FY2025-Annual-Report

NJAMHAA Annual Report FY 2025 21 CO-CHAIRS: Brigitte Johnson, Esq. President and CEO of CarePlus NJ and Member of the NJAMHAA and NJMHI Boards As one of the main issues the Hospital Community Integration Council (HCIC) has been focusing on is the Department of Health’s (DOH’s) Quality Improvement Program (QIP), which is currently in its fifth and final measurement year, the group met with Christina Cartisano, Administrative Analyst 2, Office of Health Care Financing, DOH, about QIP and the state’s plans for the successor initiative, which have not yet been determined. NJAMHAA staff and members stated that community providers need incentives, specifically reimbursement that reflects the cost of using evidence-based practices, to partner with hospital providers, and recommended that a workgroup be established with DOH to break down silos and explore federal funding for both hospital- and community-based behavioral healthcare providers, as the QIP and its predecessor, the Delivery System Reform Incentive Payment Program, offered incentives only for the hospital programs. After months of discussion to identify the top-priority billing codes to be made available for more types of providers, some members of the HCIC met with Renee Burawski, LCSW, Assistant Commissioner, Division of Mental Health and Addiction Services, and Steve Tunney, RN, MSN, Director, Behavioral Health, Division of Medical Assistance and Health Services. The group then decided to have the Billing Supervisors’ Practice Group narrow down the list of priority codes, as the state leaders requested, so that the Council could focus on its original mission of fostering stronger partnerships between hospital- and community-based behavioral healthcare providers. Kristine Pendy, LCSW Chief Operating Officer and Vice President, Clinical Services, Vantage Health System and NJAMHAA Board Member Hospital Community Integration Council The Health Maintenance Organization (HMO) Council shares information, provides training and develops strategies to address challenges, currently those particularly associated with the continuing carve-in of behavioral health services into Medicaid managed care. In the past year, the HMO Council has largely focused on hosting presentations and facilitating discussions that answer questions and address challenges to support providers in the transition. In September, Steve Tunney, RN, MSN, Director of Behavioral Health, Division of Medical Assistance and Health Services (DMAHS), gave a presentation on changes to the contract DMAHS has with the managed care organizations (MCOs). In March, Vicki Fresolone, LCSW, LCADC, Chief of Integrated Care at DMHAS, and Business Health Maintenance Organization Council Manager for the New Jersey Substance Abuse Monitoring System (NJSAMS) since 2016, delivered a presentation on NJSAMS that included information on common provider questions and errors on submissions, as well as resources and contact information for specific situations. In all FY2025 HMO Council meetings, the agendas have included sharing answers to pre-submitted questions from members, addressing remaining pre-submitted questions to the MCO representatives present, and opening the floor to additional questions. At each meeting, many issues have been clarified, others brought back to DMAHS and the MCOs and later resolved, and direct communication lines opened between providers and MCO representatives when issues specific to claims and/or organizations were best taken offline. These discussions have helped to move NJAMHAA’s advocacy on important issues forward with several requested policies accepted by DMAHS. CHAIR: Sam Currie, RPh Director of Pharmacy Services Horizon NJ Health