FY2024 Annual Report

11 NJAMHAA Annual Report FY 2024 Medicaid Managed Care Of ultimate importance has been NJAMHAA’s participation in the DMHAS and Division of Medical Assistance and Health Services’ (DMAHS’) Behavioral Health Integration Advisory Hub, providing feedback to inform the design and implementation of the carve-in of select behavioral health services into managed care as a part of the NJ FamilyCare Comprehensive Demonstration (1115 Waiver). In recent months, several impactful policies NJAMHAA has been advocating for since first commenting on the draft 1115 Waiver application in 2021 have been announced. They include: Medicaid rates will serve as an initial floor for the carve-in. C ontracting with “any willing qualified provider” will be required for the first 24 months and until the contracted network meets requirements statewide. Prior authorizations will be automatically approved for an initial undetermined period. Other transition period policies shared by DMAHS include requiring out-of-network and “single case” contracting of Medicaid-enrolled providers as necessary until full credentialing is complete and requiring managed care organizations (MCOs) to recruit all active fee-for-service behavioral health providers (or provide a reason for not doing so). In addition, work is underway to streamline the credentialing process in a number of ways with proposals that include a standard supplemental form for credentialing, a reduced (60 days) timeline for provider credentialing decisions, and reports on denials and timelines required. Another impactful proposal would require MCOs to work with providers on retroactive authorizations when a beneficiary meets medical necessity criteria. NJAMHAA will continue to provide advocacy on these and other issues, such as uniform billing processes, shortened reimbursement turnaround times and more transparency when payments are fully or partially denied. NJAMHAA’s reputation and the relationships it has established have provided multiple avenues for resolving the issues members face or anticipate, as with the carve-in. NJAMHAA’s access to legislators and policymakers provides a foundation for advocacy success and NJAMHAA encourages all members to build relationships with their local legislators to continually build on NJAMHAA’s transformative impact!