Friday, June 8, 2018

NJAMHAA Partners with Health Maintenance Organizations and many Others to Support Member Providers

In 2011, NJAMHAA created the Health Maintenance Organization (HMO) Council to ensure a robust network of providers and continuity of medically necessary care for beneficiaries with chronic conditions. Throughout this time, the HMO Council has been a dynamic group consisting of HMOs, NJAMHAA member providers and representatives from the Division of Medical Assistance and Health Services and the Division of Mental Health and Addiction Services. We engage in productive discussions about timely issues that involve HMOs and affect providers and access to their services.

The current hot topic that the HMO Council, as well as other groups that NJAMHAA facilitates, is focusing on is the upcoming changes to HMOs’ coverage of behavioral health services: Beginning July 1, 2018, HMOs will cover acute, hospital-based mental health services for all Medicaid beneficiaries and substance use services for individuals who are receiving Managed Long Term Services and Supports, people with intellectual/developmental disabilities and individuals who are covered by the Full Integrated Dually Eligible Special Needs Plan.

The inevitable change from fee-for-service reimbursement to value-based payments that is coming is another important topic that the HMO Council has been discussing and will continue to address. Presentations during meetings, as well as dedicated training outside of these meetings, are helping providers prepare for this major change, and more training will be developed as needed.

There is certainly a learning curve involved with any change and NJAMHAA understands it can be overwhelming, especially with multiple major changes being planned and implemented simultaneously. NJAMHAA aims to help minimize the stress associated with these changes by arranging for experts to provide valuable information and guidance. Stay tuned for learning opportunities through our website ( and social media.

We have open lines of communication with many individuals at HMOs, the state and many other organizations. People with expertise in various areas that are important to our members work with us to provide what is needed to help ensure our members’ success.

NJAMHAA is your partner and through our collaboration with the HMOs, the state and experts in the field, you can develop an extremely strong network! Stay informed about all that NJAMHAA offers and share opportunities with your coworkers!