NJ FamilyCare includes all individuals receiving public medical assistance through the Division of Medical Assistance and Health Services and includes those eligible for federal reimbursement through the Medicaid program and Children's Health Insurance Program established in the federal Social Security Act and those eligible for other public medical assistance programs established through various state laws.
The monthly eligibility dashboards are point in time representations of the recipients known at the end of the reporting month. The end of the reporting month typically occurs the Friday before the last Wednesday of each month; the demographic and programmatic information (age, program eligibility, managed care organization, county of residence, etc.) reflects what is present on the eligibility files for that recipient at that time. For a small number of individuals, multiple program eligibility may be present for a single month, in these cases a hierarchy is assigned so that the individual will only have one eligibility categorization for that month and will be singly counted only.
Eligibility Categories include the following:
For detailed information on these programs please refer to the following link: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/
The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) is a public-private initiative which utilizes standardized surveys in order to assess the experiences of patients in various settings. Each year a sample of beneficiaries from each NJ FamilyCare managed care organization and Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) are surveyed by mail or telephone to complete a CAHPS® survey. The survey questions ask beneficiaries to report on and evaluate various aspects of their own or their children's experiences of care and service. The CAHPS® survey for state Medicaid and FIDE SNP plans is overseen by CMS and administered by an NCQA certified HEDIS survey vendor.
Results are compiled for the four major CAHPS® categories: Overall Rating of Health Care, Overall Rating of Health Plan, Overall Rating of Personal Doctor, and Overall Rating of Specialists. Ratings are broken out by plan and may be filtered by survey type (adult, child, CHIP, and FIDE SNP). Beneficiaries receiving Managed Long Term Services and Supports (MLTSS) are included in all survey type populations.
The NJ FamilyCare Long Term Care (LTC) population includes all recipients who meet the nursing facility level of care clinical criteria and receive home and community-based or institutional services. Managed Long Term Services and Supports benefits (MLTSS) were implemented on July 1, 2014. Recipients residing in nursing facilities at the implementation of MLTSS remain under a fee-for-service payment model as long as they do not leave the facility or transfer to another facility. All other long term care recipients receive services through managed care. Through MLTSS, NJ FamilyCare's contracted Managed Care Organizations provide Long Term Care recipients additional home-based services, including care management, with the overall goal of providing quality care in the least restrictive setting.
Data for all months in the LTC/MLTSS dashboards is refreshed monthly and reflects Medicaid eligibility records current as of the end of the reporting month as well as claims reported through the end of the reporting month. Prior months' reported counts may change after refreshes due to updates to the beneficiaries' eligibility records and/or additional claims received for prior months. Note that a small number of MLTSS recipients may be counted in the dashboard as FFS, or vice versa, due to timing issues as they transition into managed care. Also due to timing issues, a small number of PACE recipients may be counted in counties not currently operating PACE programs. This issue affects a few PACE recipients residing in nursing facilities and/or having a change to their county of residence.
For additional information on MLTSS, please refer to the following link: http://www.nj.gov/humanservices/dmahs/home/mltss.html
The Healthcare Effectiveness Data and Information Set (HEDIS®) is a set of Performance Measures widely-used by America's health plans to measure performance on important dimensions of care and service. This set of Performance Measures is developed and maintained by the National Committee for Quality Assurance (NCQA). Selected HEDIS® measures are annually reported by the State’s contracted Managed Care Organizations (MCOs) for NJ FamilyCare beneficiaries to the Division of Medical Assistance and Health Services (DMAHS). These measures allow the comparison of health plan performance on key domains of care between plans and against national or regional benchmarks. As part of federal regulations 42 CFR Part 438, subpart E, the State contracts with an External Quality Review Organization (EQRO) which, in addition to other activities, validates the performance measures submitted by the State's contracted MCOs. Data for the current year's HEDIS® reports are based on services provided during the prior measurement year. Detailed specifications for the HEDIS® measures can be found on www.NCQA.org . The Medicaid and MLTSS Quality Report submitted by New Jersey's EQRO can be found on the Division's website at https://www.state.nj.us/humanservices/dmahs/news/.