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2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-2.1 - Findings, declarations

30:4D-2.1. Findings, declarations
The Legislature finds and declares that:
a. Low-income pregnant women are at higher risk of poor birth outcomes by virtue of their poverty status and non-whites in New Jersey are more likely to be indigent than whites; in 1983, more than 1,100 babies in New Jersey died before their first birthday; the State's infant mortality rate, 11.3 deaths per 1,000 live births, is among the 17 highest in the country and non-white infants in New Jersey are nearly twice as likely to die before their first birthday than white infants; the non-white and white infant mortality rates in 1983 were 19.3 and 9.2, respectively, and in 1984 the rates for black and white infants were 19.7 and 9.0, respectively; there has been no significant improvement in the infant mortality rate among older infants, ages one month to one year, during the last decade; the percentage of babies born at low birthweight, a condition which places babies at high risk of permanent disability and death, is higher in New Jersey than the national average and is among the highest third of all states; and while early continuous and comprehensive prenatal care can prevent low birthweight and infant death, only 64% of babies born to non-white mothers benefited from any early prenatal care in the State in 1983.
b. Teenage mothers are at special risk of poor pregnancy outcome in New Jersey, in 1983, 11% of all babies born to teenage mothers had low birthweights, compared to 7.2% of all births; New Jersey's low birthweight rate among teenagers is the fourth highest in the nation, and only 52% of babies born to teenagers in 1983 benefited from any early prenatal care.
c. Access to existing maternal and child health services is often limited and some basic services that are necessary to reduce poor birth outcomes are not universally available to all pregnant women with incomes below the federal poverty level; and there is a need to provide more effective coordination between maternal and child health services offered through programs administered by the Departments of Human Services and Health.
d. The State of New Jersey is committed to ensuring access to quality health care for pregnant women and children as a means of improving the health of State residents and reducing overall State expenditures; and the basic health service needs of low-income pregnant women and children can best be met by a coordinated program of comprehensive health care.
e. It is the State's objective to provide early comprehensive maternity care for pregnant women and comprehensive health care for infants and young children to reduce infant deaths and morbidity, to improve child health status, and to realize a substantial reduction in costly hospitalization.
L. 1987, c. 115, s. 1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-3a - "Invalid coach service" deemed to mean "mobility assistance vehicle service"

30:4D-3a. "Invalid coach service" deemed to mean "mobility assistance vehicle service"
4. Whenever the term "invalid coach service" occurs or any reference is made thereto in any law, contract or document which pertains to the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), the same shall be deemed to mean or refer to "mobility assistance vehicle service."
L.1997,c.102,s.4.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-3b - Establishment of enrollment simplification practices.

30:4D-3b Establishment of enrollment simplification practices.
9. No later than January 1, 2006, the Commissioner of Human Services shall, at a minimum, establish the following enrollment simplification practices for dependent children and their parents or specified caretaker relatives who are applicants for or recipients of the Medicaid program:
a. A streamlined application form as established pursuant to subsection k. of section 5 of P.L.2005, c.156 (C.30:4J-12);
b. Require new applicants to submit one recent pay stub from the applicant's employer, or, if the applicant has more than one employer, one from each of the applicant's employers, to verify income. In the event the applicant cannot provide a recent pay stub, the applicant may submit another form of income verification as deemed appropriate by the commissioner. If an applicant does not submit income verification in a timely manner, before determining the applicant ineligible for the program, the commissioner shall seek to verify the applicant's income by reviewing available Department of the Treasury and Department of Labor and Workforce Development records concerning the applicant and such other records as the commissioner determines appropriate.
The commissioner shall establish retrospective auditing or income verification procedures, such as sample auditing and matching reported income with records of the Department of the Treasury and the Department of Labor and Workforce Development and such other records as the commissioner determines appropriate.
In matching reported income with confidential records of the Department of the Treasury, the commissioner shall require an applicant to provide written authorization for the Division of Taxation in the Department of the Treasury to release applicable tax information to the commissioner for the purposes of establishing income eligibility for the program. The authorization, which shall be included on the program application form, shall be developed by the commissioner, in consultation with the State Treasurer;
c. Online enrollment and renewal, in addition to enrollment and renewal by mail. The online enrollment and renewal forms shall include electronic links to other State and federal health and social services programs;
d. Continuous enrollment;
e. Simplified renewal by sending a recipient a preprinted renewal form and requiring the recipient to sign and return the form, with any applicable changes in the information provided in the form, prior to the date the recipient's annual eligibility expires. The commissioner shall establish such auditing or income verification procedures as provided in subsection b. of this section; and
f. Provision of program eligibility-identification cards that are issued no more frequently than once a year.
L.2005, c.156, s.9; amended 2008, c.53, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-3b1 - Permanent change of station order, residency requirement, Division of Medical Assistance and Health Services; definitions.

30:4D-3b1 Permanent change of station order, residency requirement, Division of Medical Assistance and Health Services; definitions.
1. a. Notwithstanding any other law to the contrary, the Division of Medical Assistance and Health Services within the Department of Human Services shall accept a permanent change of station order to a duty location located in New Jersey, issued by any branch of the United States military to the parent or legal guardian of an applicant, for the purposes of satisfying the residency requirement for the provision of home and community based services reimbursed by the Medicaid program.
b. For the purpose of this section:
"Legal guardian" means a person who exercises continuing control over the person or property, or both, of an individual, pursuant to a court order.
"Medicaid program" means the program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Permanent change of station order" means the official documentation issued by a branch of the United States military to an active duty member requiring the member's relocation, along with the relocation of any dependents living with the member, from one duty location to another.
L.2022, c.84, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-3d - Definitions, Medicaid eligibility redetermination.

30:4D-3d Definitions, Medicaid eligibility redetermination.
1. a. As used in this section:
"Beneficiary" means an individual eligible for medical assistance through Medicaid or NJ FamilyCare.
"Commissioner" means the Commissioner of Human Services.
"Division" means the Division of Medical Assistance and Health Services in the Department of Human Services.
"Eligibility redetermination" means the administrative process by which the division or a county welfare agency reviews a beneficiary's income, financial resources, and circumstances relating to the beneficiary's application for continuation of benefits received under Medicaid or NJ FamilyCare.
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"NJ FamilyCare" means the NJ FamilyCare program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.).
b. No later than the first day of the fourteenth month next following the expiration of the federal public health emergency declared in response to the SARS-CoV-2 pandemic, the commissioner shall direct the division or a county welfare agency to conduct an eligibility redetermination for a beneficiary no less than 365 days following the date of the beneficiary's initial enrollment in, or the date of the beneficiary's last eligibility redetermination for, Medicaid or NJ FamilyCare. The commissioner shall determine the means and method by which an eligibility redetermination shall be conducted.
c. To the extent permitted under federal law and regulation, the commissioner, not later than the first day of the fourteenth month next following the expiration of the federal public health emergency declared in response to the SARS-CoV-2 pandemic, shall provide for at least 12 months of continuous Medicaid eligibility for adult eligibility groups without imposing any reporting requirements regarding changes of income or resources and regardless of the delivery system through which the beneficiary receives benefits.
d. The commissioner 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.2022, c.123, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-3e - Rules, regulations.

30:4D-3e Rules, regulations.
2. The Commissioner of Human Services shall adopt rules and regulations as shall be necessary to implement the provisions of this act, which rules and regulations shall be effective immediately upon filing with the Office of Administrative Law for a period not to exceed 18 months and may, thereafter, be amended, adopted, or readopted in accordance with the "Administrative Procedure Act" P.L.1968, c.410 (C.52:14B-1 et seq.).
L.2022, c.123, s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-4 - Division of medical assistance and health services

30:4D-4. Division of medical assistance and health services
There is hereby created in the Department of Human Services a Division of Medical Assistance and Health Services. The division shall perform those administrative and operational functions vested in the department pursuant to the provisions of this act and any other functions that the commissioner may, from time to time, elect to assign to such division. The division shall consult with and coordinate programs related to medical assistance and health care services being furnished by other State agencies to avoid duplication of effort.
L.1968, c. 413, s. 4. Amended by L.1979, c. 365, s. 3, eff. Feb. 4, 1980.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-5 - Medical assistance program

30:4D-5. Medical assistance program
The department, which is hereby designated the single State agency to administer the provisions of this act, through the Division of Medical Assistance and Health Services, by rules and regulations, shall implement and administer the program of medical assistance to provide necessary medical care and services for qualified applicants as provided by this act.
L.1968, c. 413, s. 5.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6a - $35 monthly personal needs allowance

30:4D-6a. $35 monthly personal needs allowance
Any person who is eligible for medical assistance and health services under P.L. 1968, c. 413 (C. 30:4D-1 et seq.) and who receives medical assistance under subparagraph (4)(a) of subsection a. or under paragraph (11), (13) or (14) of subsection b. of section 6 of P.L. 1968, c. 413 (C. 30:4D-6), who is not eligible for Supplemental Security Income benefits pursuant to 42 U.S.C. s. 1382(e)(1)(B), is entitled to a $35.00 monthly personal needs allowance.
L. 1985, c. 286, s. 1, eff. Nov. 1, 1985.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6c - Continued Medicaid eligibility

30:4D-6c. Continued Medicaid eligibility
2. A dependent child or the parent or caretaker relative of a dependent child who would lose eligibility for the aid to families with dependent children program under the State Plan for Title IV-A of the federal Social Security Act in effect as of July 16, 1996 due to earnings from, or increased hours of, employment, or receipt of benefits under the "unemployment compensation law," R.S.43:21-1 et seq. or the "Temporary Disability Benefits Law," P.L.1948, c.110 (C.43:21-25 et seq.), is eligible to continue receiving Medicaid benefits pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) for a period of 24 consecutive months, commencing with the month in which eligibility under provisions of the State Plan for Title IV-A of the federal Social Security Act in effect as of July 16, 1996 is no longer met, if the person:
a. (Deleted by amendment, P.L.1997, c.13).
b. would be eligible in accordance with the State Plan for Title IV-A of the federal Social Security Act in effect as of July 16, 1996, except for the person's income, resources or hours of employment.
L.1987,c.283,s.2; amended 1991, c.523, s.17; 1997, c.13, s.11.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6d - Third party, certain; primary payer

30:4D-6d. Third party, certain; primary payer
3. If a person who is eligible for continued Medicaid benefits pursuant to section 2 of this act obtains employment which provides health insurance coverage through a third party as defined in section 3 of P.L.1968, c.413 (C.30:4D-3), the third party shall be the primary payer and the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) shall be the secondary payer.
L.1987,c.283,s.3; amended 1995,c.292,s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6e - Uninsured, ineligible persons may purchase health care coverage

30:4D-6e. Uninsured, ineligible persons may purchase health care coverage
a. Any person who is not eligible for medical assistance pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) who is employed full-time or part-time and does not have health insurance coverage provided by his employer or by his spouse's employer, if any, or who cannot afford to purchase health insurance coverage that may be offered by his employer or his spouse's employer, if any, shall be eligible to purchase health care coverage through the Garden State Health Plan operated by the Division of Medical Assistance and Health Services in the Department of Human Services.
b. A small employer, as defined by the Commissioner of Human Services, who has not provided or offered to provide health insurance coverage anytime during the 12-month period immediately preceding the effective date of coverage pursuant to this section, shall be eligible to purchase health care coverage for its employees through the Garden State Health Plan operated by the Division of Medical Assistance and Health Services in the Department of Human Services.
c. The Commissioner of Human Services shall design one or more plans of benefits for employees and small employers who wish to purchase health care coverage through the Garden State Health Plan. The commissioner shall establish a schedule of premiums for enrollment in the plan, which shall ensure that the premiums charged are adequate to fund the costs of the benefits provided by the plan to persons not otherwise eligible for medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.).
d. The commissioner shall make the purchase of health care coverage through the Garden State Health Plan available to employees and small employers within one year of the effective date of P.L.1991, c.187 (C.26:2H-18.24 et al.).
e. Nothing in this section shall be construed to include the Garden State Health Plan as a health maintenance organization in any other provision of law regarding the offering or availability of coverage by a health maintenance organization.
L.1991,c.187,s.45.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6f - Eligibility of aliens for medical assistance.

30:4D-6f Eligibility of aliens for medical assistance.
2. An eligible alien as defined in section 3 of P.L.1968, c.413 (C.30:4D-1 et seq.) who otherwise meets all eligibility criteria therefor is entitled to medical assistance provided pursuant to section 6 of P.L.1968, c.413 (C.30:4D-6). An alien who does not qualify as an eligible alien but who is a resident of New Jersey and would otherwise be eligible for medical assistance provided pursuant to section 6 of P.L.1968, c.413 is entitled only to care and services necessary for the treatment of an emergency medical condition as defined in section 1903(v)(3) of the federal Social Security Act (42 U.S.C. s.1396b(v)(3)).
L.1997,c.352,s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6g - Findings, declarations relative to emergency care.

30:4D-6g Findings, declarations relative to emergency care.
1. The Legislature finds and declares that:
a. In accordance with the "Health Care Reform Act," P.L.1992, c.160 (C.26:2H-18.51 et al.), it has been and continues to be of paramount public interest for the State to take all necessary and appropriate actions to ensure access to, and the provision of, cost-effective and high-quality hospital care to its citizens. Consistent with these goals, it is and has been the policy of this State that reimbursement for emergency services and related screening and hospitalization be reasonable, in order to promote access to such care without overburdening the health care payment system. These imperative public policies continue to apply equally to both public and private payers of health care services;
b. In light of the provisions of section 14 of the "Health Care Reform Act," P.L.1992, c.160 (C.26:2H-18.64), which prohibits hospitals from denying admission or appropriate services to a patient on the basis of that patient's ability to pay or source of payment, questions have arisen as to the rates at which emergency services should be reimbursed when they are provided to enrollees in Medicaid and NJ FamilyCare managed care plans by non-participating hospitals. In order to ensure that the goal of cost-efficient access to emergency services is furthered, it is necessary to clarify the rates that have been and continue to be deemed reasonable reimbursement; and
c. It is necessary that the reimbursement clarification be understood as reaffirming the paramount public health and welfare purpose of promoting cost-efficiency in the delivery of emergency services and related screening and hospitalization.
L.2004,c.103,s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6h - Definitions relative to emergency care.

30:4D-6h Definitions relative to emergency care.
2. As used in this act:
"Contractor" means a health maintenance organization authorized to operate in this State which contracts with the Department of Human Services for the provision of health care services to recipients of Medicaid and enrollees of NJ FamilyCare.
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"NJ FamilyCare" means the Children's Health Care Coverage Program established pursuant to P.L.1997, c.272 (C.30:4I-1 et seq.) and the FamilyCare Health Coverage Program established pursuant to P.L.2000, c.71 (C.30:4J-1 et seq.).
"Non-participating hospital" means a hospital with which the contractor does not have a written provider agreement that complies with applicable State law and regulations, including N.J.A.C.8:38-15.2 and 10:74-2.1.
L.2004,c.103,s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6i - Non-participating hospital, payment for emergency treatment for Medicaid recipient.

30:4D-6i Non-participating hospital, payment for emergency treatment for Medicaid recipient.
3. A non-participating hospital that provides emergency health care services to a Medicaid recipient enrolled in a managed care plan shall accept, as payment in full, the amount that the non-participating hospital would otherwise receive from the Medicaid program for the emergency services and any related hospitalization if the recipient were a participant in fee-for-service Medicaid.
L.2004,c.103,s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6j - Criteria for Medicaid admission to certain long-term care facilities for HIV/AIDS patients.

30:4D-6j Criteria for Medicaid admission to certain long-term care facilities for HIV/AIDS patients.
1. a. Subject to federal financial participation under Title XIX of the federal Social Security Act (42 U.S.C. s.1396 et seq.), the Commissioner of Health shall establish special long-term care facility admission criteria for Medicaid-eligible persons with HIV infection or AIDS, which would apply to facilities that only serve persons with HIV infection or AIDS.
b. The criteria shall enable admission of:
(1) persons with HIV infection who have medical or psycho-social co-morbidities, including, but not limited to: diabetes, cancer, hypertension, hyperlipidemia, asthma, chronic obstructive pulmonary disease, hepatitis B or C, substance use disorder, mental illness or dementia; and
(2) persons with AIDS-defining illness and infection, including those persons newly diagnosed with HIV infection, which illness or infection includes, but is not limited to: pneumocystis carinii pneumonia (PCP), toxoplasmosis, cytomegalovirus (CMV), oral-esophageal candidiasis, wasting, bacterial pneumonia, lymphoma, cryptococcal meningitis, mycobacterium avium complex (MAC) or Kaposi's sarcoma.
L.2005, c.111, s.1; amended 2023, c.177, s.100.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6l - Enrollment in Medicaid for medical parolee.

30:4D-6l Enrollment in Medicaid for medical parolee.
3. Any inmate who is an applicant for medical parole pursuant to the provisions of section 1 of P.L.1997, c.214 (C.30:4-123.51c) shall not be denied enrollment into the Medicaid program on the sole basis that the applicant is an inmate in a correctional facility. For an inmate who becomes enrolled in Medicaid while incarcerated in a correctional facility, payments for medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.) shall commence upon the inmate's release from the correctional facility.
L.2017, c.235, s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6m - Provision of benefits for certain treatments for substance use disorder.

30:4D-6m Provision of benefits for certain treatments for substance use disorder.
1. a. Notwithstanding any State law or regulation to the contrary, the Department of Human Services shall ensure that the provision of benefits for methadone, buprenorphine, naltrexone, combination drugs containing buprenorphine and naloxone, and, if authorized by the Commissioner of Human Services, other medications approved by the federal Food and Drug Administration for the treatment of substance use disorders, to eligible persons receiving services funded by the Division of Mental Health and Addiction Services in the Department of Human Services as well as to eligible persons under the Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), shall be provided without the imposition of any prior authorization requirements, provided that the treatment is prescribed or administered by a licensed medical practitioner who is authorized to prescribe or administer that treatment pursuant to State and federal law. The Commissioner of Human Services may develop and issue guidelines to ensure the safety and efficacy of benefits provided pursuant to this section.
b. As used in this act:
"Substance use disorder" is as defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and any subsequent editions and shall include substance use withdrawal.
L.2019, c.163, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6n - Rules, regulations.

30:4D-6n Rules, regulations.
3. 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 necessary to implement the provisions of this act.
L.2019, c.163, s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6p - Coverage of certain prescription refills by Medicaid, NJ FamilyCare during state of emergency.

30:4D-6p Coverage of certain prescription refills by Medicaid, NJ FamilyCare during state of emergency.
1. a. Subject to subsection b. of this section and to the extent consistent with clinical guidelines, the State Medicaid and NJ FamilyCare programs shall provide coverage of prescription drug refills even when the covered person has not yet reached the scheduled refill date, provided that the prescription itself would remain valid beyond the refill date, in a manner calculated to ensure an enrollee's ability to maintain at least a 30-day supply, or a 90-day supply of a maintenance medication supply at home but not to exceed a 120-day supply on-hand at any given time. The coverage shall be provided based on the authorization for the most recently filled prescription and additional authorization for the refill shall not be required.
b. The provisions of this section shall be in effect if:
(1) a state of emergency or public health emergency is declared by the State or federal government, or an emergency supply of a drug is recommended by the Centers for Disease Control and Prevention; and
(2) the Commissioner of Human Services determines that an emergency supply of prescription drugs is necessary.
c. The coverage shall be provided on an in-network basis to the same extent as for any other refills of prescription drugs, except that:
(1) in the event of a drug shortage or access issue, formulary flexibility shall be provided for a covered alternative; and
(2) no fees shall be imposed for home delivery of the drugs.
d. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this section and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
e. The Division of Consumer Affairs, in consultation with the Commissioner of Human Services, may develop restrictions on the filling or refilling of prescriptions by pharmacists to address shortage concerns, provided those restrictions shall exclude restricting use for existing conditions to the maximum extent practicable.
L.2020, c.30, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6q - Medicaid, NJ FamilyCare, opioid antidote coverage.

30:4D-6q Medicaid, NJ FamilyCare, opioid antidote coverage.
2. a. The Division of Medical Assistance and Health Services in the Department of Human Services shall provide coverage for an opioid antidote under the Medicaid program and the NJ FamilyCare program without the imposition of any prior authorization or other utilization management requirements, provided that the drug is:
(1) prescribed or administered to an enrollee by a licensed medical practitioner who is authorized to prescribe or administer that treatment pursuant to State and federal law; or
(2) dispensed to an enrollee by a licensed pharmacist under a standing order to dispense an opioid antidote pursuant to section 1 of P.L.2017, c.88 (C.45:14-67.2).
b. The provisions of this section shall not be construed to limit the coverage of an opioid antidote only when administered by a medical practitioner.
c. The division shall require each managed care organization contracted with the division to provide pharmacy benefits to Medicaid and NJ FamilyCare enrollees to comply with the provisions of this section.
d. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this section and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
e. As used in this section:
"Medicaid program" means the program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Opioid antidote" means naloxone hydrochloride, or any other similarly acting drug approved by the United States Food and Drug Administration for self-administration for the treatment of an opioid overdose.
"NJ FamilyCare program" means the program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.).
L.2021, c.157, s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6r - Medicaid to cover newborn home nurse visitation.

30:4D-6r Medicaid to cover newborn home nurse visitation.
13. a. Notwithstanding any State law or regulation to the contrary, the Department of Human Services shall, contingent on maintaining or receiving necessary federal approvals, ensure that expenses incurred for services provided under the newborn home nurse visitation program established pursuant to section 2 of P.L.2021, c.187 (C.26:2H-159) shall be provided with no cost-sharing to eligible persons under the Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.). The coverage provided under this section shall:
(1) provide coverage for the services provided by the newborn home nurse visitation program established pursuant to section 2 of P.L.2021, c.187 (C.26:2H-159);
(2) notify a covered person of the services provided by the newborn home nurse visitation program, upon application by the covered person for coverage of a newborn infant;
(3) ensure that the plan does not contain any provision that requires a covered person to receive the services provided by the newborn home nurse visitation program as a condition of coverage, or that denies or limits benefits to the covered person if that person declines the services provided under the program; and
(4) have the discretion to determine how best to reimburse for the expenses incurred for services provided under the newborn home nurse visitation program, including, but not limited to, utilizing:
(a) a value-based payment methodology;
(b) an invoice claim process;
(c) a capitated payment arrangement;
(d) a payment methodology that takes into account the need for an agency or organization providing services under the program to expand its capacity to provide services and address health disparities; or
(e) any other payment arrangement agreed to by the carrier and an agency or organization providing services under the program.
b. Any copayment, coinsurance, or deductible that may be required pursuant to the contract for services covered pursuant to subsection a. of this section shall be waived.
c. The Assistant Commissioner of Human Services shall submit to the Department of Children and Families, in a form and manner prescribed by the department, a report on the claims submitted for services provided under the newborn home nurse visitation program.
The information contained in the report shall be used by the department to assess the newborn home nurse visitation program pursuant to subsection a. of section 4 of P.L.2021, c.187 (C.26:2H-161).
d. The benefits shall be provided to the same extent as for any other medical condition under the contract.
L.2021, c.187, s.13.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6s - State Medicaid program, coverage for family planning services.

30:4D-6s State Medicaid program, coverage for family planning services.
11. Coverage for family planning services under the State Medicaid program shall include prescriptions for dispensing contraceptives for up to a 12-month period at one time. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this section and to secure federal financial participation for State Medicare expenditures under the federal Medicaid program.
L.2021, c.376, s.11.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6t - Remote participation in certain meetings, eligible Medicaid recipients, authorization.

30:4D-6t Remote participation in certain meetings, eligible Medicaid recipients, authorization.
1. The Division of Medical Assistance and Health Services in the Department of Human Services, to the extent permitted under federal law, shall authorize a recipient of Medicaid benefits who is determined eligible to receive a personal care service benefit and who is attending a post-secondary educational institution and residing on that institution's campus to participate remotely by telephone or other means in a meeting of a non-medical nature regarding the recipient's Medicaid benefits. The provisions of this section shall apply to any meeting between the recipient and the division, a managed care organization contracted with the division to provide benefits under the Medicaid program, or any other entity or individual authorized by the division to conduct such meetings.
As used in this section, "Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
L.2021, c.443.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6u - Commissioner of Human Services, waivers, implementation, provisions, secure federal financial participation.

30:4D-6u Commissioner of Human Services, waivers, implementation, provisions, secure federal financial participation.
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. Coverage to eligible beneficiaries of the community-based palliative care benefit established by the amendments made by section 1 of P.L.2023, c.187 (C.30:4D-6) to section 6 of P.L.1968, c.413 (C.30:4D-6) shall be contingent on securing federal financial participation pursuant to this section.
L.2023, c.187, s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6v - Rules, regulations.

30:4D-6v Rules, regulations.
3. The Commissioner of Human Services shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to effectuate the purposes of this act including guidance on the medical conditions and prognoses that render a beneficiary eligible for community-based palliative care services.
L.2023, c.187, s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6.1 - Abortions; payment of claims

30:4D-6.1. Abortions; payment of claims
No payments for medical assistance shall be made under the act hereby supplemented for the termination of a woman's pregnancy for any reason except where it is medically indicated to be necessary to preserve the woman's life. In any case where a pregnancy is so terminated, the act shall be performed in a hospital and the physician performing the act shall submit in writing a report to the division stating in detail his reasons for finding it necessary to terminate the pregnancy.
L.1975, c. 261, s. 1, eff. Dec. 18, 1975.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6.2 - Definitions.

30:4D-6.2 Definitions.
1. For the purposes of this act:
a. "Certified trained personnel" means one or more individuals directly providing mobility assistance vehicle services possessing and carrying upon their persons a current certificate of completion of an advanced medical training course, as determined by the Commissioner of Health.
b. "Division" means the Division of Medical Assistance and Health Services in the Department of Human Services.
c. "Mobility assistance vehicle service" means the provision of nonemergency health care transportation, supervised by certified trained personnel, for Medicaid recipients who are sick, have an infirmity, or have a disability, and who are under the care and supervision of a physician and whose medical condition is not of sufficient magnitude or gravity to require transportation by ambulance, but does require transportation from place to place for medical care and whose use of an alternate form of transportation, such as taxicab, bus, other public conveyance or private vehicle might create a serious risk to life and health.
d. "Medicaid recipient" means any person who is determined to be eligible to receive mobility assistance vehicle services as provided under P.L.1981, c.134 (C.30:4D-6.2 et seq.) and meets the eligibility requirements pursuant to the "New Jersey Medical Assistance and Health Services Act," P.L.1968, c. 413.
e. "Provider" means any person, public or private institution, agency or business concern lawfully providing mobility assistance vehicle services authorized under P.L.1981, c.134 (C.30:4D-6.2).
L.1981, c.134, s.1; amended 1997, c.102, s.1; 2017, c.131, s.118.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6.3 - Provider of mobility assistance vehicle services; conditions for approval for reimbursement

30:4D-6.3. Provider of mobility assistance vehicle services; conditions for approval for reimbursement
2. No provider of mobility assistance vehicle services shall be approved for reimbursement by the Division of Medical Assistance and Health Services for services rendered to Medicaid recipients unless such provider meets all the standards and requirements issued pursuant to section 3 and section 5 of this act.
L.1981,c.134,s.2; amended 1997, c.102, s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6.4 - Minimum requirements, liability insurance, personnel; rules, regulations.

30:4D-6.4 Minimum requirements, liability insurance, personnel; rules, regulations.
3. After consulting with the Commissioner of Human Services, the Commissioner of Health is authorized and empowered to issue and enforce, or cause to be issued and enforced through the division, all necessary rules, regulations, and administrative orders with respect to:
a. The development of minimum requirements concerning the equipment, supplies, and vehicles of providers of mobility assistance vehicle services;
b. The establishment of standards for the amount of liability insurance each provider must maintain in order to be eligible to provide mobility assistance vehicle services. Evidence of such insurance, including the name of the insurer and the policy number, shall be filed at the time of application for approval by the division and from time to time as the division shall deem necessary; and
c. The establishment of standards for certified trained personnel employed by providers of mobility assistance vehicle services.
L.1981, c.134, s.3; amended 1997, c.102, s.3; 2012, c.17, s.360.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6.5 - Inapplicability of act to services by volunteer first aid, rescue and ambulance squads

30:4D-6.5. Inapplicability of act to services by volunteer first aid, rescue and ambulance squads
The provisions of this act shall not apply to services provided by volunteer first aid, rescue and ambulance squads as defined in the "New Jersey Highway Safety Act of 1971," P.L.1971, c. 351 (C. 27:5F-1 et seq.).
L.1981, c. 134, s. 4.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6.6 - Rules and regulations; application of Medical Assistance and Health Services Act

30:4D-6.6. Rules and regulations; application of Medical Assistance and Health Services Act
a. After consulting with the Commissioner of Human Services, the Commissioner of Health is authorized and empowered to adopt such rules and regulations as are necessary to carry out his functions and duties under this act and to effectuate its purposes.
b. The provisions of the "New Jersey Medical Assistance and Health Services Act" and all rules, regulations and administrative orders issued thereunder shall apply, where applicable.
L.1981, c. 134, s. 5.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6.7 - Resident of skilled or intermediate care nursing facility discharged to general or psychiatric hospital; coverage by medical assistance program

30:4D-6.7. Resident of skilled or intermediate care nursing facility discharged to general or psychiatric hospital; coverage by medical assistance program
A resident of a skilled or intermediate care nursing facility who is a recipient of medical assistance payments under P.L.1968, c. 413 (C. 30:4D-1 et seq.), and who is discharged to a general or a psychiatric hospital, shall be covered by the medical assistance program for the number of days the nursing facility maintains the resident's bed.
L.1984, c. 139, s. 1, eff. Sept. 5, 1984.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6.8 - Period of maintenance of bed for eligible resident; certification for payment

30:4D-6.8. Period of maintenance of bed for eligible resident; certification for payment
Every skilled or intermediate care nursing facility in this State shall maintain a bed for an eligible resident for a period not to exceed 10 days. The facility shall notify the Division of Medical Assistance and Health Services in the Department of Human Services upon the discharge of an eligible resident to a general or a psychiatric hospital. The division shall confirm the need to maintain a bed for the discharged resident and shall certify the facility's eligibility to receive payment.
L.1984, c. 139, s. 2, eff. Sept. 5, 1984.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6.9 - Inability of discharged resident to return within period; priority for next available bed

30:4D-6.9. Inability of discharged resident to return within period; priority for next available bed
If the discharged resident is unable to return to the nursing facility before the end of the 10 day period, the discharged resident shall have priority for the next available bed in the facility.
L.1984, c. 139, s. 3, eff. Sept. 5, 1984.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-6.10 - Conditions for reimbursement to providers; educational materials; terms defined.

30:4D-6.10 Conditions for reimbursement to providers; educational materials; terms defined.
2. a. No provider shall be approved for reimbursement by the Division of Medical Assistance and Health Services in the Department of Human Services under Medicaid for a non-medically indicated early elective delivery performed at a hospital on a pregnant woman earlier than the 39th week of gestation on or after the ten-month period following the effective date of this section. During the ten-month period following the effective date of this section, the Division of Medical Assistance and Health Services in the Department of Human Services shall provide accessible educational materials to inform pregnant women, their support networks, and Medicaid providers about the risks of non-medically indicated early elective delivery.
b. As used in this section:
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Non-medically indicated early elective delivery" means the artificial start of the birth process through medical interventions or other methods, also known as labor induction, or the surgical delivery of a baby via a cesarean section for purposes or reasons that are not fully consistent with established standards of clinical care as provided by the American College of Obstetricians and Gynecologists.
L.2019, c.87, s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7a - County welfare agency to provide adequate employees to determine Medicaid eligibility

30:4D-7a. County welfare agency to provide adequate employees to determine Medicaid eligibility
The Commissioner of Human Services shall require that a county welfare agency provide adequate employees to determine Medicaid eligibility to any hospital in the county that has been designated by the Commissioner of Health pursuant to section 9 of P.L.1991, c.187 (C.26:2H-18.32).
The Commissioner of Human Services shall bill the designated hospital quarterly for the nonfederal share of costs associated with a county welfare agency employee stationed at the hospital, and reimburse the county welfare agency upon receipt of payment from the hospital.
L.1991,c.187,s.10.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7b - Preparation of five-year plan for developing Statewide network of managed care providers

30:4D-7b. Preparation of five-year plan for developing Statewide network of managed care providers
The Commissioner of Human Services shall prepare a five-year plan to develop a Statewide network of managed care providers for Medicaid recipients pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.). A managed care plan may include, but is not limited to, the Garden State Health Plan, or its successor, any other State approved or federally qualified health maintenance organization, or any other cost effective health plan, prepaid or otherwise, that is under contract with the Division of Medical Assistance and Health Services in the Department of Human Services to provide managed care services to Medicaid recipients.
The commissioner shall prepare the plan within one year of the effective date of P.L.1991, c.187 (C.26:2H-18.24 et al.) and submit the plan to the Governor and the Chairmen of the Senate Institutions, Health and Welfare and General Assembly Health and Human Services Committees.
L.1991,c.187,s.42.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7c - Submission of plan to enroll Medicaid recipients by health maintenance organizations

30:4D-7c. Submission of plan to enroll Medicaid recipients by health maintenance organizations
Within one year of the effective date of P.L.1991, c.187 (C.26:2H-18.24 et al.), every State approved or federally qualified health maintenance organization in the State shall submit a plan to the Commissioner of Human Services to enroll Medicaid recipients pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.). The plan shall include the terms and conditions for enrolling Medicaid recipients, including the number of recipients that can reasonably be enrolled, the health care services that will be offered, and an estimate of the per capita cost for enrollment of these persons.
The commissioner shall provide a health maintenance organization, upon written request, with any nonidentifying information about Medicaid recipients that is necessary to assist the health maintenance organization in preparing its plan.
L.1991,c.187,s.43.