Healthcare Policy

ACO-Post-Acute Guidance on Metrics for Network Inclusion

This members' only resource was developed at the suggestion of NJHA members from accountable care organizations and post-acute care settings as a resource on appropriate metrics for use by ACOs and post-acute care providers to determine which providers should be included in ACO networks. While the title is specific to ACO and post-acute networks, this guidance can support the efforts of hospitals and post-acute care providers engaged in bundling and other initiatives where metrics play a key role in determining partnership development.

Managed Care Plan Responsibilities: A Compilation of Statutory and Regulatory Expectations Brochure

This members' only brochure is intended to aid providers in understanding a health insurers legal and regulatory obligations. It is a comprehensive, easy-to-use resource that contains the most noteworthy requirements with which a carrier must be compliant. NJHA continues to update the Brochure as necessary to ensure members have the most up-to-date information - this is the third edition of this resource.

Health Claims Authorization, Processing and Payment
Act Brochure & IHCAP Checklist

This member's only toolkit provides resources to assist hospitals in properly processing appeals concerning payments or violations of the Health Claims Authorization, Processing and Payment Act including a summary of relevant regulatory and legislative provisions, a checklist to ensure the appropriate procedures are followed and links to the necessary forms that must accompany and appeal.


A Full House: Updated Hospital Diversion Guidelines

Examines reasons for emergency room overcrowding and the increased practice of hospitals diverting patients to other facilities for periods of time when inadequate resources are available to treat patients.

Hospital Closure Guidelines: Best Practices from the Field Once hospitals realize they must close, they face lengthy regulatory processes, this guide offers strategies to ease the transistion. View
Medicaid Managed Care: Playing By New Jersey’s Rules This member's only reference guide should assist providers in understanding a Medicaid Managed Care Organizations statutory, regulatory and contractual obligations with regard to utilization management determinations, medical necessity determinations, coordination of benefits issues. It is a compilation of some of the most noteworthy requirements with which a Medicaid MCO must be compliant. View