FY2026 Annual Report

Annual Report FY2026 23 T he Billing Supervisors Practice Group continued preparing for the first phase of more behavioral healthcare services being carved into Medicaid managed care and working with the MCOs. The main focus has shifted from the transition to MCO’s to the challenges with denials, authorizations and the burden on the providers to manage. The group has been in communication with MCO’s to specifically navigate proper medical necessity as transition periods have ended and providers continue their due diligence to keep up with managed care changes. This due diligence includes evaluating their electronic health record platforms to meet clients’ needs seamlessly. The group is also continuing efforts to resolve issues with the Interim Managing Entity/MCO authorizations for substance use treatment, as the systems do not seem to be aligned. IT Project’s Practice Groups March 26th, which was productive with the creation of an ongoing workgroup with NJAMHAA members and state staff who met again on June 2nd. DOH staff clarified processes for obtaining identification for hospital patients before they are discharged and agreed to explore having this process started earlier. They also offered to examine hospital staff’s documentation to ensure community providers receive complete information on each patient and agreed to develop more extensive plans for individuals who are at high risk of being re-hospitalized. In addition, DMHAS will explore solutions to augment post-hospital care for individuals with substance use disorders. The state staff also agreed to encourage hospital staff to visit residential programs to understand the real-world situations and environments to which patients are discharged. Other important issues this group will address include medication nonadherence; difficulty meeting involuntary commitment thresholds despite clear functional decline; limited step-up/step-down options in the continuum for individuals with substance use disorder or co-occurring disorders; housing and continuum gaps, as well as neighborhood impact concerns when inappropriate placements occur; and staffing and workforce constraints, such as RN and LPN scope limitations. Residential Providers Practice Group (continued) Billing Supervisors Practice Group CO-CHAIRS: Jared Levy, MBA, CPA Chief Executive Officer Maryville Integrated Care Damaris Piliro, MBA-HCM Chief Executive Officer Hendricks House Group, Inc. CO-CHAIRS: Candice Copeland, MSM-HCA, MSM-MIS Vice President, Revenue Cycle Management Acenda Integrated Health Judith Rios Accountant and Senior Director Jewish Family Service of Atlantic & Cape May Counties