FFP Federal Financial Participation
FFS Fee for Service
GO Global Options for Long-term Care HCBS Home and Community Based Services
MCO Managed Care Organization
I&A Information and Assistance
I/DD Intellectual and Developmental Disabilities
InterRai MDS-HC InteRai Minimum Data Set for Home Care Version 2.0 ICF/MR Intermediate Care Facility for Persons with Mental
48
LOC Level of Care
LTC Long term Care
LTSS Long term services and supports MAAC Medical Assistance Advisory Council
MAC Medicaid Advisory Council
MBHO Managed Behavioral Health Organization
MDC Medical Day Care
MFP Money Follows the Person
Michigan University of Michigan
MMIS Medicaid Management Information System
NF Nursing Facility
PAAD Prescription Assistance for the Aged and Disabled PACE Program of All-Inclusive Care for the Elderly
PASRR Preadmission Screening and Resident Review
PCA Personal Care Assistance
PCP Primary Care Provider
PH Physical Health
POC Plan of Care
QA Quality Assurance
QM Quality Management
RAI Request for Additional Information
RN Registered Nurse
SBIRT Screening, Brief Intervention and Referral to Treatment SED Serious Emotional Disturbance
SFY State Fiscal Year
SHIP State Health Insurance Assistance Program
SMI Serious Mental Illness
SPA State Plan Amendment
SPH State Psychiatric Hospital
SAI Substance Abuse Initiative
TA Technical Assistance
49
Letters of Endorsement
Copies of the following letters of endorsement for New Jersey’s application by the New Jersey Department of Human Services are included in this section:
AARP
Home Care Association of NJ
Mental Health Association in New Jersey
New Jersey Association of Centers for Independent Living
New Jersey Council on Developmental Disabilities
New Jersey Foundation for Aging
New Jersey Hospital Association