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2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-25 - Legislative findings and declarations

30:4D-25. Legislative findings and declarations
The Legislature hereby finds and declares:
That the "Pharmaceutical Assistance to the Aged" program originally provided for the reimbursement of 80% of the prescription drug costs of low-income senior citizens who had met an income-related deductible drug expense;
That this program, designed to ease the burden of spiraling drug costs for senior citizens of modest incomes, was later modified to facilitate and simplify access to the program by requiring eligible senior citizens to pay $1.00 for each prescription drug at the time of purchase, with the State reimbursing the remainder of the cost directly to the pharmacist;
That the overwhelming success of the program, which currently boasts an enrollment of over 270,000 senior citizens, has resulted in costs far greater than those anticipated;
That although the Legislature is desirous of continuing the program as it currently exists, it recognizes that fiscal constraints and a heightened public awareness of the taxpayer's burden in this State makes it necessary to increase the share now paid by eligible senior citizens and reduce anticipated increases in the State contributions to the program in the future; and that therefore
A long-term legislative solution is now necessary which establishes this excellent and salutary program on a sound fiscal basis at a level within the means of the Treasury, thereby enabling it to continue without further substantial modification.
L.1978, c. 171, s. 1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-26 - Prescription; inclusion of name and address or identification number

30:4D-26. Prescription; inclusion of name and address or identification number
A prescription may not be included under the program unless it contains the name and address or identification number of the eligible person.
L.1978, c. 171, s. 3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-28 - Report to Governor and legislature

30:4D-28. Report to Governor and legislature
Within 6 months of the effective date of this act, the commissioner shall submit a report to the Governor and the Legislature including but not limited to the following:
a. The effects of definitional changes in the statute, such as residency and legend drugs;
b. The use of drug utilization review methods in order to curtail the abuse or inappropriate use of particular drugs;
c. A cost-analysis of alternative methods for administering the program and reimbursing participating pharmacists;
d. The effects of excluding from eligibility those persons whose prescription drug costs are covered in part by any other plan of assistance or insurance.
L.1978, c. 171, s. 5.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-29 - List of maximum quantity of drug to be dispensed per prescription

30:4D-29. List of maximum quantity of drug to be dispensed per prescription
Within 6 months after the effective date of this act, the commissioner shall, after consultation with the Drug Utilization Review Council and other authorities, prepare a list stating, for each prescribed drug, the maximum quantity which may be dispensed per prescription.
L.1978, c. 171, s. 6.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-30 - Maximum allowable cost per prescription drug; procedure to set and review on continuing basis

30:4D-30. Maximum allowable cost per prescription drug; procedure to set and review on continuing basis
Within 6 months from the effective date of this act, the commissioner shall establish a procedure for setting and reviewing on a continuing basis the maximum allowable cost per prescription drug under the program.
L.1978, c. 171, s. 7.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-31 - List of maximum quantities and procedures for setting maximum allowable cost; effective date

30:4D-31. List of maximum quantities and procedures for setting maximum allowable cost; effective date
The list of maximum quantities per prescription prepared under section 6 of this act and the procedures for setting the maximum allowable cost under section 7 of this act shall not take effect until the end of a period of 60 calendar days after the date on which the plan is transmitted to the Senate and General Assembly on a day in which both Houses are in session unless, between the date of transmittal and the end of the 60-day period the Legislature, upon a review of such plan by the Institutions, Health and Welfare Committees of both Houses acting jointly, passes a concurrent resolution stating in substance that the Legislature does not approve of the plan. Any plan submitted following such disapproval shall be subject to the same procedure.
L.1978, c. 171, s. 8.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-32 - Annual report

30:4D-32. Annual report
The commissioner shall issue an annual report to the Governor and the Legislature by October 1 of each year. Such report shall include a summary of "Pharmaceutical Assistance to the Aged" program activities for the preceding fiscal year and any recommendations or suggestions for legislative consideration.
L.1978, c. 171, s. 9.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-33 - Violations; penalties

30:4D-33. Violations; penalties
Any person violating any provision of this act shall be subject to the applicable civil and criminal penalties contained in the "New Jersey Medical Assistance and Health Service Act" (P.L.1968, c. 413, C. 30:4D-1 et seq.). Any eligible person who violates any provision of this act shall be subject to a suspension of their eligibility for one year for a first offense and permanent revocation of their eligibility for a second offense.
L.1978, c. 171, s. 10.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-34 - Reimbursement for costs of prescription drugs; application and proof of expenditure

30:4D-34. Reimbursement for costs of prescription drugs; application and proof of expenditure
Any eligible person under the program of Pharmaceutical Assistance to the Aged shall, upon the submission of such application and proof of expenditure as the department may prescribe, be reimbursed for the cost of all prescription drugs purchased by such person, minus a $2.00 copayment per prescription, during the period commencing 30 days after such person's properly completed application was received by the department and ending on the date on which such person received his proof of eligibility from the department; provided, however, that no reimbursement under this act shall be made for any prescription drug purchased prior to the effective date of this act.
L.1979, c. 27, s. 1, eff. March 1, 1979. Amended by L.1979, c. 383, s. 1, eff. Feb. 5, 1980.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-35 - Notice of availability and application forms; supplying to eligible persons

30:4D-35. Notice of availability and application forms; supplying to eligible persons
The department shall provide a notice of the availability of such reimbursement and an application form therefor to every eligible person.
L.1979, c. 27, s. 2, eff. March 1, 1979.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-35a - Pharmaceutical Assistance to the Aged and Disabled program, reimbursement, prescription drug costs, remainder.

30:4D-35a Pharmaceutical Assistance to the Aged and Disabled program, reimbursement, prescription drug costs, remainder.
4. In addition to the reimbursement required pursuant to section 1 of P.L.1979, c.27 (C.30:4D-34), any eligible person under the Pharmaceutical Assistance to the Aged and Disabled program, upon receiving proof of eligibility from the department and submitting proof of expenditure to the department, as the department may prescribe, shall be reimbursed for the remainder of the costs of all prescription drugs purchased by such person in an amount equal to the value of the benefit the person would have received had that person been enrolled in the Pharmaceutical Assistance to the Aged and Disabled program at the time of purchase, minus the required copayment per prescription, during the period commencing 30 days before such person's properly completed application was received by the department and ending on the date on which such person received proof of eligibility from the department; provided, however, that no reimbursement under this section shall be made for any prescription drug purchased prior to the first day of the fourth month next following the effective date of sections 2 through 6 of P.L.2023, c.79 (C.30:4D-22.4 et al.).
L.2023, c.79, s.4.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-35.1 - Short title

30:4D-35.1. Short title
1. This act shall be known and may be cited as the "Pharmaceutical Rebate Act."
L.1992,c.83,s.1; per s.6 as amended by 1993, c.97, s.2, expired June 30, 1994.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-35.3 - "Pharmaceutical Assistance to the Aged and Disabled Rebate Fund" established

30:4D-35.3. "Pharmaceutical Assistance to the Aged and Disabled Rebate Fund" established
3. There is established in the Department of Human Services a nonlapsing revolving fund to be known as the "Pharmaceutical Assistance to the Aged and Disabled Rebate Fund." All monies collected from rebate agreements pursuant to this act shall be deposited into this fund and shall be used by the department to offset the cost of benefits provided by the "Pharmaceutical Assistance to the Aged and Disabled" program which are funded by the Casino Revenue Fund.
L.1992,c.83,s.3; per s.6 as amended by 1993, c.97, s.2, expired June 30, 1994.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-35.4 - Rules, regulations

30:4D-35.4. Rules, regulations
4. Pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), the Commissioner of Human Services shall adopt rules and regulations necessary to carry out the purposes of this act and to ensure that the rebate amounts for pharmaceutical products covered under this program do not have the effect of establishing a new federal "best price," as that term is defined pursuant to section 1927 of the federal Social Security Act (42 U.S.C. s.1396r-8).
L.1992,c.83,s.4; per s.6 as amended by 1993, c.97, s.2, expired June 30, 1994.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-37 - $100 maximum

30:4D-37. $100 maximum
A person eligible for the Hearing Aid Assistance for the Aged and Disabled Program is entitled to receive a payment of up to $100.00 in a calendar year in which a hearing aid is purchased to offset the cost of the hearing aid. For the purposes of this act, "hearing aid" means an ear-level or body-worn electroacoustic instrument for amplifying sound whose basic components are a microphone, amplifier and receiver.
L. 1987, c. 298, s. 2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-38 - Pharmaceutical assistance recipients eligible

30:4D-38. Pharmaceutical assistance recipients eligible
A person who meets the age or disability, income and residency requirements of the "Pharmaceutical Assistance to the Aged and Disabled" program, P.L.1975, c. 194 (C. 30:4D-20 et seq.), is eligible for hearing aid assistance pursuant to this act if he is not otherwise qualified for Medicaid pursuant to P.L.1968, c. 413 (C. 30:4D-1 et seq.).
L. 1987, c. 298, s. 3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-38.1 - "Hearing Aid Assistance to the Aged and Disabled," notification as to error in estimated annual income.

30:4D-38.1 "Hearing Aid Assistance to the Aged and Disabled," notification as to error in estimated annual income.
2. a. Notwithstanding the provisions of any other law to the contrary, a recipient of benefits under the "Hearing Aid Assistance for the Aged and Disabled" program, established pursuant to P.L.1987, c.298 (C.30:4D-36 et seq.), shall notify the Department of Human Services if the recipient unintentionally errs in estimating annual income to determine eligibility for the program due to an unanticipated payment which would render the recipient ineligible for the program. Notification to the department shall be made in the time and manner prescribed by the department.
b. If the department determines that the payment was unanticipated, the recipient shall reimburse the program for only those benefits that were paid by the program after the recipient received the unanticipated payment.
c. If the department determines that the payment was not unanticipated, the recipient shall reimburse the program for all benefits that were paid by the program in the calendar year in which the payment was received.
d. Within 30 days of receipt of a determination by the department that the payment was not unanticipated, a recipient may request a hearing, which shall be conducted pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.).
e. Nothing in this section shall preclude a recipient from reapplying for benefits in the calendar year following the year in which the recipient notified the department pursuant to subsection a. of this section.
L.2003, c.281, s.2; amended 2012, c.17, s.385.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-39 - Other programs

30:4D-39. Other programs
a. If an otherwise eligible person's hearing aid costs are covered in whole by any other State or federal government program or insurance contract, the person is not eligible for hearing aid assistance under this act.
b. If an eligible person's hearing aid costs are covered in part by any other State or federal government program or insurance contract, the person may be entitled to receive a reduced hearing aid assistance under this act.
L. 1987, c. 298, s. 4.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-40 - Payment system; eligibility determination

30:4D-40. Payment system; eligibility determination
The Commissioner of Human Services shall by regulation establish a system for issuing payments to eligible persons and a system for determining eligibility which includes provisions for submitting proof of an applicant's actual and anticipated annual income, evidence of complete or partial coverage of hearing aid costs by any other government program or insurance contract and actual hearing aid costs incurred during the year.
L. 1987, c. 298, s. 5.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-41 - Rules, regulations

30:4D-41. Rules, regulations
The Commissioner of Human Services shall, pursuant to the "Administrative Procedure Act," P.L.1968, c. 410 (C. 52:14B-1 et seq.) adopt rules and regulations necessary to carry out the purposes of this act.
L. 1987, c. 298, s. 6.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-42 - Casino revenue funding

30:4D-42. Casino revenue funding
The Hearing Aid Assistance for the Aged and Disabled Program shall be funded by the Casino Revenue Fund created pursuant to section 145 of P.L.1977, c. 110 (C. 5:12-145).
L. 1987, c. 298, s. 7.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-44 - Definitions regarding the "Senior Gold Prescription Discount Act."

30:4D-44 Definitions regarding the "Senior Gold Prescription Discount Act."
2. As used in this act:
"Commissioner" means the Commissioner of Human Services.
"Department" means the Department of Human Services.
"PAAD" means the program of pharmaceutical assistance to the aged and disabled established pursuant to P.L.1975, c.194 (C.30:4D-20 et seq.).
"Prescription drug" means any legend drug which is covered by PAAD.
"Program" means the "Senior Gold Prescription Discount Program" established pursuant to this act.
"Reasonable cost" means the cost of a prescription drug as established for PAAD.
"Resident" means a resident as defined in section 3 of P.L.1975, c.194 (C.30:4D-22) for purposes of eligibility for PAAD.
L.2001, c.96, s.2; amended 2012, c.17, s.386.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-45a - Senior Gold Prescription Discount Program, reimbursement, prescription drug costs, remainder.

30:4D-45a Senior Gold Prescription Discount Program, reimbursement, prescription drug costs, remainder.
5. In addition to the reimbursement required pursuant to subsection g. of section 3 of P.L.2001, c.96 (C.30:4D-45), any eligible person under the Senior Gold Prescription Discount Program, upon receiving proof of eligibility from the department and submitting proof of expenditure to the department, as the department may prescribe, shall be reimbursed for the remainder of the costs of all prescription drugs purchased by such person in an amount equal to the value of the benefit the person would have received had that person been enrolled in the Senior Gold Prescription Discount Program at the time of purchase, minus the required copayment per prescription, during the period commencing 30 days before such person's properly completed application was received by the department and ending on the date on which such person received proof of eligibility from the department; provided, however, that no reimbursement under this section shall be made for any prescription drug purchased prior to the first day of the fourth month next following the effective date of sections 2 through 6 of P.L.2023, c.79 (C.30:4D-22.4 et al.).
L.2023, c.79, s.5.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-45.1 - "Senior Gold Prescription Discount Program," notification as to error in estimated annual income.

30:4D-45.1 "Senior Gold Prescription Discount Program," notification as to error in estimated annual income.
3. a. Notwithstanding the provisions of any other law to the contrary, a recipient of benefits under the "Senior Gold Prescription Discount Program," established pursuant to P.L.2001, c.96 (C.30:4D-43 et seq.), shall notify the Department of Human Services if the recipient unintentionally errs in estimating annual income to determine eligibility for the program due to an unanticipated payment which would render the recipient ineligible for the program. Notification to the department shall be made in the time and manner prescribed by the department.
b. If the department determines that the payment was unanticipated, the recipient shall reimburse the program for only those benefits that were paid by the program after the recipient received the unanticipated payment.
c. If the department determines that the payment was not unanticipated, the recipient shall reimburse the program for all benefits that were paid by the program in the calendar year in which the payment was received.
d. Within 30 days of receipt of a determination by the department that the payment was not unanticipated, a recipient may request a hearing, which shall be conducted pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.).
e. Nothing in this section shall preclude a recipient from reapplying for benefits in the calendar year following the year in which the recipient notified the department pursuant to subsection a. of this section.
L.2003, c.281, s.3; amended 2012, c.17, s.388.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-45.3 - Community retail pharmacy practice site, display, Senior Gold Prescription Discount Program information.

30:4D-45.3 Community retail pharmacy practice site, display, Senior Gold Prescription Discount Program information.
3. Notwithstanding any other provision of law to the contrary, a community retail pharmacy practice site shall prominently display at the point of sale for pharmaceuticals signage or promotional materials, promulgated by the Commissioner of Human Services, providing information about the "Senior Gold Prescription Discount Program" established pursuant to P.L.2001, c.96 (C.30:4D-43 et seq.). Payments to the pharmacy pursuant to subsection c. of section 3 of P.L.2001, c.96 (C.30:4D-45) may be withheld for any day that the pharmacy fails to display the signage or promotional materials required under this section, as determined by the commissioner.
L.2023, c.79, s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-46 - Report to Governor, Legislature

30:4D-46. Report to Governor, Legislature
4. The commissioner shall annually report to the Governor and the Legislature on the operations of the program and shall include with that report any recommendations for legislative action that the commissioner deems appropriate.
L.2001,c.96,s.4.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-47 - Violations of act; program identification cards

30:4D-47. Violations of act; program identification cards
5. a. A person violating any provision of this act shall be subject to the applicable civil and criminal penalties provided in P.L.1968, c.413 (C.30:4D-1 et seq.). An eligible person who violates any provision of this act shall be subject to a suspension of the person's eligibility for the program for one year for a first offense and a permanent revocation of the person's eligibility for a second offense.
b. The commissioner shall include on the program identification cards issued pursuant to subsection h. of section 3 of this act a conspicuous notice of the penalties for violating the provisions of this act.
L.2001,c.96,s.5.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-48 - New Jersey EASE program, provide information on prescription program

30:4D-48. New Jersey EASE program, provide information on prescription program
6. The New Jersey EASE program established by the department shall provide information and assistance to members of the public and potential or actual applicants to the program, including, but not limited to, making general information about the program available to the public Statewide, answering specific inquiries about the program, assisting interested persons to ascertain their eligibility for the program or other State-funded prescription drug benefits, and further assisting program applicants to complete their application as necessary.
L.2001,c.96,s.6.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-48.1 - Senior Gold prescription program information displayed on tax return instructions.

30:4D-48.1 Senior Gold prescription program information displayed on tax return instructions.
1. The Director of the Division of Taxation in the Department of the Treasury shall prominently display the eligibility qualifications for and benefits available under the "Senior Gold Prescription Discount Program," established pursuant to P.L.2001, c.96 (C.30:4D-43 et seq.), in the accompanying instruction booklet that the division makes available annually, whether electronically or in print, to taxpayers for the purpose of filing the gross income tax under the "New Jersey Gross Income Tax Act," N.J.S.54A:1-1 et seq., commencing with the instruction booklet for the purpose of filing the New Jersey gross income tax for calendar year 2011. The director shall have the discretion to determine the placement of this information within the instruction booklet, which shall include the telephone number to call for information about the Senior Gold Prescription Discount Program.
L.2011, c.131, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-49 - Funding of Senior Gold Prescription Discount Program

30:4D-49. Funding of Senior Gold Prescription Discount Program
7. The program shall be funded from the monies made available to the State from tobacco companies under the nationwide settlement of the respective actions by state governments against those companies, entered into by the State in the Master Settlement Agreement in State of New Jersey v. R.J. Reynolds Tobacco Company, et al., Superior Court, Chancery Division, Middlesex County, No. C-254-96.
L.2001,c.96,s.7.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-50 - Rules, regulations.

30:4D-50 Rules, regulations.
8. The Commissioner of Human Services, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations to effectuate the purposes of this act.
L.2001, c.96, s.8; amended 2012, c.17, s.389.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-51 - Conditions on expending funds.

30:4D-51 Conditions on expending funds.
9. Notwithstanding the provisions of any law to the contrary, no funds appropriated for the Senior Gold Prescription Discount Program established pursuant to this act shall be expended unless participating pharmaceutical manufacturing companies execute contracts with the Department of Human Services providing for the payment of rebates to the State under terms substantially similar to those of rebate payment contracts under PAAD, provided that the manufacturer's rebates for the Senior Gold Prescription Discount Program shall apply only to the amount paid by the State under the program.
L.2001, c.96, s.9; amended 2012, c.17, s.390.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-52 - Rebates to DHS for program.

30:4D-52 Rebates to DHS for program.
10. Amounts received as rebates under rebate payment contracts executed pursuant to section 9 of this act are appropriated to the Department of Human Services for the support of the Senior Gold Prescription Discount Program.
L.2001, c.96, s.10; amended 2012, c.17, s.391.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-54 - Findings, declarations relative to the Office of Medicaid Inspector General.

30:4D-54 Findings, declarations relative to the Office of Medicaid Inspector General.
2. The Legislature finds and declares that:
a. The State of New Jersey expends more than $9 billion in taxpayer funds to fund the Medicaid program each year;
b. The State has a continuing responsibility to ensure that funds expended under the Medicaid program are used appropriately and efficiently to promote the public health;
c. Fraud, waste, and abuse by providers and recipients in the Medicaid program reduces the ability of the State to properly fund the program and results in harm to the health of the citizens of this State;
d. Controlling fraud, waste, and abuse in the Medicaid program includes preventing, detecting, and investigating such fraud, waste, and abuse, and referring it for civil or criminal action when appropriate;
e. The current system for controlling Medicaid fraud, waste, and abuse is based largely on formal and informal agreements among the Department of Human Services, the Medicaid Fraud Control Unit of the Department of Law and Public Safety, the Department of Health and other local, State, and federal agencies whose clients are served by the Medicaid program or who are otherwise responsible for the control of Medicaid fraud, waste, and abuse;
f. Centralizing fraud recovery efforts and establishing an independent Office of the Medicaid Inspector General by statute to prevent, detect, and investigate fraud and abuse and coordinate the anti-fraud efforts of all State agencies funded by Medicaid will enhance the efforts of the State to control Medicaid costs;
g. The current efforts to control Medicaid fraud, waste, and abuse in New Jersey range from investigating providers before they enroll in the Medicaid program to identifying fraud, waste, and abuse on the part of both providers and recipients;
h. Changes in federal and State law, as well as in the health care industry and in available technology, suggest that it is time for a comprehensive review of the Medicaid fraud, waste, and abuse control infrastructure in this State;
i. Toward that end, the Governor has appointed the New Jersey Commission on Government Efficiency and Reform to evaluate the budget, structure, and organization of government in New Jersey, including State agencies, instrumentalities and independent authorities, local and county government and school districts, and advise the Governor on governmental restructuring, effectiveness, best practices, efficiencies, cost-saving measures, and how best to achieve economies of scale in the delivery of services and programs, at the lowest possible cost, consistent with mission and quality; and
j. While the State examines and prepares to implement such fundamental, long-term structural changes, the immediate coordination of State efforts to control Medicaid fraud, waste, and abuse at all levels of government is essential.
L.2007, c.58, s.2; amended 2012, c.17, s.392.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-55 - Definitions relative to the Office of the Medicaid Inspector General.

30:4D-55 Definitions relative to the Office of the Medicaid Inspector General.
3. As used in this act:
"Abuse" means provider practices that are inconsistent with sound fiscal, business, or medical practices and result in unnecessary costs to Medicaid or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. The term also includes recipient practices that result in unnecessary costs to Medicaid.
"Department" means the Department of Human Services.
"Fraud" means an intentional deception or misrepresentation made by any person with the knowledge that the deception could result in some unauthorized benefit to that person or another person, including any act that constitutes fraud under applicable federal or State law.
"Investigation" means an investigation of fraud, waste, abuse, or illegal acts perpetrated within Medicaid by providers or recipients of Medicaid care, services, and supplies.
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) and the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.).
"Medicaid Fraud Control Unit" means the Medicaid Fraud Control Unit in the Department of Law and Public Safety.
"Office" means the Office of the Medicaid Inspector General created by this act.
L.2007,c.58,s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-58 - Additional authority of the Medicaid Inspector General.

30:4D-58 Additional authority of the Medicaid Inspector General.
6. a. In addition to the authority otherwise provided by this act, the Medicaid Inspector General is authorized to request, and shall be entitled to receive, such information, assistance, and cooperation from any federal, State, or local government department, board, bureau, commission, or other agency or unit thereof, as may be necessary to carry out his duties and responsibilities pursuant to this act.
b. Upon the request of a prosecutor of competent jurisdiction, the office, department, any other State or local government entity, and the Medicaid Fraud Control Unit shall provide the prosecutor with information, data, assistance, staff, and other resources as shall be necessary, appropriate and available to aid and facilitate the investigation and prosecution of Medicaid fraud.
L.2007,c.58,s.6.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-59 - Transfer of certain functions, powers, employees.

30:4D-59 Transfer of certain functions, powers, employees.
7. a. The Medicaid audit, program integrity, fraud, and abuse prevention and recovery functions, all officers and employees that the Medicaid Inspector General deems qualified and substantially engaged therein, and any documents and records that the Medicaid Inspector General deems necessary and related to the transfer of such functions and personnel, shall be transferred to the Office of the Medicaid Inspector General from the Medicaid Office of Program Integrity Unit and the Third Party Liability Unit in the Division of Medical Assistance and Health Services, the Division of Aging Services, the Division of Disability Services, the Division of Developmental Disabilities, the Division of Mental Health and Addiction Services, the Division of Child Protection and Permanency, the Division of Child Behavioral Health Services, the Department of Health and the Department of the Treasury. The Medicaid Inspector General shall consult with the head of each department or agency from which such function is to be transferred to determine the officers and employees to be transferred.
b. The Medicaid Inspector General shall have general managerial control over the office and shall establish the organizational structure of the office as the Medicaid Inspector General deems appropriate to carry out the responsibilities and functions of the office. Within the limits of funds appropriated therefor, the Medicaid Inspector General may hire such employees in the unclassified service as are necessary to administer the office. These employees shall serve at the pleasure of the Medicaid Inspector General. Subject to the availability of appropriations, the Medicaid Inspector General may obtain the services of certified public accountants, qualified management consultants, professional auditors, or other professionals necessary to independently perform the functions of the office.
L.2007, c.58, s.7; amended 2012, c.16, s.115; 2012, c.17, s.394.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-60 - Reports, recommendations.

30:4D-60 Reports, recommendations.
8. a. The Medicaid Inspector General shall report the findings of audits, investigations, and reviews performed by the office, and issue recommendations for corrective or remedial action, to the Governor, the President of the Senate and the Speaker of the General Assembly, and the entity at issue. The Medicaid Inspector General shall monitor the implementation of those recommendations.
b. The Medicaid Inspector General shall provide periodic reports to the Governor, and shall issue an annual report to the Governor, and to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), which shall be available to the public.
L.2007,c.58,s.8.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-61 - Confidentiality of information.

30:4D-61 Confidentiality of information.
9. a. The Medicaid Inspector General shall not publicly disclose information that is specifically prohibited from disclosure by any provision of federal or State law.
b. Whenever a person requests access to a government record that the Medicaid Inspector General obtained from another public agency during the course of an investigation, which record was open for public inspection, examination or copying before the investigation commenced, the public agency from which the Medicaid Inspector General obtained the record shall comply with the request if made pursuant to P.L.1963, c.73 (C.47:1A-1 et seq.) and P.L.2001, c.404 (C.47:1A-5 et al.), provided that the request does not in any way identify the record sought by means of a reference to the Medicaid Inspector General's investigation or to an investigation by any other public agency, including, but not limited to, a reference to a subpoena issued pursuant to such investigation.
L.2007,c.58,s.9.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-62 - "Medicaid Fraud Control Fund"; use.

30:4D-62 "Medicaid Fraud Control Fund"; use.
10. a. There is established the "Medicaid Fraud Control Fund" as a nonlapsing, revolving fund in the Department of the Treasury. The fund shall be comprised of monies credited or accruing to the fund pursuant to this section.
b. Beginning with the fiscal year commencing July 1, 2007, the State Treasurer shall deposit 25% of the State share of monies recovered pursuant to subsection d. of section 5 of this act into the fund, to be used solely for the purposes of subsection c. of this section. Monies credited to the fund may be invested in the same manner as assets of the General Fund, and any investment earnings on the fund shall accrue to the fund and shall be available subject to the same terms and conditions as other monies in the fund.
c. In addition to the annual appropriation provided pursuant to section 13 of this act, the monies deposited into the "Medicaid Fraud Control Fund" shall be utilized by the Medicaid Inspector General and the Medicaid Fraud Control Unit for the exclusive purpose of investigating and prosecuting Medicaid fraud claims.
L.2007,c.58,s.10.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-63 - Rules, regulations.

30:4D-63 Rules, regulations.
11. The Medicaid Inspector General may adopt rules and regulations, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), necessary to accomplish the objectives and carry out the duties prescribed by this act.
L.2007,c.58,s.11.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-64 - Annual appropriation, minimum required.

30:4D-64 Annual appropriation, minimum required.
13. For each fiscal year beginning after the fiscal year in which this act takes effect, the Governor shall recommend and the Legislature shall appropriate at least $3,000,000 from the General Fund to the Office of the Medicaid Inspector General to effectuate the purposes of this act.
L.2007,c.58,s.13.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-65 - Findings, declarations relative to the "iPHD Project."

30:4D-65 Findings, declarations relative to the "iPHD Project."
1. The Legislature finds and declares that:
a. Many New Jersey administrative departments and agencies, including, but not limited to, the Departments of Health, Human Services, Community Affairs, Corrections, and Agriculture, currently create, maintain, receive, and transmit individually identifiable data and aggregated data sets in order to perform necessary and vital administrative functions delegated to the agencies.
b. The creation of a process by which a State or federal administrative department or agency or an authorized researcher can access data and data sets created or maintained by a federal, State, or local administrative department or agency will help facilitate the development and evaluation of this data, reduce duplicative data collection and maintenance efforts, and allow for comparison of data for accuracy and reliability.
c. The linkage of multiple sources of State, federal, and local data and the application of valid statistical techniques can facilitate the identification of population trends and individual and community-level determinants directly related to the health, safety, security, and well-being of New Jersey residents.
d. The establishment of a secure, Statewide, integrated Population Health Data Project ("iPHD Project)" containing certain data collected by New Jersey administrative departments and agencies, that includes data related to health and publicly supported programs that will facilitate approved, project-by-project analysis and research and the development of the most effective means for improving the health, safety, security, and well-being of New Jersey residents and the overall cost-efficiency of government programs.
e. The Medicaid Accountable Care Organization Demonstration Project established pursuant to P.L.2011, c.114 (C.30:4D-8.1 et seq.) requires the Rutgers Center for State Health Policy to analyze patient data received from the Department of Human Services and from certified Medicaid Accountable Care Organizations in order to evaluate the achievement of the health care quality improvement and cost containment goals of the Demonstration Project, and the Rutgers Center for State Health Policy currently has the technological and operational resources required to receive, maintain, and transmit individually identifiable data and data sets in a secure database.
f. The Rutgers Center for State Health Policy is responsible for evaluating New Jersey's Comprehensive Medicaid Waiver Demonstration Project with funding from the New Jersey Department of Human Services and the Robert Wood Johnson Foundation, whereby it receives comprehensive Medicaid enrollment data, fee-for-service claims data, and managed care encounter data, and conducts analyses of Medicaid claims and encounter data to inform recommendations to improve care and reduce costs for the top one percent of Medicaid beneficiaries who account for a disproportionate share of program spending.
L.2015, c.193, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-68 - Establishment of operational iPHD project.

30:4D-68 Establishment of operational iPHD project.
4. a. No later than 12 months after the effective date of this act, the Rutgers Center for State Health Policy shall establish an operational iPHD Project capable of securely receiving, maintaining, and transmitting data in accordance with this act and the HIPAA privacy and security standards applicable to this act. The Rutgers Center for State Health Policy may employ staff to assist with carrying out the functions associated with the establishment and maintenance of the iPHD Project.
b. Notwithstanding any provision of this act to the contrary, the iPHD Project shall seek to receive, maintain, and transmit de-identified data wherever possible, and shall only receive, maintain, and transmit individually identifiable information if permitted by this section and other applicable law and if the information is in a form and format that is secured to prevent disclosure of individually identifiable information.
c. A consortium of researchers from New Jersey academic institutions and from medical schools affiliated with New Jersey universities will be organized by the Rutgers Center for State Health Policy to facilitate actionable population health research to help improve health outcomes for New Jersey residents, as well as promote New Jersey's research institutions as leaders in social science research.
L.2015, c.193, s.4.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-70 - Annual report.

30:4D-70 Annual report.
6. No later than 12 months following the receipt of data by the iPHD Project pursuant to this act, and on an annual basis thereafter, the Rutgers Center for State Health Policy, in consultation with the Governing Board, shall publish a report that is made available and accessible to the public and that contains the following information:
a. A description of the implementation of the iPHD Project, including identification of the sources and types of data received and maintained by the iPHD Project over the prior 12 months;
b. A list of all aggregated data maintained by the iPHD Project;
c. A description of each IRB-approved disclosure of data or data sets by the iPHD Project;
d. A description of disclosures to Medicaid Accountable Care Organizations recognized by the State in accordance with P.L.2011, c.114 (C.30:4D-8.1 et seq.);
e. A list of publications and other reports based on iPHD Project data;
f. A strategic plan for achieving the purposes of this act during the successive 12 month period; and
g. Any other information deemed appropriate by the Governing Board.
L.2015, c.193, s.6.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-71 - Application for, receipt of funding.

30:4D-71 Application for, receipt of funding.
7. The iPHD Project Governing Board and the Rutgers Center for State Health Policy may apply for and receive funding in relation to the iPHD Project from the following sources:
a. Grants from research or other private entities;
b. Fees paid by persons or entities requesting access to iPHD Project data or the performance of analyses by the iPHD Project, which fees have been approved by the Governing Board to support the cost of preparing data for access or the performance of analyses;
c. Federal grants; and
d. Grants or other financial assistance from State or local departments, agencies, authorities, and organizations at the discretion of these entities, for specific projects of interest to these entities.
L.2015, c.193, s.7.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-72 - Access to data, agreement.

30:4D-72 Access to data, agreement.
8. Any department or agency that creates, receives, or maintains publicly supported programs data or health data shall, only after execution of an enforceable data use, data sharing, or other similar agreement that is acceptable to the department or agency, transmit or allow access to such data as is necessary and appropriate to further the goals of this act and shall cooperate with iPHD Project requests for receipt of, or access to, such data. Notwithstanding the foregoing, no department or agency shall be required to transmit data it creates, receives, or maintains to the iPHD Project, or to allow access to such data, if the Attorney General's review or the applicable department's or agency's review determines that such transmission or access would violate State or federal law. The Attorney General's review shall include consideration of an analysis from the department or agency whose data is being requested. This section shall not prohibit the Rutgers Center for State Health Policy or any department or agency from creating, receiving, maintaining, or transmitting data in data systems that are separate and distinct from the iPHD Project.
L.2015, c.193, s.8.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4E-1 - Legislative findings and declaration

30:4E-1. Legislative findings and declaration
The Legislature hereby finds and declares that the effective and appropriate provision of home health care and homemaker services to persons in their homes can be an important step toward eliminating not only the nursing home bed shortage which currently exists in this State but also preventing the inappropriate placement of our citizens into other forms of institutional care.
Although there exists in this State a large number of agencies providing home health care and homemaker services, there also exists the problem of severe service fragmentation. There are different types of agencies, providing somewhat different services, subjected to different State and Federal regulations, and eligible for different sources of reimbursement. This fragmentation has in fact meant that to date home health care has not been able to reach its full potential as an integral part of the health care delivery system.
The Legislature finds therefore that there is a tremendous need for greater coordination and information in the home health care field. There needs to be effected not only coordination of the services rendered by home health care and homemaker agencies, but also some coordination of the often conflicting State and Federal regulations. Only through such coordination will home health care and homemaker agencies be able to render an adequate array of services to patients in their homes, thereby avoiding prolonged institutionalization, concomitant high costs and associated adverse social and medical implications.
L.1980, c. 35, s. 1, eff. June 12, 1980.