reglab/statecodes huggingface dataset:
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.10 - Findings, declarations

30:4D-17.10. Findings, declarations
The Legislature finds and declares that:
a. A substantial proportion of nursing home residents do not need the level of medical care provided in skilled nursing or intermediate care facilities, and to the extent these inappropriate placements occur, there are adverse financial and social consequences;
b. After entering a nursing home, many residents become dependent on that facility, experiencing depletion of their financial resources and erosion of their social contacts in the community;
c. Inappropriate placements of residents in skilled nursing or intermediate care facilities result in reduced access to available beds for those Medicaid recipients who are actually in need of nursing home care;
d. It is, therefore, in the best interests of the citizens of New Jersey that a nursing home preadmission screening program, as currently operates in 30 other states, be established Statewide to determine the needs of Medicaid-eligible and other individuals seeking admission to a skilled nursing or intermediate care facility, prior to placement in that facility.
L. 1988, c. 97, s. 1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.11 - Definitions

30:4D-17.11. Definitions
As used in this act:
a. "Commissioner" means the Commissioner of the Department of Human Services.
b. "Division" means the Division of Medical Assistance and Health Services in the Department of Human Services.
c. "Preadmission screening" means: (1) an initial evaluation to determine eligibility for the preadmission screening program;
(2) preparation of an assessment of the individual's need for care in a skilled nursing or intermediate care facility and of the individual's formal and informal support systems; and (3) preparation of an initial care plan and arrangement of, or referral to, needed services.
L. 1988, c. 97, s. 2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.12 - Nursing Home Preadmission Screening Program

30:4D-17.12. Nursing Home Preadmission Screening Program
The commissioner shall establish a Nursing Home Preadmission Screening Program in the division, which shall be operational to serve each county in the State no later than one year after the effective date of this act.
The commissioner, in consultation with the Commissioners of the Departments of Health and Community Affairs, and with other agencies of State government, as appropriate, shall develop standards for preadmission screening.
L. 1988, c. 97, s. 3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.13 - Responsibility for preadmission screening

30:4D-17.13. Responsibility for preadmission screening
A skilled nursing or intermediate care facility is responsible for ensuring that preadmission screening has been performed with respect to every individual who, at the time of application for admission to that facility, is eligible for medical assistance under P.L. 1968, c. 413 (C. 30:4D-1 et seq.) or will become eligible within six months following admission, as a condition of reimbursement by the Medicaid program established pursuant to P.L. 1968, c. 413 (C. 30:4D-1 et seq.) for care provided to the individual in that facility.
L. 1988, c. 97, s. 4.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.14 - Procedures for preadmission screening

30:4D-17.14. Procedures for preadmission screening
a. The commissioner shall contract with appropriate agencies for the performance of preadmission screening or perform the screening directly through the division. Preadmission screening shall be made available, upon request and for a reasonable fee to be established by the commissioner, to a private pay individual, whether or not the individual expects to become eligible for the Medicaid program.
b. The commissioner shall develop procedures for monitoring the preadmission screening program, for which purpose the commissioner may establish an independent review process, to ensure that screening standards are being met by the division or by those agencies which are under contract to perform preadmission screening pursuant to subsection a. of this section.
L. 1988, c. 97, s. 5.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.15 - Rules, regulations

30:4D-17.15. Rules, regulations
The commissioner, in accordance with the "Administrative Procedure Act," P.L. 1968, c. 410 (C. 52:14B-1 et seq.), shall adopt such rules and regulations as are necessary to effectuate the purposes of this act.
L. 1988, c. 97, s. 6.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.18a - Rules, regulations.

30:4D-17.18a Rules, regulations.
4. The Commissioner of Human Services, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), and subject to the approval of the Commissioner of Health as appropriate, shall adopt rules and regulations to effectuate the purposes of P.L.1993, c.16 (C.30:4D-17.16 et seq.) and section 2 of P.L.1998, c.41 (C.30:4D-17.17a); except that, notwithstanding any provision of P.L.1968, c.410 (C.52:14B-1 et seq.) to the contrary, the Commissioner of Human Services, may adopt, immediately upon filing with the Office of Administrative Law, such regulations as the commissioner deems necessary to implement the provisions of P.L.1993, c.16 (C.30:4D-17.16 et seq.) and section 2 of P.L.1998, c.41 (C.30:4D-17.17a), which shall be effective for a period not to exceed six months and may thereafter be amended, adopted or re-adopted by the Commissioner of Human Services, in accordance with the requirements of P.L.1968, c.410 (C.52:14B-1 et seq.).
L.1998, c.41, s.4; amended 2012, c.17, s.372.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.19 - HMOs, certain, to contract for services provided at certain Newark schools

30:4D-17.19. HMOs, certain, to contract for services provided at certain Newark schools
1. Every health maintenance organization under contract with the Division of Medical Assistance and Health Services in the Department of Human Services that provides health care services to residents of Essex county shall contract with the Children's Hospital of New Jersey at Newark Beth Israel Medical Center for the provision of primary health care, including Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services, and dental services to be provided at designated schools in the City of Newark. Health maintenance organizations and the Children's Hospital of New Jersey shall establish the rates of reimbursement for the health care services, except that the rates shall not be less than the median rates that the health maintenance organization currently reimburses primary health care and dental providers in Essex county.
L.2001,c.333,s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.20 - Written informed parental consent

30:4D-17.20. Written informed parental consent
2. The Children's Hospital of New Jersey shall obtain written informed consent of a parent or guardian for the provision of primary health care and dental services prior to providing any health care services to a child at a designated school pursuant to this act.
L.2001,c.333,s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.21 - Approval as provider of psychological services

30:4D-17.21. Approval as provider of psychological services
3. The Division of Medical Assistance and Health Services in the Department of Human Services shall approve the Children's Hospital of New Jersey as a participating provider of psychological services under the Medicaid program pursuant to this act.30:4D-17.22. Compliance with licensure, Medicaid requirements; authorization
L.2001,c.333,s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.22 - Compliance with licensure, Medicaid requirements; authorization

30:4D-17.22. Compliance with licensure, Medicaid requirements; authorization
4. a. The Children's Hospital of New Jersey shall comply with all State licensure and Medicaid requirements before any health care services may be provided at the designated schools pursuant to this act.
b. The Children's Hospital of New Jersey shall obtain authorization in writing from the Newark Board of Education to provide health care services at designated schools pursuant to this act.
L.2001,c.333,s.4.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.25 - Definitions relative to long-term care for Medicaid recipients.

30:4D-17.25 Definitions relative to long-term care for Medicaid recipients.
3. As used in this act:
"Commissioner" means the Commissioner of Human Services.
"Funding parity between nursing home care and home and community-based care" means that the distribution of the amounts expended for these two categories of long-term care under the Medicaid program reflects an appropriate balance between the service delivery costs of those persons whose needs and preferences can most appropriately be met in a nursing home and those persons whose needs and preferences can most appropriately be met in a home or community-based setting.
"Home and community-based care" means Medicaid home and community-based long-term care options available in this State, including, but not limited to, the Global Options Waiver, Adult Day Health Services, Traumatic Brain Injury, AIDS Community Care Alternatives Program, Community Resources for People with Disabilities, and Community Resources for People with Disabilities Private Duty Nursing.
L.2006, c.23, s.3; amended 2012, c.17, s.374.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.27 - Duties of commissioner relative to report on budget, management plan.

30:4D-17.27 Duties of commissioner relative to report on budget, management plan.
5. The commissioner, in consultation with the Medicaid Long-Term Care Funding Advisory Council established pursuant to this act, shall:
a. no later than October 1, 2007, present a report to the Governor, and to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), that provides a detailed budget and management plan for effectuating the purposes of this act, including a projected schedule and procedures for the implementation and operation of the Medicaid long-term care expenditure reforms required pursuant thereto; and
b. no later than January 1, 2008, present a report to the Governor, and to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), that documents the reallocation of funds to home and community-based care pursuant to section 4 of this act, and present an updated report no later than January 1 of each succeeding year until the commissioner determines that total Medicaid expenditures for long-term care have been sufficiently rebalanced to achieve funding parity between nursing home care and home and community-based care, at which point the commissioner shall document and certify to the Governor and the Legislature that such funding parity has been achieved.
L.2006, c.23,s.5.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.28 - Duties of commissioner relative to funding parity, coordination, assessment instrument.

30:4D-17.28 Duties of commissioner relative to funding parity, coordination, assessment instrument.
6. The commissioner, in consultation with the Medicaid Long-Term Care Funding Advisory Council established pursuant to this act, shall:
a. Implement, by such time as the commissioner certifies to the Governor and the Legislature that funding parity has been achieved pursuant to subsection b. of section 5 of this act, a comprehensive data system to track long-term care expenditures and services and consumer profiles and preferences. The data system shall include, but not be limited to: the number of vacant nursing home beds annually and the number of nursing home residents transferred to home and community-based care pursuant to this act; annual long-term care expenditures for nursing home care and each of the home and community based long-term care options available to Medicaid recipients; and annual percentage changes in both long-term care expenditures for, and the number of Medicaid recipients utilizing, nursing home care and each of the home and community based long-term care options, respectively;
b. Commence the following no later than January 1, 2008:
(1) implement a system of Statewide long-term care service coordination and management designed to minimize administrative costs, improve access to services, and minimize obstacles to the delivery of long-term care services to people in need;
(2) identify home and community based long-term care service models that are determined by the commissioner to be efficient and cost-effective alternatives to nursing home care, and develop clear and concise performance standards for those services for which standards are not already available in a home and community-based services waiver;
(3) develop and implement a comprehensive consumer assessment instrument that is designed to facilitate an expedited process to authorize the provision of home and community-based care to a person through fast track eligibility prior to completion of a formal financial eligibility determination; and
(4) develop and implement a comprehensive quality assurance system with appropriate and regular assessments that is designed to ensure that all forms of long-term care available to consumers in this State are financially viable, cost-effective, and promote and sustain consumer independence; and
c. Seek to make information available to the general public on a Statewide basis, through print and electronic media, regarding the various forms of long-term care available in this State and the rights accorded to long-term care consumers by statute and regulation, as well as information about public and nonprofit agencies and organizations that provide informational and advocacy services to assist long-term care consumers and their families.
L.2006, c.23, s.6; amended 2012, c.17, s.376.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.29 - Medicaid Long-Term Care Funding Advisory Council.

30:4D-17.29 Medicaid Long-Term Care Funding Advisory Council.
7. a. There is established the Medicaid Long-Term Care Funding Advisory Council within the Department of Human Services. The advisory council shall meet at least quarterly during each fiscal year until such time as the commissioner certifies to the Governor and the Legislature that funding parity has been achieved pursuant to subsection b. of section 5 of this act, and shall be entitled to receive such information from the Departments of Health, Human Services, and the Treasury as the advisory council deems necessary to carry out its responsibilities under this act.
b. The advisory council shall:
(1) monitor and assess, and advise the commissioner on, the implementation and operation of the Medicaid long-term care expenditure reforms and other provisions of this act; and
(2) develop recommendations for a program to recruit and train a stable workforce of home care providers, including recommendations for changes to provider reimbursement under Medicaid home and community-based care programs.
c. The advisory council shall comprise 14 members as follows:
(1) the commissioner and the State Treasurer, or their designees, as ex officio members; and
(2) 12 public members to be appointed by the commissioner as follows: one person appointed upon the recommendation of AARP; one person upon the recommendation of the New Jersey Association of Area Agencies on Aging, one person upon the recommendation of the New Jersey Association of County Offices for the Disabled; one person upon the recommendation of the Health Care Association of New Jersey; one person upon the recommendation of the New Jersey Association of Non-Profit Homes for the Aging; one person upon the recommendation of the New Jersey Hospital Association; one person upon the recommendation of the Rutgers Center for State Health Policy; one person upon the recommendation of the New Jersey Elder Rights Coalition; one person upon the recommendation of the County Welfare Directors Association of New Jersey; one person upon the recommendation of the New Jersey Adult Day Services Association; one person upon the recommendation of a labor union that represents home and community-based health care workers; and one person who is a representative of the home care industry.
d. The advisory council shall organize as soon as possible after the appointment of its members, and shall annually select from its membership a chairman who shall serve until his successor is elected and qualifies. The members shall also select a secretary who need not be a member of the advisory council.
e. The department shall provide such staff and administrative support to the advisory council as it requires to carry out its responsibilities.
L.2006, c.23, s.7; amended 2012, c.17, s.377.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.30 - Waiver of federal requirements.

30:4D-17.30 Waiver of federal requirements.
8. The Commissioner of Human Service shall apply to the federal Centers for Medicare & Medicaid Services for any waiver of federal requirements, or for any State plan amendments or home and community-based services waiver amendments, which may be necessary to obtain federal financial participation for State Medicaid expenditures in order to effectuate the purposes of this act.
L.2006, c.23, s.8; amended 2012, c.17, s.378.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.31 - Tracking of expenditures.

30:4D-17.31 Tracking of expenditures.
9. The commissioner shall track Medicaid long-term care expenditures necessary to carry out the provisions of this act.
L.2006, c.23, s.9; amended 2012, c.17, s.379.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.32 - Inclusion of budget line for Medicaid long-term care expenditures.

30:4D-17.32 Inclusion of budget line for Medicaid long-term care expenditures.
10. There shall be included a unique global budget appropriation line item for Medicaid long-term care expenditures in the annual appropriations act for fiscal year 2008 and each succeeding fiscal year in order to provide flexibility to align these expenditures with services to be provided during each fiscal year as necessary to effectuate the purposes of this act.
L.2006, c.23,s.10.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.33 - Medicaid medical home demonstration project; terms defined.

30:4D-17.33 Medicaid medical home demonstration project; terms defined.
1. a. The Division of Medical Assistance and Health Services in the Department of Human Services, subject to federal approval and the availability of federal financial participation under Title XIX of the Social Security Act, shall establish a three-year Medicaid medical home demonstration project as provided in this act. The demonstration project shall be developed in consultation and implemented with the managed care organizations that contract with the Medicaid program to provide health care services to Medicaid recipients or with other appropriate vendors that contract with the Medicaid program to provide health care services to general public assistance recipients.
b. The Medicaid program shall:
(1) Consider payment methodologies that support care-coordination through multi-disciplinary teams, including payment for care of patients with chronic diseases and the elderly, and that encourage services such as: (a) patient or family education for patients with chronic diseases; (b) home-based services; (c) telephonic communication; (d) group care; (e) oral health examinations, when applicable; and (f) culturally and linguistically appropriate care. In addition, the payment system shall be structured to reward quality and improved patient outcomes;
(2) Develop a system to support primary care providers in developing an organizational structure necessary to provide a medical home; and
(3) Identify primary care providers for participation in the demonstration project that provide care to their patients using a medical home model, which at a minimum shall include primary care providers utilizing a multi-disciplinary team that provides patient-centered care coordination through the use of health information technology and chronic disease registries across the patient's life-span and across all domains of the health care system and the patient's community.
c. Nothing in this act shall be construed to limit the choice of a Medicaid or general public assistance recipient who is participating in the medical home demonstration project to directly access a qualified health care provider for family planning services who is not participating in the demonstration project.
d. Subject to the availability of federal matching funds, the Division of Medical Assistance and Health Services shall begin implementing the demonstration project no later than January 1, 2011.
e. As used in this act:
"General public assistance" means the Work First New Jersey General Public Assistance program established pursuant to P.L.1947, c.156 (C.44:8-107 et seq.);
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.); and
"Primary care provider" includes, but is not limited to, a primary care professional medical practice, a federally qualified or community health center, and a primary care outpatient clinic operated by a general hospital.
L.2010, c.74, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.34 - Annual evaluation.

30:4D-17.34 Annual evaluation.
2. The Director of the Division of Medical Assistance and Health Services shall evaluate the demonstration project annually to assess: whether cost savings are achieved through implementation of the medical home project; the rates of health screening; and the outcomes and hospitalization rates for persons with chronic illnesses, and the hospitalization and readmission rates for persons who are frail and elderly.
L.2010, c.74, s.2; amended 2017, c.131, s.119.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.35 - Application for plan amendments, waivers.

30:4D-17.35 Application for plan amendments, waivers.
3. 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.
L.2010, c.74, s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.36 - Annual report.

30:4D-17.36 Annual report.
4. The Commissioner of Human Services shall report annually to the Governor, and to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), on the findings and recommendations of the demonstration project.
L.2010, c.74, s.4.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.37 - Rules, regulations.

30:4D-17.37 Rules, regulations.
5. The Commissioner of Human Services shall, in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), adopt such rules and regulations as the commissioner deems necessary to carry out the provisions of this act.
L.2010, c.74, s.5.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.38 - Monitoring of long-term care services.

30:4D-17.38 Monitoring of long-term care services.
1. a. The Department of Human Services shall monitor the services provided to an individual receiving services under the Medicaid Managed Long Term Services and Supports section 1115 demonstration waiver, in accordance with this section.
b. In the case of an individual who receives services under one of these programs through a managed care organization, the department shall annually perform a review of a sample of the number of encounters the individual has had with the managed care organization in a given month, as compared with the services authorized for the individual by the program, to help ensure efficient utilization of services from the managed care organization.
c. In the case of an individual who receives services under one of these programs through a provider whose claims are processed by a third-party billing agent, the department shall require the third party-billing agent to annually perform a review of a sample of the provider's billing limits and the services provided to the individual, to help ensure that: services are provided if those services are authorized for the individual by the program; and claims are processed if those claims do not exceed the billing limits authorized for the individual by the program.
L.2015, c.153, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.39 - Medicaid home visitation demonstration project.

30:4D-17.39 Medicaid home visitation demonstration project.
1. a. The Department of Human Services, subject to federal approval and the availability of federal financial participation under Title XIX of the Social Security Act, shall establish a three-year Medicaid home visitation demonstration project. The demonstration project shall be designed to provide ongoing health and parenting information, parent and family support, and links to essential health and social services during pregnancy, infancy, and early childhood. The demonstration project shall be developed in consultation with the Department of Children and Families and the Department of Health.
b. The project shall be modeled on home visitation programs currently administered by the Department of Children and Families, the Department of Health, and the Division of Family Development in the Department of Human Services.
c. The project shall be implemented in stages, prioritizing expansion of services in counties with the highest number of births to eligible families and where current home visitation programs provide services to less than 10 percent of the eligible population.
L.2017, c.50, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.40 - Application for amendments, waivers.

30:4D-17.40 Application for amendments, waivers.
2. 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.
L.2017, c.50, s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.41 - Rules, regulations.

30:4D-17.41 Rules, regulations.
3. The Commissioner of Human Services, in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt such rules and regulations as the commissioner deems necessary to carry out the provisions of this act.
L.2017, c.50, s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-18 - Reporting and oversight

30:4D-18. Reporting and oversight
The commissioner shall report to the Governor and the Legislature, at least once each year, which report shall include a summary of its activities for the preceding year and any recommendations or suggestions for legislative consideration.
The commissioner shall meet at least once a year with representatives of the statewide recognized professional societies of each of the providers of all of the medical services for the purpose of hearing suggestions on a continuing basis for the improvement of the administration and operation of this act, the commissioner shall report these suggestions to the Governor and the Legislature.
The Legislature through the Senate and Assembly Standing Committees on Institutions and Welfare shall review, on a continuous basis, the development, administration and operation of the program provided for in this act. To facilitate this review and oversight, the commissioner shall submit to the committees the report provided for above, the report of the department's program for the progressive implementation of Medicaid in New Jersey and such other reports as shall be called for by the committees from time to time.
Periodically during a fiscal year and at least 30 days prior to announcing any modification of eligibility requirements under a categorical program, the Commissioner of Institutions and Agencies shall specially report to the Senate and Assembly standing committees on Institutions and Welfare, outlining in detail the proposed modifications, including estimates of the impact on the case loads and costs as to the program directly affected and on other categorical programs.
L.1968, c. 413, s. 18.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-19 - Severability clause

30:4D-19. Severability clause
If any provision of this act or the application thereof to any person or circumstance is held invalid, such invalidity shall not affect other provisions or applications of the act which can be given effect without the invalid provision or application, and to this end the provisions of this act are declared to be severable.
L.1968, c. 413, s. 19.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-19.2 - Findings, declarations relative to intergovernmental transfer program under Medicaid

30:4D-19.2. Findings, declarations relative to intergovernmental transfer program under Medicaid
1. The Legislature finds and declares that:
a. Federal law permits states to enhance existing federal financial participation under the Medicaid program through the use of intergovernmental transfers;
b. Participation in an intergovernmental transfer program by the State and certain governmental entities will enhance the health and welfare of the citizens of New Jersey by providing additional funds for health-related services; and
c. In order to secure the additional federal funds under the Medicaid program, it is the intent of this act to authorize and implement an intergovernmental transfer program.
L.2000, c.28, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-19.3 - Definitions relative to intergovernmental transfer program under Medicaid.

30:4D-19.3 Definitions relative to intergovernmental transfer program under Medicaid.
2. As used in this act:
"Bank" means a State or federally chartered bank, savings bank, or savings and loan association located in this State that is authorized to receive public funds and that is selected by the participating governmental entities to carry out the provisions of this act.
"Intergovernmental transfer" means the transfer of money to the State account by a participating governmental entity as contemplated by an intergovernmental transfer agreement.
"Intergovernmental transfer agreement" means an agreement among the State Treasurer, the Commissioners of Human Services and Health, and a participating governmental entity pertaining to participation in and implementation of the intergovernmental transfer program.
"Intergovernmental transfer program" or "program" means a program to enhance federal financial participation under the Medicaid program by using intergovernmental transfers.
"Medicaid" means the "New Jersey Medical Assistance and Health Services Program" established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Medicaid State plan" means the plan submitted by the State to the federal Centers for Medicare & Medicaid Services in the Department of Health and Human Services, including any amendments thereto.
"Participant accounts" means the accounts maintained at the bank by each participating governmental entity for the purpose of effectuating the intergovernmental transfer program.
"Participating governmental entity" means any governmental entity that owns a nursing facility enrolled in the Medicaid program and qualifies for a supplemental payment under the Medicaid State plan, and which signs an intergovernmental transfer agreement.
"State account" means the account maintained at the bank by the State Treasurer for the purpose of the intergovernmental transfer program.
"Supplemental payment" means the Medicaid payment made by the State to a participating governmental entity for a specified fiscal year, as set forth and provided for in an intergovernmental transfer agreement.
L.2000, c.28, s.2; amended 2012, c.17, s.380.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-19.4 - Intergovernmental transfer program established.

30:4D-19.4 Intergovernmental transfer program established.
3. There is established an intergovernmental transfer program subject to the provisions of this act.
a. Notwithstanding the provisions of any other law to the contrary, a governmental entity eligible to receive a supplemental payment is authorized to participate in the intergovernmental transfer program and to take all actions necessary to effectuate completion of the intergovernmental transfer program, including, but not limited to:
(1) entering into agreements, including an intergovernmental transfer agreement, with any entity, including the State Treasurer, the Commissioner of Human Services, the Commissioner of Health, and other participating governmental entities;
(2) cooperating with a bank in the execution of any additional documentation required by the bank to effect the borrowing by any participating governmental entity through the issuance of short-term notes in the manner prescribed for the issuance of tax anticipation notes pursuant to N.J.S.40A:4-64, except that the short-term notes shall not be subject to the provisions of N.J.S.40A:4-66, or in any other manner permitted by law, and to pledge to the bank a security interest in all of its right, title and interest in and to its participant account for repayment of short-term notes;
(3) transferring participating governmental entity funds to the State account;
(4) executing certifications, letters of instruction or other instruments necessary to effectuate the intergovernmental transfer program; and
(5) receiving and utilizing supplemental payments received in accordance with the Medicaid State plan, in the manner set forth under the terms of an intergovernmental transfer agreement and as may be necessary to achieve the purposes of the intergovernmental transfer agreement.
b. Notwithstanding any other law to the contrary, the State Treasurer, the Commissioner of Human Services and the Commissioner of Health, acting on behalf of the State, are authorized to participate in the intergovernmental transfer program and to take all actions and make payments in connection with the completion of the intergovernmental transfer program, including, but not limited to:
(1) entering into agreements, including the intergovernmental transfer agreement, with any entity, including participating governmental entities, upon such terms and conditions as the State Treasurer deems necessary or desirable to allow for the entity's participation in the intergovernmental transfer program;
(2) cooperating with any bank in the execution of any additional documentation required by the bank to transfer supplemental payments to the participant accounts and otherwise effectuate the intergovernmental transfer program; and
(3) executing, approving, and authorizing certifications, letters of instruction, legal opinions, or other instruments as the State Treasurer deems necessary or desirable to effectuate the intergovernmental transfer program.
L.2000, c.28, s.3; amended 2012, c.17, s.381.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-19.5 - Appropriations for supplemental payments under intergovernmental transfer program; costs.

30:4D-19.5 Appropriations for supplemental payments under intergovernmental transfer program; costs.
4. a. There are appropriated to the Department of Human Services such sums as are determined necessary by the Director of the Division of Budget and Accounting in the Department of the Treasury to make supplemental payments in accordance with the Medicaid State plan under the intergovernmental transfer program. The sums so appropriated shall be deposited in the State account and used to make supplemental payments to the participant accounts pursuant to this subsection and as set forth in an intergovernmental transfer agreement.
b. There are appropriated to the Department of Human Services and Department of the Treasury such additional sums as are determined necessary by the Director of the Division of Budget and Accounting in the Department of the Treasury to pay costs incurred by the State in connection with the execution and delivery of any agreements authorized hereunder, including the costs of professional services, attorneys, and any other costs necessary to complete the intergovernmental transfer program.
L.2000, c.28, s.4; amended 2012, c.17, s.382.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-21 - Pharmaceutical assistance eligibility.

30:4D-21. Pharmaceutical assistance eligibility.
2. a. Any resident of this State who is either a recipient of disability insurance benefits under Title II of the federal Social Security Act (42 U.S.C. s. 401 et seq.) or 65 years of age and over and whose annual income is less than $52,142 if single or, if married, whose annual income combined with that of the person's spouse is less than $59,209, shall be eligible for "Pharmaceutical Assistance to the Aged and Disabled" if the person is not otherwise qualified for assistance under P.L.1968, c.413 (C.30:4D-1 et seq.). Annual income shall not include gain from the sale of a principal residence that is excluded from gross income pursuant to N.J.S.54A:6-9.
b. (1) Except as provided in paragraph (2) of this subsection, beginning January 1, 1996 and annually thereafter, the income eligibility limits provided in subsection a. of this section shall increase by the amount of the maximum Social Security benefit cost-of-living increase for that year for single and married persons, respectively. The commissioner shall adopt the new income limits annually by regulation pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.).
(2) No cost-of-living increase shall be applied under paragraph (1) of this subsection in calendar year 2023. The cost-of-living increase shall resume beginning January 1, 2024, and the income eligibility limits shall be annually increased thereafter consistent with the requirements of paragraph (1) of this subsection.
L.1975,c.194,s.2; amended 1975,c.312; 1981,c.499,s.1; 1985,c.291,s.1; 1987,c.221; 1989,c.16; 1991,c.84; 1995,c.27,s.1; 2021, c.131; 2023, c.79, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-21.2 - Reparations to Japanese Americans not counted as income for PAAD eligibility

30:4D-21.2. Reparations to Japanese Americans not counted as income for PAAD eligibility
1. Funds received from the federal government pursuant to sections 105 and 106 of the "Civil Liberties Act of 1988," Pub.L.100-383 (50 U.S.C. App. s. 1989b-4 and s. 1989b-5) shall not be counted as income for the purpose of determining eligibility for the Pharmaceutical Assistance to the Aged and Disabled program established pursuant to P.L.1975, c.194 (C.30:4D-20 et seq.).
L.1992,c.30.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-21.3 - Holocaust reparations, restitution not considered income for determination of PAAD eligibility

30:4D-21.3. Holocaust reparations, restitution not considered income for determination of PAAD eligibility
2. Amounts received as reparations or restitution for the loss of liberty or damage to health by the victims of National Socialist (Nazi) persecution; returns of tangible or intangible property seized, misappropriated, or lost as a result of National Socialist (Nazi) actions or policies and any cash values in replacement of such property; payments of insurance policies purchased by the victims of National Socialist (Nazi) persecution; and any accumulated or accrued interest on such amounts shall not be counted as income for the purpose of determining eligibility for the Pharmaceutical Assistance to the Aged and Disabled program established pursuant to P.L.1975, c.194 (C.30:4D-20 et seq.).
L.1998,c.113,s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-21.4 - PAAD recipients, notification as to error in estimated annual income.

30:4D-21.4 PAAD recipients, notification as to error in estimated annual income.
1. a. Notwithstanding the provisions of any other law to the contrary, a recipient of benefits under the "Pharmaceutical Assistance to the Aged and Disabled" program, established pursuant to P.L.1975, c.194 (C.30:4D-20 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.1; amended 2012, c.17, s.383.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-21.5 - Automatic enrollment in certain pharmaceutical assistance programs.

30:4D-21.5 Automatic enrollment in certain pharmaceutical assistance programs.
1. a. If a person who is a recipient of benefits under the "Pharmaceutical Assistance to the Aged and Disabled," or PAAD, program becomes ineligible for PAAD because the person's income exceeds the program's income eligibility limit and the person still remains eligible for the "Senior Gold Prescription Discount Program," the person shall be enrolled automatically in the "Senior Gold Prescription Discount Program."
b. If a person who is a recipient of benefits under the "Senior Gold Prescription Discount Program" has a decrease in income that renders the person eligible for PAAD, the person shall automatically be enrolled in PAAD.
c. The Department of Human Services shall establish one application form for use in applying for the PAAD program and the "Senior Gold Prescription Discount Program." The form shall provide for the inclusion of all information necessary to determine eligibility for both programs and advise applicants of the automatic enrollment provisions of subsections a. and b. of this section.
L.2009, c.272, s.1; amended 2012, c.17, s.384.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-22.1 - Pharmacy payment condition

30:4D-22.1. Pharmacy payment condition
2. Payments to pharmacies made by the "Pharmaceutical Assistance to the Aged and Disabled" program in accordance with section 3 of P.L.1975, c.194 (C.30:4D-22) shall not be made unless, at the time of each prescription drug purchase for which a pharmacy submits a claim, the pharmacy prominently displays on the receipt provided with the drug the usual price charged to other persons in the community by the pharmacy.
L.1995,c.5,s.2; per s. 3, expired July 1, 1998.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-22.2 - "Prescription drugs," syringes, needles included; certain

30:4D-22.2. "Prescription drugs," syringes, needles included; certain
1. In addition to the "prescription drugs" defined pursuant to section 3 of P.L.1975, c.194 (C.30:4D-22), "prescription drugs" also means syringes and needles for injectable medicines used for the treatment of multiple sclerosis.
L.1995,c.323,s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-22.4 - Community retail pharmacy practice site, display, Pharmaceutical Assistance to the Aged and Disabled information.

30:4D-22.4 Community retail pharmacy practice site, display, Pharmaceutical Assistance to the Aged and Disabled information.
2. 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 "Pharmaceutical Assistance to the Aged and Disabled" program established pursuant to P.L.1975, c.194 (C.30:4D-20 et seq.). Payments to the pharmacy pursuant to section 3 of P.L.1975, c.194 (C.30:4D-22) 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.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-23 - Prescription drug costs; payment under other plan or insurance; effect on eligibility

30:4D-23. Prescription drug costs; payment under other plan or insurance; effect on eligibility
Any otherwise eligible person whose prescription drug costs are wholly covered by any other plan of assistance or insurance shall be ineligible for assistance under the provisions of this act. Any otherwise eligible person whose prescription drug costs are covered in part by any other plan of assistance or insurance may be required to receive reduced assistance under the provisions of this act.
L.1975, c. 194, s. 4, eff. Aug. 21, 1975. Amended by L.1977, c. 268, s. 2, eff. Jan. 1, 1978.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-24 - Regulations

30:4D-24. Regulations
The commissioner shall by regulation establish a system of payments or reimbursements and a system for determining eligibility, including provisions for submission of proof of actual and anticipated annual income, and evidence of complete or partial coverage of prescription drug costs by any other assistance or insurance plans.
L.1975, c. 194, s. 5, eff. Aug. 21, 1975. Amended by L.1977, c. 268, s. 3, eff. Jan. 1, 1978.