reglab/housing_qa huggingface dataset:
NJ Rev Stat § 30:4D-8.17 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-8.17 - Definitions relative to Regional Health Hubs.

30:4D-8.17 Definitions relative to Regional Health Hubs.  2. As used in this act: "Commissioner" means the Commissioner of Human Services. "Core region" means the geographic area of responsibility for a Regional Health Hub. "Data catchment area" means the zip codes in New Jersey for which a Regional Health Hub receives NJ FamilyCare claims data. "Department" means the Department of Human Services. "Existing Regional Health Hub" means those four organizations designated as Regional Health Hubs by the FY20 New Jersey State Budget, P.L.2019, c.150 and identified in subsection b. of section 3 of this act. "Health information platform" means a Health Information Exchange (HIE) or other electronic platform that is used to run population-level analytics or exchange health information among various organizations.  "New Regional Health Hub" means an entity that is designated by the commissioner as a Regional Health Hub after the effective date of, and as provided by, this act. "Prospective service region" or "prospective region" means a geographical area that is designated by the commissioner, pursuant to subsection a. of section 4 of this act, as being in need of a Regional Health Hub. "Regional Health Hub" means any entity that is designated as a Regional Health Hub, as provided by this act, including an existing Regional Health Hub or a new Regional Health Hub. L.2019, c.517, s.2.
NJ Rev Stat § 30:4D-8.18 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-8.18 - Regional Health Hub Program.

30:4D-8.18 Regional Health Hub Program.  3. a. The Department of Human Services shall establish a Regional Health Hub Program, and shall designate Regional Health Hubs in appropriate areas of the State, as provided by this act. The Regional Health Hub Program shall replace the Medicaid Accountable Care Organization Demonstration Project established pursuant to P.L.2011, c.114 (C.30:4D-8.1 et seq.), which is now subject to expiration by law. b. The following certified accountable care organizations and accountable care look-alike organizations, which are operating in this State as of the effective date of this act, shall be grandfathered into the Regional Health Hub Program, and shall be automatically designated as Regional Health Hubs, for the purposes of this act:  (1) the Healthy Greater Newark ACO;  (2) the Trenton Health Team;  (3) the Camden Coalition of Health Care Providers; and  (4) the Health Coalition of Passaic County. c. The Department of Human Services, in consultation with the Department of Health, shall be authorized to designate additional non-profit organizations to operate as Regional Health Hubs under the Regional Health Hub Program, pursuant to section 4 of this act, as determined to be appropriate. L.2019, c.517, s.3.
NJ Rev Stat § 30:4D-8.20 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-8.20 - Revocation of status.

30:4D-8.20 Revocation of status.  5. a. The commissioner may revoke an organization's status as a Regional Health Hub if the organization fails to perform the mandatory activities of a Regional Health Hub, as described in subsection a. of section 6 of this act. b. Before revoking an organization's status as a Regional Health Hub, the commissioner shall notify the organization of the potential revocation and provide a reasonable timeframe for corrective action. c. The commissioner's revocation of Regional Health Hub status shall be a final agency action for the purposes of the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). d. After revoking an organization's status as a Regional Health Hub, the commissioner shall immediately determine whether a new Regional Health Hub is needed in the area where status was revoked. If such need is determined to exist, the commissioner shall designate a new Regional Health Hub to serve the area, as provided by subsection d. of section 4 of this act. L.2019, c.517, s.5.
NJ Rev Stat § 30:4D-8.22 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-8.22 - Submission of annual proposal.

30:4D-8.22 Submission of annual proposal.  7. a. Each Regional Health Hub shall annually submit a proposal to the department, describing the Regional Health Hub's annual goals, and the elective activities that the Regional Health Hub will undertake during the upcoming fiscal year. b. In order to become effective, each Regional Health Hub's proposal shall be approved by the department in consultation with the Department of Health. Approval shall be at the sole discretion of the department in consultation with the Department of Health, and the department may request that the Regional Health Hub modify and resubmit a proposal, in order to receive approval. c. In order to facilitate the development of proposals under this section, the department shall annually provide each Regional Health Hub with a list of the department's goals, projects, or priorities for the upcoming fiscal year. d. When finalizing a proposal under this section, the department and relevant Regional Health Hub shall negotiate joint goals, projects, and priorities for the upcoming fiscal year, and agree upon the associated funding that will be needed to accomplish those joint goals, projects, and priorities.  e. Each proposal approved pursuant to this section shall include, at a minimum: (1) a description of the joint goals, projects, and priorities agreed upon by the Regional Health Hub and the department for the upcoming fiscal year pursuant to subsection d. of this section; (2) an indication of the amount of funding that will be needed to attain each joint goal, project, and priority identified in the proposal, and an indication of the total amount of funding, overall, that will be needed to execute the proposal; (3) a description of the clear deliverables and performance metrics that will be used to evaluate and measure success in relation to the achievement of the goals, projects, and priorities described in the proposal; and (4) a description of performance-based payments, which shall be tied to the achievement of the clear deliverables and performance metrics described in paragraph (3) of this subsection. Each year, at least 10 percent, but no more than 25 percent of the total funding provided by the department to each Regional Health Hub to undertake the activities described in section 6 of this act shall be contingent upon the Regional Health Hub's achievement of such deliverables and performance metrics. Determination of whether a Regional Health Hub has achieved such deliverables and performance metrics shall be at the sole discretion of the department. L.2019, c.517, s.7.
NJ Rev Stat § 30:4D-8.23 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-8.23 - Funding for Regional Health Hub.

30:4D-8.23 Funding for Regional Health Hub.  8. a. A Regional Health Hub may be funded in part by the department, in accordance with the provisions of the annual appropriations act. As described in paragraph (4) of subsection e. of section 7 of this act, a portion of such funding shall be contingent on the Regional Health Hub's achievement of deliverables and performance metrics, as specified in the Regional Health Hub's approved proposal each year.  b. In addition to funding described in subsection a. of this section, the commissioner shall have the discretion to support a Regional Health Hub's innovation projects that advance Medicaid priorities using other available dollars as appropriate. c. A Regional Health Hub shall not receive funding provided for under this section until the Regional Health Hub has submitted an annual proposal, as described in section 7 of this act. L.2019, c.517, s.8.
NJ Rev Stat § 30:4D-8.24 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-8.24 - Health information platform.

30:4D-8.24 Health information platform.  9. a. A health information platform operated pursuant to paragraph (1) of subsection a. of section 6 of this act shall contain detailed health data from the Regional Health Hub's core region, including macro-level analytics of broad population trends, and micro-level analytics of both individual health data, and disease trends by category of disease, age group, or other subset.  b. Each Regional Health Hub shall maintain a data sharing use and reciprocal support agreement, and any applicable use case agreement, with any Statewide health information platform designated by the commissioner in order to promote interoperability. c. The department shall, consistent with federal and Sate law, make available NJ FamilyCare claims data to the Regional Health Hubs, as needed for the Regional Health Hub's population health work or other tasks, and enter into appropriate data sharing agreements for the exchange of such data. The department shall share with each Regional Health Hub the NJ FamilyCare claims data for beneficiaries residing within the Regional Health Hub's data catchment area, as mutually agreed to by the Regional Health Hub and the department. The data catchment area shall include, but need not be limited to, the Regional Health Hub's core region, and may overlap with the data catchment areas for other Regional Health Hubs. d. The Departments of Human Services, Health, Children and Families, and Community Affairs shall be authorized, to the extent permissible by federal and State law or regulation, to share with the health information platforms established, or the Regional Health Hubs designated, pursuant to this act, any available health data that is maintained by the departments. L.2019, c.517, s.9.
NJ Rev Stat § 30:4D-8.25 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-8.25 - Consultations relative to pilot program.

30:4D-8.25 Consultations relative to pilot program.  10. Any State department that implements a pilot program related to health care delivery shall be encouraged to consult with the Regional Health Hubs operating in the regions of the State that will be affected by the pilot program, in order to ensure that all relevant considerations have been accounted for, and that the pilot program is effectively and efficiently implemented with the assistance of all relevant stakeholders.  L.2019, c.517, s.10.
NJ Rev Stat § 30:4D-8.26 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-8.26 - Application for amendments, waivers.

30:4D-8.26 Application for amendments, waivers.  11. In addition to utilizing any State-appropriated funding that supports Regional Health Hubs, the Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act, and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program, and shall take such additional steps as may be necessary to secure, on behalf of participating Regional Health Hubs, such waivers, exemptions, or advisory opinions to ensure that such Regional Health Hubs are in compliance with applicable provisions of State and federal law related to fraud and abuse, including, but not limited to, anti-kickback, self-referral, false claim, and civil monetary penalty provisions.  L.2019, c.517, s.11.
NJ Rev Stat § 30:4D-8.27 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-8.27 - Rules, regulations.

30:4D-8.27 Rules, regulations.  12. The Commissioner of Human Services shall adopt rules and regulations, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), as may be necessary to implement the provisions of this act. L.2019, c.517, s.12.
NJ Rev Stat § 30:4D-9.2 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-9.2 - Medicaid to not provide coverage for certain early elective deliveries.

30:4D-9.2 Medicaid to not provide coverage for certain early elective deliveries.  3. a. Notwithstanding the provisions of any other law or regulation to the contrary, any contract between a carrier and the Division of Medical Assistance and Health Services in the Department of Human Services that provides benefits to persons who are eligible for Medicaid under P.L.1968, c.413 (C.30:4D-1 et seq.) shall not provide coverage for a non-medically indicated early elective delivery performed at a hospital on a pregnant woman earlier than the 39th week of gestation. b. As used in this section, "non-medically indicated early elective delivery" means the artificial start of the birth process through medical interventions or other methods, also known as labor induction, or the surgical delivery of a baby via a cesarean section for purposes or reasons that are not fully consistent with established standards of clinical care as provided by the American College of Obstetricians and Gynecologists. L.2019, c.87, s.3.
NJ Rev Stat § 30:4D-10 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-10 - Review of sealed bids; report and recommendation; considerations

30:4D-10. Review of sealed bids; report and recommendation; considerations  Upon the opening of sealed bids submitted in accordance with sections 8. a. and 9, the commissioner shall review the same and make a report and recommendation for acceptance or rejection of a bid to the State Medicaid Commission which shall be convened to receive, consider and act upon the commissioner's recommendation. The State Medicaid Commission shall in reviewing the bids and the recommendations of the commissioner be guided by such considerations as: a. The amount of the bids. b. The ability of the underwriter and fiscal agent in carrying out the scope of medical assistance benefits with providers which ability the underwriter already has or is in a position to secure, whereby payments are made on behalf of subscribers or policyholders directly to various providers of medical services under cost reimbursement formulas or in accordance with fee schedules agreed upon in advance. c. The demonstrated effectiveness of control mechanisms to assure quality of care, appropriate utilization of service and claims cost control. L.1968, c. 413, s. 10.
NJ Rev Stat § 30:4D-11 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-11 - Approval or disapproval of lowest responsible bid; direction of payment

30:4D-11. Approval or disapproval of lowest responsible bid; direction of payment  The State Medicaid Commission by majority vote of all its members shall (a) approve or disapprove the lowest responsible bid submitted under 8. a. and should the bid be disapproved (b) direct that payment of claims under this act be made by the Department of Institutions and Agencies in the manner provided in section 8. b. or 8. c. as shall be determined by the State Medicaid Commission. L.1968, c. 413, s. 11.
NJ Rev Stat § 30:4D-12 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-12 - Unnecessary use of care and services; methods and procedures; maintenance of records required for reimbursement

30:4D-12. Unnecessary use of care and services; methods and procedures; maintenance of records required for reimbursement  Subject to the limitations provided in sections 7, 8 and 9 of this act, the department shall (a) develop and employ such methods and procedures relating to the utilization of and the payment for medical care and services available under the plan as may be necessary to safeguard against unnecessary utilization of such care and services; (b) Assure that payments (including payments for any drugs provided under the plan) are not in excess of reasonable charges (reasonable costs in the instance of inpatient hospital services) consistent with efficiency, economy and quality of care; (c) Prescribe standards that providers must meet; (d) Require that any provider who renders health care services authorized under this act shall keep and maintain such individual records as are necessary to fully disclose the name of the recipient to whom the service was rendered, the date of the service rendered, the nature and extent of each such service rendered, and any additional information, as the department may require by regulation. Records herein required to be kept and maintained shall be retained by the provider for a period of at least 5 years from the date the service was rendered; (e) Require that providers who render health care services authorized under this act shall not be entitled to reimbursement for the services rendered unless said services are documented pursuant to subsection (d) of this section. Any evidence other than the documentation required pursuant to subsection (d) of this section shall be inadmissible in any proceeding conducted pursuant to this act for the purpose of proving that said services were rendered; unless the evidence is found to be clear and convincing by the finder of fact; and (f) Examine and make copies of any books and records of a provider if they relate in any way to services rendered to any recipient under this act, and visit and inspect the premises or facilities of any provider it may deem necessary to carry out the provisions of this act and regulations adopted pursuant thereto. L.1968, c. 413, s. 12. Amended by L.1979, c. 365, s. 14, eff. Feb. 4, 1980.
NJ Rev Stat § 30:4D-13 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-13 - Enrollment fees or premium charges

30:4D-13. Enrollment fees or premium charges  Subject to the limitations set forth in sections 7, 8 and 9 of this act, the department shall assure that no enrollment fee, premium or similar charge is imposed on an applicant as a condition of eligibility for medical assistance under this act. L.1968, c. 413, s. 13.
NJ Rev Stat § 30:4D-14 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-14 - Preparation of comprehensive medical plan

30:4D-14. Preparation of comprehensive medical plan  Subject to the limitations provided in this act and the Federal Social Security Act, the department shall prepare a comprehensive medical plan whereby the benefits of this program will be extended in accordance with the mandatory schedule for providing benefits required by the Federal legislation. This plan shall include alternative means of expanding the medical care benefits and coverage provided in this act. Such plan shall be reevaluated from time to time but no less than annually and shall be based upon a documented review of medical needs of low-income families in New Jersey, a detailed analysis of priorities of service, coverage, program costs and an evaluation of progress. L.1968, c. 413, s. 14. Amended by L.1979, c. 365, s. 15, eff. Feb. 4, 1980.
NJ Rev Stat § 30:4D-15 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-15 - Eligibility determination

30:4D-15. Eligibility determination  The department shall assure: (a) That all individuals wishing to make application for medical assistance shall have the opportunity to do so; (b) That the processing of applications shall be simplified to the end that medical benefits shall be furnished to recipients as soon as possible. L.1968, c. 413, s. 15.
NJ Rev Stat § 30:4D-16 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-16 - Provision of funds by state

30:4D-16. Provision of funds by state  The State shall provide such funds as may be necessary to meet its share of the costs incurred under this act. L.1968, c. 413, s. 16.
NJ Rev Stat § 30:4D-17a (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-17a - Additional action by Attorney General.

30:4D-17a Additional action by Attorney General.  3. In addition to any other action authorized or required by law, the Attorney General shall refer any matter regarding a person who is licensed or otherwise authorized to practice a health care profession in this State pursuant to Title 45 or Title 52 of the Revised Statutes and has been convicted of an offense under the provisions of section 17 of P.L.1968, c.413 (C.30:4D-17), to the appropriate professional and occupational licensing board within the Division of Consumer Affairs in the Department of Law and Public Safety or the Director of the Division of Consumer Affairs, as applicable, for such action as they determine appropriate regarding that person's license or other authorization to practice as a health care professional. L.2010, c.30, s.3.
NJ Rev Stat § 30:4D-17b (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-17b - Construction of act.

30:4D-17b Construction of act.  4. Nothing in section 17 of P.L.1968, c.413 (C.30:4D-17) or in section 3 of P.L.2010, c.30 (C.30:4D-17a) shall be construed to preclude the indictment or conviction for any other offense defined by law, or to impair or limit the discretion and authority of the State regarding any civil action, criminal prosecution, or other action authorized by law. L.2010, c.30, s.4.
NJ Rev Stat § 30:4D-17.1 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-17.1 - Suspension or disqualification of providers, termination of benefits to recipients; rules and regulations

30:4D-17.1. Suspension or disqualification of providers, termination of benefits to recipients; rules and regulations  a. The director may suspend, debar or disqualify for good cause any provider presently participating or who has applied for participation in the program, or may suspend, debar or disqualify for good cause any person, company, firm, association, corporation or other entity who is participating directly or indirectly in the Medicaid program, or who is an agent, servant, employee or independent contractor of a provider in the Medicaid program. b. The director may terminate or otherwise restrict medical assistance benefits to any eligible recipient thereof for good cause. c. The director may promulgate such rules, regulations and administrative orders as are necessary to effectuate the provisions and purposes of this section. L.1979, c. 365, s. 17, eff. Feb. 4, 1980.
NJ Rev Stat § 30:4D-17.2 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-17.2 - Enforcement of commissioner's decisions; orders by civil action

30:4D-17.2. Enforcement of commissioner's decisions; orders by civil action  Any decision, order, final judgment, or final determination of the commissioner or director issued pursuant to the provisions of this act not involving the recovery of Medicaid payments may be enforced in a civil action brought in a summary manner by the Attorney General on behalf of either the commissioner or director in the Superior Court. In any such action said order, decision, final judgment or final determination shall be considered res judicata, except that an appeal may be taken to the Appellate Division of the Superior Court from the final decision of the commissioner or director in accordance with the applicable Rules of the Court. L.1979, c. 365, s. 18, eff. Feb. 4, 1980.
NJ Rev Stat § 30:4D-17.4 (2021)
2021 New Jersey Revised Statutes|Title 30 - Institutions and Agencies|Section 30:4D-17.4 - Reimbursement for retroactive eligibility

30:4D-17.4. Reimbursement for retroactive eligibility  If an applicant is determined to be eligible under P.L. 1968, c. 413 (C. 30:4D-1 et seq.) retroactively and the provider bills the applicant directly for the services and benefits rendered during the retroactive period, the provider shall, upon notification of the applicant's retroactive eligibility, submit claims for reimbursement for covered services or benefits rendered during the retroactive period. Upon certification that the applicant is so eligible, the provider shall reimburse the applicant or other person who has made prior payment to the provider.  L. 1985, c. 303, s. 7.