reglab/statecodes huggingface dataset:
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7.5 - Property held in trust; attachment of lien

30:4D-7.5. Property held in trust; attachment of lien
If it is found that any party chargeable under any lien or certificate of debt filed pursuant to this act is possessed of any goods, rights, credits, chattels, moneys or effects which are held by any person, firm, or corporation for the present or subsequent use of said individual, then the lien or certificate of debt provided for herein, or a notice of the existence of said lien or certificate of debt, may be forwarded by registered or certified mail to said person, firm or corporation and shall become binding upon any property rights so held. Such person, firm or corporation shall thereafter be precluded from disposing of said property rights until said lien or certificate of debt is satisfied or until the department consents thereto, or until the procedure set forth in section 13 of this amendatory and supplementary act is followed.
Any person, firm or corporation disposing of any such property or moneys after receipt of notice of said lien or certificate of debt shall be liable to the department for the value of such property or moneys of which disposition has been made, or the amount set forth in the department's lien or certificate of debt, whichever is less.
L.1979, c. 365, s. 10, eff. Feb. 4, 1980.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7.6 - County clerk; register of deeds; recording liens and certificates of debt

30:4D-7.6. County clerk; register of deeds; recording liens and certificates of debt
The clerk of the county or register of deeds and mortgages, or clerk of the superior court, as the case may be, shall provide suitable books in which he shall enter the liens and certificates of debt filed hereunder properly indexed in the name of the party against whom the lien or certificate of debt has been filed. All liens and certificates of debt and other papers incidental thereto required hereunder shall be received and recorded by the clerk of the county, register of deeds and mortgages, or clerk of the superior court, as the case may be, without payment of fees by the department or the division.
L.1979, c. 365, s. 11, eff. Feb. 4, 1980.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7.7 - Compromise, settlement or waiver of lien; discharge of lien

30:4D-7.7. Compromise, settlement or waiver of lien; discharge of lien
The commissioner or director or such person designated by the commissioner or director is hereby authorized to compromise, settle or waive in whole or in part any lien or certificate of debt filed under the provisions of this act in accordance with rules and regulations promulgated by the commissioner pursuant to subsection l . of section 7 of P.L.1968, c. 413 (C. 30:4D-7).
To discharge any lien or certificate of debt filed hereunder, the commissioner or director, or his duly constituted agent shall file with the clerk of the county, register of deeds and mortgages, or clerk of the superior court, as the case may be, a duly acknowledged certificate or warrant setting forth the fact that the department desires to discharge the lien or certificate of debt of record.
L.1979, c. 365, s. 12, eff. Feb. 4, 1980. Amended by L.1981, c. 511, s. 16, eff. Jan. 12, 1982.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7.8 - Action to determine validity of lien; deposit and bond; discharge prior to adjudication

30:4D-7.8. Action to determine validity of lien; deposit and bond; discharge prior to adjudication
Any person affected in any manner, whether directly or indirectly, by any lien filed under this act, or any certificate of debt filed prior to a final agency adjudication in accordance with subsection (h) of section 17 of P.L.1968, c. 413 (C. 30:4D-17(h) ), and desiring to examine the validity thereof or the facts and circumstances surrounding the entry thereof, may do so in an action brought in the Superior Court. The action shall be brought against the department, and the court may proceed in the action in a summary manner or otherwise and enter such judgment as it may deem appropriate.
Any person desiring to secure immediate discharge of any lien or of any certificate of debt filed prior to a final agency adjudication under subsection (h) of section 17 of P.L.1968, c. 413 (C. 30:4D-17(h) ) may deposit with the court an amount of money sufficient to cover the sureties to be approved by said court. Upon proper notice of the deposit and posting of bond, a satisfaction of said lien or certificate of debt shall be filed forthwith with the county clerk, register of deeds and mortgages or the clerk of the superior court, as the case may be.
L.1979, c. 365, s. 13, eff. Feb. 4, 1980.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.2 - Definitions relative to a Medicaid ACO.

30:4D-8.2 Definitions relative to a Medicaid ACO.
2. As used in this act:
"ACO" means an accountable care organization.
"Behavioral health care provider" means a provider licensed or approved by the Department of Human Services to render services to New Jersey residents.
"Department" means the Department of Human Services.
"Designated area" means a municipality or defined geographic area in which no fewer than 5,000 Medicaid recipients reside.
"Disproportionate share hospital" means a hospital designated by the Commissioner of Human Services pursuant to Pub.L.89-87 (42 U.S.C. s.1396a et seq.) and Pub.L.102-234.
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Medicaid ACO Demonstration Project" or "demonstration project" means the demonstration project established pursuant to this act.
"Primary care provider" includes the following licensed individuals: physicians, physician assistants, advanced practice nurses, and nurse midwives whose professional practice involves the provision of primary care, including internal medicine, family medicine, geriatric care, pediatric care, or obstetrical/gynecological care.
"Qualified behavioral health care provider" means a behavioral health care provider who participates in the Medicaid program and renders clinic-based and home-based services to individuals residing in the designated area served by the Medicaid ACO.
"Qualified primary care provider" means a primary care provider who participates in the Medicaid program and who spends at least 25% of his professional time or 10 hours per seven-day week, whichever is less, rendering clinical or clinical supervision services at an office or clinic setting located within the designated area served by a Medicaid ACO.
L.2011, c.114, s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.3 - Establishment of three-year Medicaid ACO Demonstration Project.

30:4D-8.3 Establishment of three-year Medicaid ACO Demonstration Project.
3. a. The Department of Human Services shall establish a three-year Medicaid ACO Demonstration Project in which nonprofit corporations organized with the voluntary support and participation of local general hospitals, clinics, pharmacies, health centers, qualified primary care and behavioral health care providers, and public health and social services agencies may apply to the department for certification and participation in the project. The department shall consult with the Department of Health and Senior Services with respect to establishment and oversight of the demonstration project.
Nothing in this act shall preclude the department, Medicaid managed care organizations, qualified primary care and behavioral health care providers, licensed health care facilities, or any other provider or payer of health care services from participating in other ACOs, health or behavioral health ACO models, medical home programs, or projects.
b. Applicants for participation in the demonstration project shall be nonprofit corporations created and operated for the primary purpose of improving the quality and efficiency of care provided to Medicaid recipients residing in a given designated area.
L.2011, c.114, s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.6 - Remission of payment to ACO.

30:4D-8.6 Remission of payment to ACO.
6. The department shall remit payment of cost savings to a participating Medicaid ACO following approval by the department, in consultation with the Department of Health and Senior Services, of the ACO's gainsharing plan and identification of cost savings and agreement from the federal government to share in the cost of the funds distributed.
L.2011, c.114, s.6.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.7 - Voluntary participation in demonstration project.

30:4D-8.7 Voluntary participation in demonstration project.
7. a. A managed care organization that has contracted with the department may voluntarily seek participation in the demonstration project by notifying the Medicaid ACO of its desire to participate. The ACO shall submit a separate Medicaid managed care organization gainsharing plan meeting the requirements of section 5 of this act to the department for review and approval. The Medicaid managed care organization gainsharing plan may be identical to the gainsharing plan approved for use in connection with the Medicaid fee-for-service program, or may contain variations with respect to the manner in which health outcomes, quality, care coordination, and access are to be improved and the manner in which cost savings are achieved and distributed as gainsharing payments, but the managed care organization gainsharing plan shall not affect the calculation or distribution of shared savings pursuant to the approved gainsharing plan applicable to the Medicaid fee-for-service program or the calculation or distribution of shared savings pursuant to any other approved gainsharing plan used by the ACO.
b. A Medicaid managed care organization may withdraw from participation after one year by notifying the department in writing of its desire to withdraw.
c. Nothing in this act shall:
(1) alter or limit the obligations of a Medicaid managed care organization participating in the demonstration project pursuant to an approved gainsharing plan to comply with State and federal law applicable to the Medicaid managed care organization; or
(2) preclude an ACO from expanding its operations to include participation with new health care providers located within the ACO's designated area.
L.2011, c.114, s.7.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.8 - Duties of the department; authorization to seek grants.

30:4D-8.8 Duties of the department; authorization to seek grants.
8. a. The department, in consultation with the Department of Health, shall:
(1) design and implement the application process for approval of participating ACOs in the demonstration project;
(2) collect data from participants in the demonstration project; and
(3) approve a methodology proposed by the Medicaid ACO applicant for calculation of cost savings and for monitoring of health outcomes and quality of care under the demonstration project.
b. The department and the Department of Health shall be authorized to jointly seek public and private grants to implement and operate the demonstration project.
L.2011, c.114, s.8; amended 2012, c.17, s.365.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.9 - Annual evaluation.

30:4D-8.9 Annual evaluation.
9. The department, in consultation with the Department of Health, shall evaluate the demonstration project annually to assess whether: cost savings, including, but not limited to, savings in administrative costs and savings due to improved health outcomes, are achieved through implementation of the demonstration project.
The department, in consultation with the Department of Health, and with the assistance of the Rutgers Center for State Health Policy, shall evaluate the demonstration project annually to assess whether there is improvement in the rates of health screening, the outcomes and hospitalization rates for persons with chronic illnesses, and the hospitalization and readmission rates for patients residing in the designated areas served by the ACOs. The department and the Department of Health shall provide the Rutgers Center for State Health Policy with all data necessary to perform the annual evaluation of the demonstration project.
L.2011, c.114, s.9; amended 2012, c.17, s.366.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.10 - Application for State plan amendments, waivers.

30:4D-8.10 Application for State plan amendments, waivers.
10. a. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program, and shall take such additional steps as may be necessary to secure on behalf of participating ACOs such waivers, exemptions, or advisory opinions to ensure that such ACOs are in compliance with applicable provisions of State and federal laws related to fraud and abuse, including, but not limited to, anti-kickback, self-referral, false claims, and civil monetary penalties.
b. The Commissioners of Health and Senior Services and Human Services may apply for participation in federal ACO demonstration projects that align with the goals of this act.
c. The provisions of this act shall not be construed to require State funding for any evaluation or start-up costs of an ACO.
L.2011, c.114, s.10.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.11 - Construction of act.

30:4D-8.11 Construction of act.
11. Nothing in this act shall be construed to limit the choice of a Medicaid recipient to access care for family planning services or any other type of health care services from a qualified health care provider who is not participating in the demonstration project.
L.2011, c.114, s.11.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.12 - Continuation of payments for certain services.

30:4D-8.12 Continuation of payments for certain services.
12. a. Under the demonstration project, payment shall continue to be made to providers of services and suppliers participating in the Medicaid ACO for services provided to managed care recipients or individuals who receive services on a fee-for-service basis in the same manner as they would otherwise be made, except that the ACO is eligible to receive gainsharing payments under sections 5 and 6 of this act if it meets the requirements set forth therein.
b. Nothing in this act shall be construed to authorize the Department of Human Services or Health to waive or limit any provisions of federal or State law or reimbursement methodologies governing Medicaid reimbursement to federally qualified health centers, including, but not limited to, Medicaid prospective payment reimbursement and any supplemental payments made to a federally qualified health center providing services to Medicaid managed care recipients.
L.2011, c.114, s.367; amended 2012, c.17, s.367.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.13 - Certain licensure requirements waived.

30:4D-8.13 Certain licensure requirements waived.
13. Notwithstanding the requirements of P.L.1999, c.409 (C.17:48H-1 et seq.), a Medicaid ACO certified pursuant to this act shall not be required to obtain licensure or certification from the Department of Banking and Insurance as an organized delivery system when providing services to Medicaid recipients.
L.2011, c.114, s.13.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.14 - Report to Governor, Legislature.

30:4D-8.14 Report to Governor, Legislature.
14. Upon completion of the demonstration project, the Commissioners of Human Services and Health shall report to the Governor, and to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), on the demonstration project, and include in the report the findings of the evaluation carried out pursuant to section 9 of this act. The commissioners shall make such recommendations as they deem appropriate.
If, after three years following enactment of this act, the commissioners find the demonstration project was successful in reducing costs and improving health outcomes and the quality of care for Medicaid recipients, the commissioners may recommend that Medicaid ACOs be established on a permanent basis and in additional communities in which Medicaid recipients reside.
L.2011, c.114, s.14; amended 2012, c.17, s.368.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.15 - Rules, regulations.

30:4D-8.15 Rules, regulations.
15. The Commissioner of Human Services, in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) and with input from the Commissioner of Health, shall, within 180 days of the effective date of this act, adopt rules and regulations establishing the standards for gainsharing plans submitted by Medicaid ACOs. The Commissioner of Human Services shall also adopt, with input from the Commissioner of Health such rules and regulations governing the ongoing oversight and monitoring of the quality of care delivered to Medicaid recipients in the designated areas served by the Medicaid ACOs, and such other requirements as the Commissioner of Human Services deems necessary to carry out the provisions of this act.
L.2011, c.114, s.15; amended 2012, c.17, s.369.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.16 - Findings, declarations relative to the establishment of a Regional Health Hub Program.

30:4D-8.16 Findings, declarations relative to the establishment of a Regional Health Hub Program.
1. The Legislature finds and declares that:
a. Significant State resources are invested in both the health and social service sectors in New Jersey, and the development of improvements in how Medicaid benefits and payment models interact with social services would provide a benefit to all New Jersey residents.
b. A more regional approach to care, involving the coordinated provision of person-centered health care in combination with robust connections to social services and community resources, is required at both the patient and organizational levels.
c. It is in New Jersey's best interest to establish a regional network of non-profit organizations that partner with Medicaid and State agencies to reduce health disparities and improve health outcomes and the delivery of care for Medicaid recipients in the State. Such non-profit organizations have the capacity to become local innovation engines that use real-time actionable data and diverse stakeholder input to develop and implement innovative models for the delivery of effective, person-centered care.
d. It is both reasonable and appropriate for the Department of Human Services to designate and recognize existing accountable care organizations as Regional Health Hubs, and to establish new Regional Health Hubs in appropriate areas of the State, as provided by this act, in order to enable the State to:
(1) identify existing and emerging threats to health and wellbeing, and problems with the State's regional health care delivery systems, and identify and determine how to implement solutions to those problems;
(2) promote and facilitate cooperation, coordination, innovation, and goal setting by and among relevant stakeholders;
(3) evaluate the progress that has been made in achieving identified goals and priorities; and
(4) otherwise encourage and enable the overall improvement of the health of New Jersey residents and the delivery of health care throughout the State.
L.2019, c.517, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.17 - Definitions relative to Regional Health Hubs.

30:4D-8.17 Definitions relative to Regional Health Hubs.
2. As used in this act:
"Commissioner" means the Commissioner of Human Services.
"Core region" means the geographic area of responsibility for a Regional Health Hub.
"Data catchment area" means the zip codes in New Jersey for which a Regional Health Hub receives NJ FamilyCare claims data.
"Department" means the Department of Human Services.
"Existing Regional Health Hub" means those four organizations designated as Regional Health Hubs by the FY20 New Jersey State Budget, P.L.2019, c.150 and identified in subsection b. of section 3 of this act.
"Health information platform" means a Health Information Exchange (HIE) or other electronic platform that is used to run population-level analytics or exchange health information among various organizations.
"New Regional Health Hub" means an entity that is designated by the commissioner as a Regional Health Hub after the effective date of, and as provided by, this act.
"Prospective service region" or "prospective region" means a geographical area that is designated by the commissioner, pursuant to subsection a. of section 4 of this act, as being in need of a Regional Health Hub.
"Regional Health Hub" means any entity that is designated as a Regional Health Hub, as provided by this act, including an existing Regional Health Hub or a new Regional Health Hub.
L.2019, c.517, s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.18 - Regional Health Hub Program.

30:4D-8.18 Regional Health Hub Program.
3. a. The Department of Human Services shall establish a Regional Health Hub Program, and shall designate Regional Health Hubs in appropriate areas of the State, as provided by this act. The Regional Health Hub Program shall replace the Medicaid Accountable Care Organization Demonstration Project established pursuant to P.L.2011, c.114 (C.30:4D-8.1 et seq.), which is now subject to expiration by law.
b. The following certified accountable care organizations and accountable care look-alike organizations, which are operating in this State as of the effective date of this act, shall be grandfathered into the Regional Health Hub Program, and shall be automatically designated as Regional Health Hubs, for the purposes of this act:
(1) the Healthy Greater Newark ACO;
(2) the Trenton Health Team;
(3) the Camden Coalition of Health Care Providers; and
(4) the Health Coalition of Passaic County.
c. The Department of Human Services, in consultation with the Department of Health, shall be authorized to designate additional non-profit organizations to operate as Regional Health Hubs under the Regional Health Hub Program, pursuant to section 4 of this act, as determined to be appropriate.
L.2019, c.517, s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.20 - Revocation of status.

30:4D-8.20 Revocation of status.
5. a. The commissioner may revoke an organization's status as a Regional Health Hub if the organization fails to perform the mandatory activities of a Regional Health Hub, as described in subsection a. of section 6 of this act.
b. Before revoking an organization's status as a Regional Health Hub, the commissioner shall notify the organization of the potential revocation and provide a reasonable timeframe for corrective action.
c. The commissioner's revocation of Regional Health Hub status shall be a final agency action for the purposes of the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.).
d. After revoking an organization's status as a Regional Health Hub, the commissioner shall immediately determine whether a new Regional Health Hub is needed in the area where status was revoked. If such need is determined to exist, the commissioner shall designate a new Regional Health Hub to serve the area, as provided by subsection d. of section 4 of this act.
L.2019, c.517, s.5.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.22 - Submission of annual proposal.

30:4D-8.22 Submission of annual proposal.
7. a. Each Regional Health Hub shall annually submit a proposal to the department, describing the Regional Health Hub's annual goals, and the elective activities that the Regional Health Hub will undertake during the upcoming fiscal year.
b. In order to become effective, each Regional Health Hub's proposal shall be approved by the department in consultation with the Department of Health. Approval shall be at the sole discretion of the department in consultation with the Department of Health, and the department may request that the Regional Health Hub modify and resubmit a proposal, in order to receive approval.
c. In order to facilitate the development of proposals under this section, the department shall annually provide each Regional Health Hub with a list of the department's goals, projects, or priorities for the upcoming fiscal year.
d. When finalizing a proposal under this section, the department and relevant Regional Health Hub shall negotiate joint goals, projects, and priorities for the upcoming fiscal year, and agree upon the associated funding that will be needed to accomplish those joint goals, projects, and priorities.
e. Each proposal approved pursuant to this section shall include, at a minimum:
(1) a description of the joint goals, projects, and priorities agreed upon by the Regional Health Hub and the department for the upcoming fiscal year pursuant to subsection d. of this section;
(2) an indication of the amount of funding that will be needed to attain each joint goal, project, and priority identified in the proposal, and an indication of the total amount of funding, overall, that will be needed to execute the proposal;
(3) a description of the clear deliverables and performance metrics that will be used to evaluate and measure success in relation to the achievement of the goals, projects, and priorities described in the proposal; and
(4) a description of performance-based payments, which shall be tied to the achievement of the clear deliverables and performance metrics described in paragraph (3) of this subsection. Each year, at least 10 percent, but no more than 25 percent of the total funding provided by the department to each Regional Health Hub to undertake the activities described in section 6 of this act shall be contingent upon the Regional Health Hub's achievement of such deliverables and performance metrics. Determination of whether a Regional Health Hub has achieved such deliverables and performance metrics shall be at the sole discretion of the department.
L.2019, c.517, s.7.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.23 - Funding for Regional Health Hub.

30:4D-8.23 Funding for Regional Health Hub.
8. a. A Regional Health Hub may be funded in part by the department, in accordance with the provisions of the annual appropriations act. As described in paragraph (4) of subsection e. of section 7 of this act, a portion of such funding shall be contingent on the Regional Health Hub's achievement of deliverables and performance metrics, as specified in the Regional Health Hub's approved proposal each year.
b. In addition to funding described in subsection a. of this section, the commissioner shall have the discretion to support a Regional Health Hub's innovation projects that advance Medicaid priorities using other available dollars as appropriate.
c. A Regional Health Hub shall not receive funding provided for under this section until the Regional Health Hub has submitted an annual proposal, as described in section 7 of this act.
L.2019, c.517, s.8.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.24 - Health information platform.

30:4D-8.24 Health information platform.
9. a. A health information platform operated pursuant to paragraph (1) of subsection a. of section 6 of this act shall contain detailed health data from the Regional Health Hub's core region, including macro-level analytics of broad population trends, and micro-level analytics of both individual health data, and disease trends by category of disease, age group, or other subset.
b. Each Regional Health Hub shall maintain a data sharing use and reciprocal support agreement, and any applicable use case agreement, with any Statewide health information platform designated by the commissioner in order to promote interoperability.
c. The department shall, consistent with federal and Sate law, make available NJ FamilyCare claims data to the Regional Health Hubs, as needed for the Regional Health Hub's population health work or other tasks, and enter into appropriate data sharing agreements for the exchange of such data. The department shall share with each Regional Health Hub the NJ FamilyCare claims data for beneficiaries residing within the Regional Health Hub's data catchment area, as mutually agreed to by the Regional Health Hub and the department. The data catchment area shall include, but need not be limited to, the Regional Health Hub's core region, and may overlap with the data catchment areas for other Regional Health Hubs.
d. The Departments of Human Services, Health, Children and Families, and Community Affairs shall be authorized, to the extent permissible by federal and State law or regulation, to share with the health information platforms established, or the Regional Health Hubs designated, pursuant to this act, any available health data that is maintained by the departments.
L.2019, c.517, s.9.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.25 - Consultations relative to pilot program.

30:4D-8.25 Consultations relative to pilot program.
10. Any State department that implements a pilot program related to health care delivery shall be encouraged to consult with the Regional Health Hubs operating in the regions of the State that will be affected by the pilot program, in order to ensure that all relevant considerations have been accounted for, and that the pilot program is effectively and efficiently implemented with the assistance of all relevant stakeholders.
L.2019, c.517, s.10.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.26 - Application for amendments, waivers.

30:4D-8.26 Application for amendments, waivers.
11. In addition to utilizing any State-appropriated funding that supports Regional Health Hubs, the Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act, and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program, and shall take such additional steps as may be necessary to secure, on behalf of participating Regional Health Hubs, such waivers, exemptions, or advisory opinions to ensure that such Regional Health Hubs are in compliance with applicable provisions of State and federal law related to fraud and abuse, including, but not limited to, anti-kickback, self-referral, false claim, and civil monetary penalty provisions.
L.2019, c.517, s.11.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-8.27 - Rules, regulations.

30:4D-8.27 Rules, regulations.
12. The Commissioner of Human Services shall adopt rules and regulations, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), as may be necessary to implement the provisions of this act.
L.2019, c.517, s.12.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-9.2 - Medicaid to not provide coverage for certain early elective deliveries.

30:4D-9.2 Medicaid to not provide coverage for certain early elective deliveries.
3. a. Notwithstanding the provisions of any other law or regulation to the contrary, any contract between a carrier and the Division of Medical Assistance and Health Services in the Department of Human Services that provides benefits to persons who are eligible for Medicaid under P.L.1968, c.413 (C.30:4D-1 et seq.) shall not provide coverage for a non-medically indicated early elective delivery performed at a hospital on a pregnant woman earlier than the 39th week of gestation.
b. As used in this section, "non-medically indicated early elective delivery" means the artificial start of the birth process through medical interventions or other methods, also known as labor induction, or the surgical delivery of a baby via a cesarean section for purposes or reasons that are not fully consistent with established standards of clinical care as provided by the American College of Obstetricians and Gynecologists.
L.2019, c.87, s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-10 - Review of sealed bids; report and recommendation; considerations

30:4D-10. Review of sealed bids; report and recommendation; considerations
Upon the opening of sealed bids submitted in accordance with sections 8. a. and 9, the commissioner shall review the same and make a report and recommendation for acceptance or rejection of a bid to the State Medicaid Commission which shall be convened to receive, consider and act upon the commissioner's recommendation. The State Medicaid Commission shall in reviewing the bids and the recommendations of the commissioner be guided by such considerations as:
a. The amount of the bids.
b. The ability of the underwriter and fiscal agent in carrying out the scope of medical assistance benefits with providers which ability the underwriter already has or is in a position to secure, whereby payments are made on behalf of subscribers or policyholders directly to various providers of medical services under cost reimbursement formulas or in accordance with fee schedules agreed upon in advance.
c. The demonstrated effectiveness of control mechanisms to assure quality of care, appropriate utilization of service and claims cost control.
L.1968, c. 413, s. 10.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-11 - Approval or disapproval of lowest responsible bid; direction of payment

30:4D-11. Approval or disapproval of lowest responsible bid; direction of payment
The State Medicaid Commission by majority vote of all its members shall (a) approve or disapprove the lowest responsible bid submitted under 8. a. and should the bid be disapproved (b) direct that payment of claims under this act be made by the Department of Institutions and Agencies in the manner provided in section 8. b. or 8. c. as shall be determined by the State Medicaid Commission.
L.1968, c. 413, s. 11.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-12 - Unnecessary use of care and services; methods and procedures; maintenance of records required for reimbursement

30:4D-12. Unnecessary use of care and services; methods and procedures; maintenance of records required for reimbursement
Subject to the limitations provided in sections 7, 8 and 9 of this act, the department shall (a) develop and employ such methods and procedures relating to the utilization of and the payment for medical care and services available under the plan as may be necessary to safeguard against unnecessary utilization of such care and services;
(b) Assure that payments (including payments for any drugs provided under the plan) are not in excess of reasonable charges (reasonable costs in the instance of inpatient hospital services) consistent with efficiency, economy and quality of care;
(c) Prescribe standards that providers must meet;
(d) Require that any provider who renders health care services authorized under this act shall keep and maintain such individual records as are necessary to fully disclose the name of the recipient to whom the service was rendered, the date of the service rendered, the nature and extent of each such service rendered, and any additional information, as the department may require by regulation. Records herein required to be kept and maintained shall be retained by the provider for a period of at least 5 years from the date the service was rendered;
(e) Require that providers who render health care services authorized under this act shall not be entitled to reimbursement for the services rendered unless said services are documented pursuant to subsection (d) of this section. Any evidence other than the documentation required pursuant to subsection (d) of this section shall be inadmissible in any proceeding conducted pursuant to this act for the purpose of proving that said services were rendered; unless the evidence is found to be clear and convincing by the finder of fact; and
(f) Examine and make copies of any books and records of a provider if they relate in any way to services rendered to any recipient under this act, and visit and inspect the premises or facilities of any provider it may deem necessary to carry out the provisions of this act and regulations adopted pursuant thereto.
L.1968, c. 413, s. 12. Amended by L.1979, c. 365, s. 14, eff. Feb. 4, 1980.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-13 - Enrollment fees or premium charges

30:4D-13. Enrollment fees or premium charges
Subject to the limitations set forth in sections 7, 8 and 9 of this act, the department shall assure that no enrollment fee, premium or similar charge is imposed on an applicant as a condition of eligibility for medical assistance under this act.
L.1968, c. 413, s. 13.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-14 - Preparation of comprehensive medical plan

30:4D-14. Preparation of comprehensive medical plan
Subject to the limitations provided in this act and the Federal Social Security Act, the department shall prepare a comprehensive medical plan whereby the benefits of this program will be extended in accordance with the mandatory schedule for providing benefits required by the Federal legislation. This plan shall include alternative means of expanding the medical care benefits and coverage provided in this act. Such plan shall be reevaluated from time to time but no less than annually and shall be based upon a documented review of medical needs of low-income families in New Jersey, a detailed analysis of priorities of service, coverage, program costs and an evaluation of progress.
L.1968, c. 413, s. 14. Amended by L.1979, c. 365, s. 15, eff. Feb. 4, 1980.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-15 - Eligibility determination

30:4D-15. Eligibility determination
The department shall assure:
(a) That all individuals wishing to make application for medical assistance shall have the opportunity to do so;
(b) That the processing of applications shall be simplified to the end that medical benefits shall be furnished to recipients as soon as possible.
L.1968, c. 413, s. 15.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17a - Additional action by Attorney General.

30:4D-17a Additional action by Attorney General.
3. In addition to any other action authorized or required by law, the Attorney General shall refer any matter regarding a person who is licensed or otherwise authorized to practice a health care profession in this State pursuant to Title 45 or Title 52 of the Revised Statutes and has been convicted of an offense under the provisions of section 17 of P.L.1968, c.413 (C.30:4D-17), to the appropriate professional and occupational licensing board within the Division of Consumer Affairs in the Department of Law and Public Safety or the Director of the Division of Consumer Affairs, as applicable, for such action as they determine appropriate regarding that person's license or other authorization to practice as a health care professional.
L.2010, c.30, s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17b - Construction of act.

30:4D-17b Construction of act.
4. Nothing in section 17 of P.L.1968, c.413 (C.30:4D-17) or in section 3 of P.L.2010, c.30 (C.30:4D-17a) shall be construed to preclude the indictment or conviction for any other offense defined by law, or to impair or limit the discretion and authority of the State regarding any civil action, criminal prosecution, or other action authorized by law.
L.2010, c.30, s.4.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.1 - Suspension or disqualification of providers, termination of benefits to recipients; rules and regulations

30:4D-17.1. Suspension or disqualification of providers, termination of benefits to recipients; rules and regulations
a. The director may suspend, debar or disqualify for good cause any provider presently participating or who has applied for participation in the program, or may suspend, debar or disqualify for good cause any person, company, firm, association, corporation or other entity who is participating directly or indirectly in the Medicaid program, or who is an agent, servant, employee or independent contractor of a provider in the Medicaid program.
b. The director may terminate or otherwise restrict medical assistance benefits to any eligible recipient thereof for good cause.
c. The director may promulgate such rules, regulations and administrative orders as are necessary to effectuate the provisions and purposes of this section.
L.1979, c. 365, s. 17, eff. Feb. 4, 1980.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.2 - Enforcement of commissioner's decisions; orders by civil action

30:4D-17.2. Enforcement of commissioner's decisions; orders by civil action
Any decision, order, final judgment, or final determination of the commissioner or director issued pursuant to the provisions of this act not involving the recovery of Medicaid payments may be enforced in a civil action brought in a summary manner by the Attorney General on behalf of either the commissioner or director in the Superior Court. In any such action said order, decision, final judgment or final determination shall be considered res judicata, except that an appeal may be taken to the Appellate Division of the Superior Court from the final decision of the commissioner or director in accordance with the applicable Rules of the Court.
L.1979, c. 365, s. 18, eff. Feb. 4, 1980.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.4 - Reimbursement for retroactive eligibility

30:4D-17.4. Reimbursement for retroactive eligibility
If an applicant is determined to be eligible under P.L. 1968, c. 413 (C. 30:4D-1 et seq.) retroactively and the provider bills the applicant directly for the services and benefits rendered during the retroactive period, the provider shall, upon notification of the applicant's retroactive eligibility, submit claims for reimbursement for covered services or benefits rendered during the retroactive period. Upon certification that the applicant is so eligible, the provider shall reimburse the applicant or other person who has made prior payment to the provider.
L. 1985, c. 303, s. 7.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.5 - Adjusted reimbursement rates

30:4D-17.5. Adjusted reimbursement rates
The commissioner may establish adjusted reimbursement rates for skilled nursing and intermediate care facilities which experience financial hardship due to an average monthly Medicaid recipient census in excess of a percentage of licensed bed capacity as determined by the commissioner. The adjusted rates shall be adopted pursuant to the "Administrative Procedure Act," P.L. 1968, c. 410 (C. 52:14B-1 et seq.).
L. 1985, c. 303, s. 8.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.6 - Withdrawal as Medicaid provider

30:4D-17.6. Withdrawal as Medicaid provider
a. If a skilled nursing or intermediate care facility notifies the commissioner within 180 days following the date of enactment of this amendatory and supplementary act that the facility shall no longer be a Medicaid provider and that (1) the facility has one or more Medicaid qualified applicants residing therein or (2) the facility has one or more patients residing therein who are paying privately for their care at the facility under the terms of an agreement entered into before August 24, 1985 and who will become Medicaid qualified applicants upon the expiration of the agreement, the commissioner may, at the request of the facility, permit the facility to continue to provide skilled nursing or intermediate care services to those Medicaid current and prospective qualified applicants residing therein without being required to admit any new Medicaid qualified applicants.
The commissioner may grant a facility's request to do so if the request is in the best interests of the Medicaid qualified applicants residing therein. For the period of time that any Medicaid qualified applicants continue to reside in the facility, that facility shall comply with all applicable provisions of P.L. 1968, c. 413 (C. 30:4D-1 et seq.).
b. If a skilled nursing or intermediate care facility which withdraws as a Medicaid provider pursuant to this section subsequently reapplies to the department to become a Medicaid provider, the commissioner may require as a condition of becoming a Medicaid provider that the facility enter into a three year Medicaid provider contract with the department.
L. 1985, c. 303, s. 9. Amended by L. 1986, c. 8, s. 3, eff. March 28, 1986.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.7 - $13 million contingency account

30:4D-17.7. $13 million contingency account
There is appropriated $13,000,000.00 from the General Fund to the Department of Human Services. These funds are to be deposited in a newly established contingency account within the Division of Medical Assistance and Health Services. No funds shall be expended without the submission of adequate documentation as to the need for these funds to effect the purpose of this act and without the approval of the Director of the Division of Budget and Accounting who shall consult with the Legislative Budget Officer prior to authorizing expenditures.
L. 1985, c. 303, s. 10.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.8 - Posting, distribution of law

30:4D-17.8. Posting, distribution of law
Each skilled nursing facility and intermediate care facility shall post a statement of the provisions of this amendatory and supplementary act that apply to that facility in a prominent place in the facility, and a copy of the statement shall be given to each person who applies for admission, at the time of application.
L. 1985, c. 303, s. 12.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-17.9 - Annual report

30:4D-17.9. Annual report
The Commissioner of Human Services shall report annually to the Governor and the Legislature on the effect of the provisions of this amendatory and supplementary act on reducing the shortage of skilled nursing and intermediate care facility bed space for Medicaid recipients, the status of the availability of bed space throughout the State and whether any additional admission requirements are necessary to ensure an adequate number of skilled nursing and intermediate care facility beds for Medicaid eligible persons.
L. 1985, c. 303, s. 13.