reglab/statecodes huggingface dataset:
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.1a - Computation to determine adjustment of rate; formula

52:14-17.1a. Computation to determine adjustment of rate; formula
On the first business day of January and the first business day of July of each year a computation shall be made to determine whether the mileage reimbursement allowed in section 1 of P.L.1943, c. 188 (C. 52:14-17.1) is to be adjusted on that date according to the following formula:
C.P.-B.P.
Adjustment = ...........
18
where:
a. Adjustment means the result of the above calculation in the number of whole cents plus one-half cent where the remainder is five-ninths or greater;
b. C.P. means the price paid for regular gasoline by the State on the date of the computation; and
c. B.P. means the price paid for regular gasoline by the State on the effective date of this amendatory and supplementary act.
L.1980, c. 19, s. 2, eff. March 26, 1980.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.2 - Appeal

52:14-17.2. Appeal
Any officer or employee of this State, who may be removed by the Governor, pursuant to Article V, Section IV, paragraph five, of the Constitution, may appeal from the order of removal to the Appellate Division of the Superior Court as in the case of an appeal from a final decision of a State administrative agency in lieu of prerogative writ.
L.1948, c. 118, p. 828, s. 1. Amended by L.1953, c. 49, p. 855, s. 6.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.3 - Time for appeal

52:14-17.3. Time for appeal
Any such appeal shall be taken within twenty days from the date of the making of the removal order by filing a notice of appeal with the Appellate Division and the Secretary of State.
L.1948, c. 118, p. 828, s. 3. Amended by L.1953, c. 49, p. 855, s. 7.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.4 - Governor as respondent; representation; record; depositions

52:14-17.4. Governor as respondent; representation; record; depositions
The Governor shall be the respondent and shall be designated by the name of his office only. He may designate the Attorney-General or other counsel to represent the respondent in the proceeding. The Attorney-General shall file with the Appellate Division the original or a certified copy of the record of the proceedings under review, except a transcript of the testimony which shall be filed by the appellant if the same was taken stenographically. By leave of court depositions may be taken for use upon the hearing of the appeal.
L.1948, c. 118, p. 828, s. 3. Amended by L.1953, c. 49, p. 855, s. 8.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.10 - Disposition of case

52:14-17.10. Disposition of case
The court may affirm the order of removal, or it may reverse or nullify the same and order the reinstatement of the appellant to the office or position of employment from which he was removed, as of the date of removal, or as of such date as the court may determine, upon the determination of a matter of law or when it clearly appears that there was no evidence before the Governor reasonably to support the order of removal.
L.1948, c. 118, p. 829, s. 9.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.12 - Fees

52:14-17.12. Fees
No filing or other fees shall be demanded of the respondent, and no costs shall be awarded against him. For the filing of the notice of appeal with the Secretary of State, the Secretary of State shall be entitled to a fee of ten dollars ($10.00) to be paid by the appellant. The Clerk of the Superior Court shall be entitled to the same fees from an appellant as are due by an appellant upon other appeals to the Appellate Division.
L.1948, c. 118, p. 830, s. 11. Amended by L.1953, c. 49, p. 856, s. 15.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.13 - Work-week for State service; compensation for overtime services

52:14-17.13. Work-week for State service; compensation for overtime services
The work week for basic annual salary for employees in the State service, insofar as practicable and except as provided in section 2 of this act, shall not be more than 40 hours; and, notwithstanding any inconsistent provisions of law, any employee in the State service who is authorized or required to work in any week more than the hours of work established as the regular and normal work week for that class or agency shall be eligible to receive, at the discretion of the department head with the approval of the State Treasurer, the President of the Civil Service Commission and the Director of the Division of Budget and Accounting in the Department of Treasury, either (1) compensation for the hours worked in excess of the established work week for that class or agency at a rate representing 1 1/2 times the individual's hourly rate calculated by a proration of the annual salary rate of the individual employee, or (2) compensatory time off at the rate of 1 1/2 hours for each hour worked in excess of the established work week for that class or agency.
L.1951, c. 51, p. 400, s. 1. Amended by L.1966, c. 323, s. 1, eff. July 1, 1967; L.1968, c. 52, s. 1, eff. June 5, 1968.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.13a - Employees on approved paid leave on day state offices officially closed; denial of compensatory time off

52:14-17.13a. Employees on approved paid leave on day state offices officially closed; denial of compensatory time off
No employee of this State, or of any State agency or instrumentality, who is on approved vacation leave with pay on any day on which the department, division, agency or other office within which he is employed is officially closed due to inclement weather, hazardous transportation conditions, a declaration of public mourning, or for any other reason, shall be eligible to receive compensatory time off granted in connection with such official closing in the form of any type of leave of absence with pay.
L.1979, c. 399, s. 1, eff. Feb. 8, 1980.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.14 - Designation of positions to which act applies; rules and regulations

52:14-17.14. Designation of positions to which act applies; rules and regulations
The State Treasurer, the President of the Civil Service Commission and the Director of the Division of Budget and Accounting in the Department of the Treasury shall have authority to designate the classes of positions or individual positions to which the provisions of this act shall apply and may exclude from such designations any class of positions or individual positions where the conditions of employment and the nature of the duties performed or the difficulty of maintaining adequate time controls make it impracticable to establish a specific work week and to apply to such classes of positions or individual positions the provisions of this act; shall determine the eligibility of any employee or any class of employees in the State service to receive overtime compensation or compensatory time off in accordance with the provisions of this act; and shall promulgate such rules and regulations as, in their discretion, appear to be necessary in order to achieve an equitable application of the provisions of this act.
L.1951, c. 51, p. 401, s. 2. Amended by L.1966, c. 323, s. 2, eff. July 1, 1967; L.1968, c. 52, s. 2, eff. June 5, 1968.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.16 - Establishment of committee

52:14-17.16. Establishment of committee
There is hereby established a committee on bonding of State officers and employees to consist of the Attorney-General, the State Treasurer and the Director of the Division of Budget and Accounting.
L.1959, c. 39, p. 133, s. 1, eff. May 28, 1959.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.17 - Setting of type and amount of bonds; giving of bonds by officers required to be bonded

52:14-17.17. Setting of type and amount of bonds; giving of bonds by officers required to be bonded
The committee shall, not later than October 1, 1959 and annually thereafter, set the type and amount of the bonds of all State officers, now or hereafter required to be bonded pursuant to any law of this State, having due regard for the duties and responsibilities of said officers, for terms concurrent with their respective terms of office. Said officers shall, before entering upon the performance of their duties, give their official bonds in the amount fixed by the committee.
L.1959, c. 39, p. 133, s. 2.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.18 - Other officers and employees; type and amount of bonds

52:14-17.18. Other officers and employees; type and amount of bonds
All State officers and employees other than those specifically required to be bonded pursuant to any law of this State, who in the opinion of the committee should be bonded, shall be bonded with the type of bond and in such amount to be determined by the committee.
L.1959, c. 39, p. 133, s. 3.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.19 - Purchase of bonds; cancellation or termination

52:14-17.19. Purchase of bonds; cancellation or termination
Bonds purchased pursuant to this act shall be purchased by the State Treasurer from a company or companies authorized to issue such bonds and authorized to do business in this State. The premium on bonds provided for herein shall be paid by the State. The State Treasurer may, at any time any such bond coverage is no longer required, cause any such bond to be cancelled or terminated and may collect any rebate of premium thereon.
L.1959, c. 39, p. 133, s. 4.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.20 - Approval of bonds; filing; record

52:14-17.20. Approval of bonds; filing; record
All bonds required by this act shall be approved as to form by the Attorney-General and filed in the office of the Secretary of State. A record shall be kept in the office of the Secretary of State giving the name of the officer or employee for whom each bond is issued, the name of the agency in which such officer or employee is employed, the name of the company issuing the bond, and the amount, date and time of expiration thereof and of any certificate renewing such bond.
L.1959, c. 39, p. 133, s. 5.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.25 - Short title

52:14-17.25. Short title
This act shall be known and may be cited as the "New Jersey State Health Benefits Program Act."
L.1961, c. 49, p. 509, s. 1. Amended by L.1964, c. 125, s. 2, eff. July 1, 1964; L.1972, c. 75, s. 1.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.26a - Fraudulent obtaining, attempt to obtain benefits, fourth degree crime.

52:14-17.26a Fraudulent obtaining, attempt to obtain benefits, fourth degree crime.
16. Any person who knowingly obtains, or attempts or conspires to obtain, coverage or benefits under the State Health Benefits Program for himself or another, knowing that the person for whom membership or benefits are sought is ineligible therefor, shall be guilty of a crime of the fourth degree. Nothing in this section shall preclude prosecution or conviction for any other offense.
L.2008, c.89, s.16.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.27a - Audit programs for SHBP.

52:14-17.27a Audit programs for SHBP.
17. a. The State Health Benefits Commission shall establish an audit program through which it shall conduct a continuous review of the various public employers participating in the State Health Benefits Program for the purpose of ensuring that only eligible employees and retirees, and their dependents, are receiving health care coverage under the program. Every public entity whose employees are covered by the program, as well as employees and retirees thereof, and their dependents, and any other public entity having relevant information, shall cooperate fully with the commission and shall provide all information, records and documents requested by the commission in connection with an audit.
b. The State Health Benefits Commission shall establish and contract for a Medicare Primary Assignment and Audit Program through which it shall conduct a continuous review of the State Health Benefits Program for the purposes of ensuring that all persons who are participants and their dependents of the State Health Benefits Program and who are eligible for Medicare under federal law are properly enrolled in Medicare with Medicare as the primary provider of their health care benefits coverage and with the State Health Benefits Program as their secondary provider of their health care benefits coverage.
L.2008, c.89, s.17; amended 2018, c.88, s.1.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.27b - Utilization of super conciliator.

52:14-17.27b Utilization of super conciliator.
55. Whenever the State Health Benefits Plan Design Committee of the State Health Benefits Program or the School Employees' Health Benefits Plan Design Committee of the School Employees' Health Benefits Program fails to render a decision on a matter before the committee because it has not received a vote of the majority of the committee members after 60 days have passed following the initial consideration of the matter, the committee shall utilize a super conciliator, randomly selected from a list developed by the New Jersey Public Employment Relations Commission. The super conciliator shall assist the committee based upon procedures and subject to qualifications established by the commission pursuant to regulation.
The super conciliator shall promptly schedule investigatory proceedings. The purpose of the proceedings shall be to:
Investigate and acquire all relevant information regarding the committee's failure to render a decision;
Discuss with the members of the committee their differences, and utilize means and mechanisms, including but not limited to requiring 24-hour per day negotiations, until a voluntary settlement is reached, and provide recommendations to resolve the members' differences; and
Institute any other non-binding procedures deemed appropriate by the super conciliator.
If the actions taken by the super conciliator fail to resolve the dispute, the super conciliator shall issue a final report, which shall be provided to the committee promptly and made available to the public within 10 days thereafter.
The super conciliator, while functioning in a mediatory capacity, shall not be required to disclose any files, records, reports, documents, or other papers classified as confidential which are received or prepared by him or to testify with regard to mediation conducted by him under this section. Nothing contained herein shall exempt an individual from disclosing information relating to the commission of a crime.
L.2011, c.78, s.55.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.28e - Negotiations concerning contributions for health care benefits.

52:14-17.28e Negotiations concerning contributions for health care benefits.
77. A public employer and employees who are in negotiations for the next collective negotiations agreement to be executed after the employees in that unit have reached full implementation of the premium share set forth in section 39 of P.L.2011, c.78 (C.52:14-17.28c) shall conduct negotiations concerning contributions for health care benefits as if the full premium share was included in the prior contract. The public employers and public employees shall remain bound by the provisions of sections 39, 40, and 43 of P.L.2011, c.78 (C.52:14-17.28c, C.52:14-17.28d, and C.52:14-17.34a), notwithstanding the expiration of those sections, until the full amount of the contribution required by section 39 has been implemented in accordance with the schedule set forth in section 40.
Employees subject to any collective negotiations agreement in effect on the effective date of P.L.2011, c.78, that has an expiration date on or after the expiration of sections 39 through 44, inclusive, of P.L.2011, c.78 (C.52:14-17.28c et al.), shall be subject, upon expiration of that collective negotiations agreement, to sections 39, 40, and 43 until the health care contribution schedule set forth in section 40 is fully implemented.
After full implementation, those contribution levels shall become part of the parties' collective negotiations and shall then be subject to collective negotiations in a manner similar to other negotiable items between the parties.
A public employee whose amount of contribution in retirement was determined in accordance with section 40 or 43 shall be required to contribute in retirement the amount so determined pursuant to section 40 or 43 notwithstanding that section 40 or 43 has expired, with the retirement allowance, and any future cost of living adjustment thereto, used to identify the percentage of the cost of coverage.
L.2011, c.78, s.77.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29a - Employee drug prescription program; extension to retirees under state police retirement system

52:14-17.29a. Employee drug prescription program; extension to retirees under state police retirement system
The State Health Benefits Commission shall undertake by an amendatory or supplementary contract to extend the coverage of the employee drug prescription program, authorized pursuant to subsection (F) of section 5 of P.L.1961, c. 49 (C. 52:14-17.29), to State employees retiring or who have retired on or after January 1, 1980 under the State Police Retirement System after 25 or more years of service and who as of the time of their retirement are or shall be medically certified to be suffering from an illness characterized as terminal by two or more physicians licensed in the practice of medicine and surgery in this State.
L.1981, c. 304, s. 1, eff. Nov. 11, 1981.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29b - Provision of inpatient care following mastectomy

52:14-17.29b Provision of inpatient care following mastectomy
1. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits, shall provide coverage for a minimum of 72 hours of inpatient care following a modified radical mastectomy and a minimum of 48 hours of inpatient care following a simple mastectomy. The contract shall also provide that a carrier shall not require a health care provider to obtain authorization from the carrier for prescribing 72 or 48 hours, as appropriate, of inpatient care as provided for in this section.
The provisions of this section shall not be construed: to require a patient to receive inpatient care for 72 or 48 hours, as appropriate, if the patient in consultation with the patient's physician determines that a shorter length of stay is medically appropriate; or to relieve a patient or a patient's physician, if appropriate, of any notification requirements to the carrier under the contract.
L.1997,c.94.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29c - Coverage for treatment of inherited metabolic diseases by State Health Benefits Program.

52:14-17.29c Coverage for treatment of inherited metabolic diseases by State Health Benefits Program.
9. The State Health Benefits Commission shall provide benefits to each person covered under the State Health Benefits Program for the therapeutic treatment of inherited metabolic diseases, including the purchase of medical foods and low protein modified food products, when diagnosed and determined to be medically necessary by the covered person's physician.
For the purposes of this section, "inherited metabolic disease" means a disease caused by an inherited abnormality of body chemistry for which testing is mandated pursuant to P.L.1977, c.321 (C.26:2-110 et seq.); "low protein modified food product" means a food product that is specially formulated to have less than one gram of protein per serving and is intended to be used under the direction of a physician for the dietary treatment of an inherited metabolic disease, but does not include a natural food that is naturally low in protein; and "medical food" means a food that is intended for the dietary treatment of a disease or condition for which nutritional requirements are established by medical evaluation and is formulated to be consumed or administered enterally under direction of a physician.
The health care services shall be provided to the same extent as for any other medical condition under the program.
L.1997,c.338,s.9.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29d - Definitions.

52:14-17.29d Definitions.
1. As used in this act:
"Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation or health maintenance organization authorized to issue health benefits plans in this State.
"Mental health condition" means a condition defined to be consistent with generally recognized independent standards of current medical practice referenced in the current version of the Diagnostic and Statistical Manual of Mental Disorders.
"Psychiatric Collaborative Care Model" means the evidence-based, integrated behavioral health service delivery method wherein a primary care provider and a care manager collaborate with a psychiatric consultant to provide care to a patient. "Psychiatric Collaborative Care Model" shall include those benefits that are billed using the following list of Current Procedural Terminology (CPT) codes, which list shall be updated by the Commissioner of Banking and Insurance whenever the codes are altered or supplemented:
(a) 99492 - Initial psychiatric collaborative care management;
(b) 99493 - Subsequent psychiatric collaborative care management; and
(c) 99494 - Initial or subsequent psychiatric collaborative care management, additional time.
"Same terms and conditions" means that a carrier cannot apply more restrictive non-quantitative limitations, such as utilization review and other criteria or more quantitative limitations such as copayments, deductibles, aggregate or annual limits or benefit limits to mental health condition and substance use disorder benefits than those applied to substantially all other medical or surgical benefits.
"Substance use disorder" means a disorder defined to be consistent with generally recognized independent standards of current medical practice referenced in the most current version of the Diagnostic and Statistical Manual of Mental Disorders.
L.1999, c.441, s.1; amended 2019, c.58, s.9; 2022, c.33, s.9.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29e - SHBC to provide benefits for mental health conditions, substance use disorders; collaborative care model.

52:14-17.29e SHBC to provide benefits for mental health conditions, substance use disorders; collaborative care model.
2. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for mental health conditions and substance use disorders under the same terms and conditions as provided for any other sickness under the contract and shall meet the requirements of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C. s.18031(j), and any amendments to, and federal guidance or regulations issued under that act, including 45 C.F.R. Parts 146 and 147 and 45 C.F.R. s.156.115(a)(3).
Coverage provided pursuant to this section shall include benefits delivered through the psychiatric Collaborative Care Model.
b. The commission shall provide notice to employees regarding the coverage required by this section in accordance with this subsection and regulations promulgated by the Commissioner of Health pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the employee; (2) the yearly informational packet sent to the employee; or (3) July 1, 2000. The commission shall also ensure that the carrier under contract with the commission, upon receipt of information that a covered person is receiving treatment for a mental health condition or substance use disorder, shall promptly notify that person of the coverage required by this section.
c. Nothing in this section shall reduce the requirement for a carrier to provide benefits pursuant to section 9 of P.L.2017, c.28 (C.52:14-17.29u).
L.1999, c.441, s.2; amended 2019, c.58, s.10; 2022, c.33, s.10.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29f - Pap smear benefits in State health benefits contracts

52:14-17.29f. Pap smear benefits in State health benefits contracts
6. The State Health Benefits Commission shall provide benefits to each person covered under the State Health Benefits Program for expenses incurred in conducting a Pap smear. The benefits shall be provided to the same extent as for any other medical condition under the contract.
As used in this section, and notwithstanding the provisions of this section to the contrary, "Pap smear" means an initial Pap smear and any confirmatory test when medically necessary and as ordered by the covered person's physician and includes all laboratory costs associated with the initial Pap smear and any such confirmatory test.
L.2001,c.227,s.6.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29g - Notice to enrollees in State Health Benefits Program managed care plans if primary care physician is terminated from plan.

52:14-17.29g Notice to enrollees in State Health Benefits Program managed care plans if primary care physician is terminated from plan.
1. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of P.L.2001, c.284 (C.52:14-17.29g) provides that if an enrollee's or member's primary care physician's contract as a participating physician in a health maintenance organization or State managed care plan will be terminated, the health maintenance organization or State managed care plan, as appropriate, shall provide the enrollee or member with 90-days' notice of the termination. If 90-days' notice cannot be provided because the termination will occur prior to the end of the 90-day period, the health maintenance organization or State managed care plan shall notify the enrollee or member as soon as the health maintenance organization or State managed care plan has knowledge of the termination.
b. Notwithstanding the provisions of any policy governing open enrollment to the contrary, an enrollee or member who has been notified by a health maintenance organization or State managed care plan pursuant to this section may change his coverage to another health benefits plan under the State Health Benefits Program upon receiving notice that his primary care physician will no longer be a participating physician with the health maintenance organization or State managed care plan, in which the person is currently enrolled.
L.2001, c.284, s.1; amended 2007, c.103, s.24.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29h - State Health Benefits Commission contracts to cover certain out-of-network services.

52:14-17.29h State Health Benefits Commission contracts to cover certain out-of-network services.
11. The State Health Benefits Commission shall ensure that every contract purchased or renewed by the commission on or after the effective date of P.L.2001, c.367 (C.26:2S-6.1 et al.), which provides hospital or medical expense benefits through a managed care plan as defined in section 2 of P.L.1997, c.192 (C.26:2S-2), shall meet the requirements of section 2 of P.L.2001, c.367 (C.26:2S-6.1).
L.2001,c.367,s.11.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29i - State Health Benefits Program, coverage for mammograms.

52:14-17.29i State Health Benefits Program, coverage for mammograms.
9. a. The State Health Benefits Commission shall provide benefits to each person covered under the State Health Benefits Program for expenses incurred in conducting:
(1) one baseline mammogram examination for women who are 40 years of age; a mammogram examination every year for women age 40 and over; and, in the case of a woman who is under 40 years of age and has a family history of breast cancer or other breast cancer risk factors, a mammogram examination at such age and intervals as deemed medically necessary by the woman's health care provider; and
(2) an ultrasound evaluation, a magnetic resonance imaging scan, a three-dimensional mammography, or other additional testing of an entire breast or breasts, after a baseline mammogram examination, if the mammogram demonstrates extremely dense breast tissue, if the mammogram is abnormal within any degree of breast density including not dense, moderately dense, heterogeneously dense, or extremely dense breast tissue, or if the patient has additional risk factors for breast cancer including but not limited to family history of breast cancer, prior personal history of breast cancer, positive genetic testing, extremely dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology, or other indications as determined by the patient's health care provider. The coverage required under this paragraph may be subject to utilization review, including periodic review, by the carrier of the medical necessity of the additional screening and diagnostic testing.
b. The benefits shall be provided to the same extent as for any other medical condition under the contract.
L.2004, c.86, s.9; amended 2013, c.196, s.9.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29l - Disease and chronic care management plan.

52:14-17.29l Disease and chronic care management plan.
31. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of P.L.2007, c.92 (C.43:15C-1 et al.) to provide benefits under the State managed care plans includes a disease and chronic care management plan for specified conditions meeting nationally recognized accreditation standards and including specified outcome measures and objectives for disease and chronic care management.
L.2007, c.92, s.31.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29m - State health benefits plan to provide benefits for orthotic and prosthetic appliances.

52:14-17.29m State health benefits plan to provide benefits for orthotic and prosthetic appliances.
9. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits, shall provide benefits to any person covered thereunder for expenses incurred in obtaining an orthotic or prosthetic appliance from any licensed orthotist or prosthetist, or any certified pedorthist, as determined medically necessary by the covered person's physician.
As used in this section, "orthotic appliance," "prosthetic appliance," "licensed orthotist" and "licensed prosthetist" have the meaning assigned to them in section 3 of P.L.1991, c.512 (C.45:12B-3) and "certified pedorthist" has the meaning assigned to it in subsection j. of section 18 of P.L.1991, c.512 (C.45:12B-18).
b. On and after the effective date of this act, a contract purchased by the commission shall reimburse for orthotic and prosthetic appliances at the same rate as reimbursement for such appliances under the federal Medicare reimbursement schedule.
c. The benefits shall be provided to the same extent as for any other medical condition under the contract.
L.2007, c.345, s.9.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29n - State Health Benefits Commission to provide coverage for hearing aids for certain persons aged 15 or younger.

52:14-17.29n State Health Benefits Commission to provide coverage for hearing aids for certain persons aged 15 or younger.
10. The State Health Benefits Commission shall, on or after the effective date of this act, provide benefits for medically necessary expenses incurred in the purchase of a hearing aid for a covered person 15 years of age or younger, as provided in this section.
The benefits shall include the purchase of a hearing aid for each ear, when medically necessary and as prescribed or recommended by a licensed physician or audiologist. The commission may limit the benefit provided in this section to $1,000 per hearing aid for each hearing-impaired ear every 24 months. A covered person may choose a hearing aid that is priced higher than the benefit payable under this section and may pay the difference between the price of the hearing aid and the benefit payable under this section, without financial or contractual penalty to the provider of the hearing aid.
L.2008, c.126, s.10.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29o - SHBC to provide for installment payments to obstetrical provider for maternity services.

52:14-17.29o SHBC to provide for installment payments to obstetrical provider for maternity services.
9. a. Within 30 days of the effective date of this act, the State Health Benefits Commission shall provide, in every health benefits plan that provides for maternity services, for reimbursement in installments to an obstetrical provider licensed in New Jersey for maternity services rendered during the term of a covered person's pregnancy.
b. For the purposes of this section, "obstetrical provider licensed in New Jersey" means:
(1) an obstetrician/gynecologist licensed by the State Board of Medical Examiners; or
(2) a midwife licensed by the State Board of Medical Examiners as a certified midwife or a certified nurse midwife.
L.2009, c.113, s.9.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29r - SHBC to provide coverage for oral anticancer medications.

52:14-17.29r SHBC to provide coverage for oral anticancer medications.
9. a. The State Health Benefits Commission shall ensure that every contract purchased on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than the contract provides for intravenously administered or injected anticancer medications.
b. Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.
c. A State Health Benefits Commission contract shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the contract as of the effective date of this act.
L.2011, c.188, s.9.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29s - SHBC to provide coverage for prescription eye drops.

52:14-17.29s SHBC to provide coverage for prescription eye drops.
9. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits that include coverage for prescription eye drops, shall provide coverage for expenses incurred for refills of prescription eye drops in accordance with the Guidance for Early Refill Edits of Topical Ophthalmic Products provided to Medicare Part D plan sponsors by the Centers for Medicare & Medicaid Services of the U.S. Department of Health and Human Services, provided that:
(1) the prescribing health care practitioner indicates on the original prescription that additional quantities of the prescription eye drops are needed; and
(2) the refill requested by the covered person does not exceed the number of additional quantities indicated on the original prescription by the prescribing health care practitioner.
L.2013, c.50, s.9.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29t - State Health Benefits Program, coverage for synchronization of prescribed medications.

52:14-17.29t State Health Benefits Program, coverage for synchronization of prescribed medications.
9. The State Health Benefits Commission shall ensure that every contract under the State Health Benefits Program purchased on or after the effective date of this act, which provides benefits for pharmacy services, prescription drugs, or for participation in a prescription drug plan, shall, on at least one occasion per year for each covered person:
(1) apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for less than a 30 days' supply if the prescriber or pharmacist indicates the fill or refill is in the best interest of the covered person or is for the purpose of synchronizing the covered person's chronic medications;
(2) provide coverage for a drug prescribed for the treatment of a chronic illness dispensed in accordance with a plan among the covered person, the prescriber and the pharmacist to synchronize the refilling of multiple prescriptions for the covered person; and
(3) determine dispensing fees based exclusively on the total number of prescriptions dispensed; dispensing fees shall not be prorated or based on the number of the days' supply of medication prescribed or dispensed.
This section shall not apply to prescriptions for opioid analgesics. "Opioid analgesic" means a drug in the opioid analgesic drug class prescribed to treat moderate to severe pain or other conditions, whether in immediate release or extended release form, and whether or not combined with other drug substances to form a single drug product or dosage form.
L.2015, c.206, s.9.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29y - SHBC to cover digital tomosynthesis of the breast.

52:14-17.29y SHBC to cover digital tomosynthesis of the breast.
9. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide coverage for expenses incurred in conducting digital tomosynthesis to detect or screen for breast cancer in women 40 years of age and over; and for diagnostic purposes in women of any age.
b. In the case of digital tomosynthesis conducted to detect or screen for breast cancer in women 40 years of age and over, no deductible, coinsurance or other cost sharing shall be applied; and in the case of digital tomosynthesis conducted for diagnostic purposes in women of any age, the same deductibles, coinsurance, and other cost sharing as apply to similar services under the contract shall be applied.
L.2017, c.305, s.9.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29z - SHBC to provide coverage for donated human breast milk.

52:14-17.29z SHBC to provide coverage for donated human breast milk.
9. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for expenses incurred in the provision of pasteurized donated human breast milk, which may include human milk fortifiers if indicated by the prescribing licensed medical practitioner, provided that:
(1) the covered person is an infant under the age of six months;
(2) the milk is obtained from a human milk bank that meets quality guidelines established by the Department of Health ; and
(3) a licensed medical practitioner has issued an order for an infant who is medically or physically unable to receive maternal breast milk or participate in breast feeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breast feeding despite optimal lactation support; or
(4) a licensed medical practitioner has issued an order for an infant who meets any of the following conditions:
(a) a body weight below healthy levels determined by the licensed medical practitioner;
(b) a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or
(c) a congenital or acquired condition that may benefit from the use of donor breast milk as determined by the Department of Health.
b. Nothing in this section shall preclude the carrier from performing utilization review, including periodic review of the medical necessity of a particular service.
c. The benefits shall be provided to the same extent as for any other prescribed items under the contract.
d. If there is no supply of human breast milk that meets the requirements of paragraph (2) of subsection a. of this section, the carrier shall not be required to provide coverage of expenses pursuant to this section.
L.2017, c.309, s.9.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29aa - SHBC not to provide coverage for certain early elective deliveries.

52:14-17.29aa SHBC not to provide coverage for certain early elective deliveries.
4. a. Notwithstanding any other law or regulation to the contrary, the State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall not provide coverage for a non-medically indicated early elective delivery performed at a hospital on a pregnant woman earlier than the 39th week of gestation.
b. As used in this section, "non-medically indicated early elective delivery" means the artificial start of the birth process through medical interventions or other methods, also known as labor induction, or the surgical delivery of a baby via a cesarean section for purposes or reasons that are not fully consistent with established standards of clinical care as provided by the American College of Obstetricians and Gynecologists.
L.2019, c.87, s.4.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29bb - State Health Benefits Commission to provide coverage for standard fertility preservation services.

52:14-17.29bb State Health Benefits Commission to provide coverage for standard fertility preservation services.
6. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility.
For the purposes of this section:
"Iatrogenic infertility" means an impairment of fertility caused by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
"May directly or indirectly cause" means a medical treatment with a likely side effect of iatrogenic infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or as defined by the New Jersey Department of Health.
"Standard fertility preservation services" means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or as defined by the New Jersey Department of Health. "Standard fertility preservation services" shall not include the storage of sperm or oocytes.
The benefits shall be provided to the same extent as for any other medical condition under the contract. The same copayments, deductibles, and benefit limits shall apply to the provision of standard fertility preservation services pursuant to this section as those applied to other medical or surgical benefits under the contract.
b. The State Health Benefits Commission shall not purchase a contract that determines the provision of standard fertility preservation services based on a covered person's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions, or based on personal characteristics, including age, sex, sexual orientation, marital status, or gender identity.
L.2019, c.306, s.6.