reglab/housing_qa huggingface dataset:
NJ Rev Stat § 52:14-17.26a (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.26a - Fraudulent obtaining, attempt to obtain benefits, fourth degree crime.

52:14-17.26a Fraudulent obtaining, attempt to obtain benefits, fourth degree crime.  16. Any person who knowingly obtains, or attempts or conspires to obtain, coverage or benefits under the State Health Benefits Program for himself or another, knowing that the person for whom membership or benefits are sought is ineligible therefor, shall be guilty of a crime of the fourth degree. Nothing in this section shall preclude prosecution or conviction for any other offense. L.2008, c.89, s.16.
NJ Rev Stat § 52:14-17.27a (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.27a - Audit programs for SHBP.

52:14-17.27a Audit programs for SHBP.  17. a. The State Health Benefits Commission shall establish an audit program through which it shall conduct a continuous review of the various public employers participating in the State Health Benefits Program for the purpose of ensuring that only eligible employees and retirees, and their dependents, are receiving health care coverage under the program. Every public entity whose employees are covered by the program, as well as employees and retirees thereof, and their dependents, and any other public entity having relevant information, shall cooperate fully with the commission and shall provide all information, records and documents requested by the commission in connection with an audit. b. The State Health Benefits Commission shall establish and contract for a Medicare Primary Assignment and Audit Program through which it shall conduct a continuous review of the State Health Benefits Program for the purposes of ensuring that all persons who are participants and their dependents of the State Health Benefits Program and who are eligible for Medicare under federal law are properly enrolled in Medicare with Medicare as the primary provider of their health care benefits coverage and with the State Health Benefits Program as their secondary provider of their health care benefits coverage.  L.2008, c.89, s.17; amended 2018, c.88, s.1.
NJ Rev Stat § 52:14-17.27b (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.27b - Utilization of super conciliator.

52:14-17.27b Utilization of super conciliator.  55. Whenever the State Health Benefits Plan Design Committee of the State Health Benefits Program or the School Employees' Health Benefits Plan Design Committee of the School Employees' Health Benefits Program fails to render a decision on a matter before the committee because it has not received a vote of the majority of the committee members after 60 days have passed following the initial consideration of the matter, the committee shall utilize a super conciliator, randomly selected from a list developed by the New Jersey Public Employment Relations Commission. The super conciliator shall assist the committee based upon procedures and subject to qualifications established by the commission pursuant to regulation. The super conciliator shall promptly schedule investigatory proceedings. The purpose of the proceedings shall be to: Investigate and acquire all relevant information regarding the committee's failure to render a decision; Discuss with the members of the committee their differences, and utilize means and mechanisms, including but not limited to requiring 24-hour per day negotiations, until a voluntary settlement is reached, and provide recommendations to resolve the members' differences; and Institute any other non-binding procedures deemed appropriate by the super conciliator. If the actions taken by the super conciliator fail to resolve the dispute, the super conciliator shall issue a final report, which shall be provided to the committee promptly and made available to the public within 10 days thereafter. The super conciliator, while functioning in a mediatory capacity, shall not be required to disclose any files, records, reports, documents, or other papers classified as confidential which are received or prepared by him or to testify with regard to mediation conducted by him under this section. Nothing contained herein shall exempt an individual from disclosing information relating to the commission of a crime. L.2011, c.78, s.55.
NJ Rev Stat § 52:14-17.28e (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.28e - Negotiations concerning contributions for health care benefits.

52:14-17.28e Negotiations concerning contributions for health care benefits.  77. A public employer and employees who are in negotiations for the next collective negotiations agreement to be executed after the employees in that unit have reached full implementation of the premium share set forth in section 39 of P.L.2011, c.78 (C.52:14-17.28c) shall conduct negotiations concerning contributions for health care benefits as if the full premium share was included in the prior contract. The public employers and public employees shall remain bound by the provisions of sections 39, 40, and 43 of P.L.2011, c.78 (C.52:14-17.28c, C.52:14-17.28d, and C.52:14-17.34a), notwithstanding the expiration of those sections, until the full amount of the contribution required by section 39 has been implemented in accordance with the schedule set forth in section 40.  Employees subject to any collective negotiations agreement in effect on the effective date of P.L.2011, c.78, that has an expiration date on or after the expiration of sections 39 through 44, inclusive, of P.L.2011, c.78 (C.52:14-17.28c et al.), shall be subject, upon expiration of that collective negotiations agreement, to sections 39, 40, and 43 until the health care contribution schedule set forth in section 40 is fully implemented.  After full implementation, those contribution levels shall become part of the parties' collective negotiations and shall then be subject to collective negotiations in a manner similar to other negotiable items between the parties. A public employee whose amount of contribution in retirement was determined in accordance with section 40 or 43 shall be required to contribute in retirement the amount so determined pursuant to section 40 or 43 notwithstanding that section 40 or 43 has expired, with the retirement allowance, and any future cost of living adjustment thereto, used to identify the percentage of the cost of coverage. L.2011, c.78, s.77.
NJ Rev Stat § 52:14-17.29a (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29a - Employee drug prescription program; extension to retirees under state police retirement system

52:14-17.29a. Employee drug prescription program; extension to retirees under state police retirement system  The State Health Benefits Commission shall undertake by an amendatory or supplementary contract to extend the coverage of the employee drug prescription program, authorized pursuant to subsection (F) of section 5 of P.L.1961, c. 49 (C. 52:14-17.29), to State employees retiring or who have retired on or after January 1, 1980 under the State Police Retirement System after 25 or more years of service and who as of the time of their retirement are or shall be medically certified to be suffering from an illness characterized as terminal by two or more physicians licensed in the practice of medicine and surgery in this State. L.1981, c. 304, s. 1, eff. Nov. 11, 1981.
NJ Rev Stat § 52:14-17.29b (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29b - Provision of inpatient care following mastectomy

52:14-17.29b Provision of inpatient care following mastectomy  1. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits, shall provide coverage for a minimum of 72 hours of inpatient care following a modified radical mastectomy and a minimum of 48 hours of inpatient care following a simple mastectomy. The contract shall also provide that a carrier shall not require a health care provider to obtain authorization from the carrier for prescribing 72 or 48 hours, as appropriate, of inpatient care as provided for in this section. The provisions of this section shall not be construed: to require a patient to receive inpatient care for 72 or 48 hours, as appropriate, if the patient in consultation with the patient's physician determines that a shorter length of stay is medically appropriate; or to relieve a patient or a patient's physician, if appropriate, of any notification requirements to the carrier under the contract. L.1997,c.94.
NJ Rev Stat § 52:14-17.29c (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29c - Coverage for treatment of inherited metabolic diseases by State Health Benefits Program.

52:14-17.29c Coverage for treatment of inherited metabolic diseases by State Health Benefits Program.  9. The State Health Benefits Commission shall provide benefits to each person covered under the State Health Benefits Program for the therapeutic treatment of inherited metabolic diseases, including the purchase of medical foods and low protein modified food products, when diagnosed and determined to be medically necessary by the covered person's physician. For the purposes of this section, "inherited metabolic disease" means a disease caused by an inherited abnormality of body chemistry for which testing is mandated pursuant to P.L.1977, c.321 (C.26:2-110 et seq.); "low protein modified food product" means a food product that is specially formulated to have less than one gram of protein per serving and is intended to be used under the direction of a physician for the dietary treatment of an inherited metabolic disease, but does not include a natural food that is naturally low in protein; and "medical food" means a food that is intended for the dietary treatment of a disease or condition for which nutritional requirements are established by medical evaluation and is formulated to be consumed or administered enterally under direction of a physician. The health care services shall be provided to the same extent as for any other medical condition under the program. L.1997,c.338,s.9.
NJ Rev Stat § 52:14-17.29d (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29d - Definitions relative to mental health conditions and substance use disorders.

52:14-17.29d Definitions relative to mental health conditions and substance use disorders.  1. As used in this act: "Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation or health maintenance organization authorized to issue health benefits plans in this State. "Mental health condition" means a condition defined to be consistent with generally recognized independent standards of current medical practice referenced in the current version of the Diagnostic and Statistical Manual of Mental Disorders. "Same terms and conditions" means that a carrier cannot apply more restrictive non-quantitative limitations, such as utilization review and other criteria or more quantitative limitations such as copayments, deductibles, aggregate or annual limits or benefit limits to mental health condition and substance use disorder benefits than those applied to substantially all other medical or surgical benefits.  "Substance use disorder" means a disorder defined to be consistent with generally recognized independent standards of current medical practice referenced in the most current version of the Diagnostic and Statistical Manual of Mental Disorders. L.1999, c.441, s.1; amended 2019, c.58, s.9.
NJ Rev Stat § 52:14-17.29e (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29e - SHBC to provide benefits for mental health conditions and substance use disorders.

52:14-17.29e SHBC to provide benefits for mental health conditions and substance use disorders.  2. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for mental health conditions and substance use disorders under the same terms and conditions as provided for any other sickness under the contract and shall meet the requirements of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C. s.18031(j), and any amendments to, and federal guidance or regulations issued under that act, including 45 C.F.R. Parts 146 and 147 and 45 C.F.R. s.156.115(a)(3).  b. The commission shall provide notice to employees regarding the coverage required by this section in accordance with this subsection and regulations promulgated by the Commissioner of Health pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the employee; (2) the yearly informational packet sent to the employee; or (3) July 1, 2000. The commission shall also ensure that the carrier under contract with the commission, upon receipt of information that a covered person is receiving treatment for a mental health condition or substance use disorder, shall promptly notify that person of the coverage required by this section. c. Nothing in this section shall reduce the requirement for a carrier to provide benefits pursuant to section 9 of P.L.2017, c.28 (C.52:14-17.29u). L.1999, c.441, s.2; amended 2019, c.58, s.10.
NJ Rev Stat § 52:14-17.29f (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29f - Pap smear benefits in State health benefits contracts

52:14-17.29f. Pap smear benefits in State health benefits contracts  6. The State Health Benefits Commission shall provide benefits to each person covered under the State Health Benefits Program for expenses incurred in conducting a Pap smear. The benefits shall be provided to the same extent as for any other medical condition under the contract. As used in this section, and notwithstanding the provisions of this section to the contrary, "Pap smear" means an initial Pap smear and any confirmatory test when medically necessary and as ordered by the covered person's physician and includes all laboratory costs associated with the initial Pap smear and any such confirmatory test. L.2001,c.227,s.6.
NJ Rev Stat § 52:14-17.29g (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29g - Notice to enrollees in State Health Benefits Program managed care plans if primary care physician is terminated from plan.

52:14-17.29g Notice to enrollees in State Health Benefits Program managed care plans if primary care physician is terminated from plan.  1. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of P.L.2001, c.284 (C.52:14-17.29g) provides that if an enrollee's or member's primary care physician's contract as a participating physician in a health maintenance organization or State managed care plan will be terminated, the health maintenance organization or State managed care plan, as appropriate, shall provide the enrollee or member with 90-days' notice of the termination. If 90-days' notice cannot be provided because the termination will occur prior to the end of the 90-day period, the health maintenance organization or State managed care plan shall notify the enrollee or member as soon as the health maintenance organization or State managed care plan has knowledge of the termination. b. Notwithstanding the provisions of any policy governing open enrollment to the contrary, an enrollee or member who has been notified by a health maintenance organization or State managed care plan pursuant to this section may change his coverage to another health benefits plan under the State Health Benefits Program upon receiving notice that his primary care physician will no longer be a participating physician with the health maintenance organization or State managed care plan, in which the person is currently enrolled. L.2001, c.284, s.1; amended 2007, c.103, s.24.
NJ Rev Stat § 52:14-17.29h (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29h - State Health Benefits Commission contracts to cover certain out-of-network services.

52:14-17.29h State Health Benefits Commission contracts to cover certain out-of-network services.  11. The State Health Benefits Commission shall ensure that every contract purchased or renewed by the commission on or after the effective date of P.L.2001, c.367 (C.26:2S-6.1 et al.), which provides hospital or medical expense benefits through a managed care plan as defined in section 2 of P.L.1997, c.192 (C.26:2S-2), shall meet the requirements of section 2 of P.L.2001, c.367 (C.26:2S-6.1). L.2001,c.367,s.11.
NJ Rev Stat § 52:14-17.29i (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29i - State Health Benefits Program, coverage for mammograms.

52:14-17.29i State Health Benefits Program, coverage for mammograms.  9. a. The State Health Benefits Commission shall provide benefits to each person covered under the State Health Benefits Program for expenses incurred in conducting: (1) one baseline mammogram examination for women who are 40 years of age; a mammogram examination every year for women age 40 and over; and, in the case of a woman who is under 40 years of age and has a family history of breast cancer or other breast cancer risk factors, a mammogram examination at such age and intervals as deemed medically necessary by the woman's health care provider; and (2) an ultrasound evaluation, a magnetic resonance imaging scan, a three-dimensional mammography, or other additional testing of an entire breast or breasts, after a baseline mammogram examination, if the mammogram demonstrates extremely dense breast tissue, if the mammogram is abnormal within any degree of breast density including not dense, moderately dense, heterogeneously dense, or extremely dense breast tissue, or if the patient has additional risk factors for breast cancer including but not limited to family history of breast cancer, prior personal history of breast cancer, positive genetic testing, extremely dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology, or other indications as determined by the patient's health care provider. The coverage required under this paragraph may be subject to utilization review, including periodic review, by the carrier of the medical necessity of the additional screening and diagnostic testing. b. The benefits shall be provided to the same extent as for any other medical condition under the contract. L.2004, c.86, s.9; amended 2013, c.196, s.9.
NJ Rev Stat § 52:14-17.29l (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29l - Disease and chronic care management plan.

52:14-17.29l Disease and chronic care management plan.  31. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of P.L.2007, c.92 (C.43:15C-1 et al.) to provide benefits under the State managed care plans includes a disease and chronic care management plan for specified conditions meeting nationally recognized accreditation standards and including specified outcome measures and objectives for disease and chronic care management.  L.2007, c.92, s.31.
NJ Rev Stat § 52:14-17.29m (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29m - State health benefits plan to provide benefits for orthotic and prosthetic appliances.

52:14-17.29m State health benefits plan to provide benefits for orthotic and prosthetic appliances.  9. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits, shall provide benefits to any person covered thereunder for expenses incurred in obtaining an orthotic or prosthetic appliance from any licensed orthotist or prosthetist, or any certified pedorthist, as determined medically necessary by the covered person's physician. As used in this section, "orthotic appliance," "prosthetic appliance," "licensed orthotist" and "licensed prosthetist" have the meaning assigned to them in section 3 of P.L.1991, c.512 (C.45:12B-3) and "certified pedorthist" has the meaning assigned to it in subsection j. of section 18 of P.L.1991, c.512 (C.45:12B-18). b. On and after the effective date of this act, a contract purchased by the commission shall reimburse for orthotic and prosthetic appliances at the same rate as reimbursement for such appliances under the federal Medicare reimbursement schedule. c. The benefits shall be provided to the same extent as for any other medical condition under the contract. L.2007, c.345, s.9.
NJ Rev Stat § 52:14-17.29n (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29n - State Health Benefits Commission to provide coverage for hearing aids for certain persons aged 15 or younger.

52:14-17.29n State Health Benefits Commission to provide coverage for hearing aids for certain persons aged 15 or younger.  10. The State Health Benefits Commission shall, on or after the effective date of this act, provide benefits for medically necessary expenses incurred in the purchase of a hearing aid for a covered person 15 years of age or younger, as provided in this section. The benefits shall include the purchase of a hearing aid for each ear, when medically necessary and as prescribed or recommended by a licensed physician or audiologist. The commission may limit the benefit provided in this section to $1,000 per hearing aid for each hearing-impaired ear every 24 months. A covered person may choose a hearing aid that is priced higher than the benefit payable under this section and may pay the difference between the price of the hearing aid and the benefit payable under this section, without financial or contractual penalty to the provider of the hearing aid. L.2008, c.126, s.10.
NJ Rev Stat § 52:14-17.29o (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29o - SHBC to provide for installment payments to obstetrical provider for maternity services.

52:14-17.29o SHBC to provide for installment payments to obstetrical provider for maternity services.  9. a. Within 30 days of the effective date of this act, the State Health Benefits Commission shall provide, in every health benefits plan that provides for maternity services, for reimbursement in installments to an obstetrical provider licensed in New Jersey for maternity services rendered during the term of a covered person's pregnancy.  b. For the purposes of this section, "obstetrical provider licensed in New Jersey" means:  (1) an obstetrician/gynecologist licensed by the State Board of Medical Examiners; or  (2) a midwife licensed by the State Board of Medical Examiners as a certified midwife or a certified nurse midwife. L.2009, c.113, s.9.