reglab/statecodes huggingface dataset:
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7d - Report by commissioner

30:4D-7d. Report by commissioner
Within six months of the effective date of P.L.1991, c.187 (C.26:2H-18.24 et al.), the Commissioner of Human Services shall report to the Governor and the Chairmen of the Senate Institutions, Health and Welfare and General Assembly Health and Human Services Committees on ways: to increase the number of providers in the Medicaid program pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.); to improve Medicaid provider relations with the Medicaid program; to reduce administrative burdens encountered by Medicaid providers; and to streamline Statewide administration of the Medicaid program.
L.1991,c.187,s.44.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7e - Rules, regulations

30:4D-7e. Rules, regulations
38. The Commissioner of Human Services shall, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) adopt rules and regulations necessary to implement the provisions of sections 9, 11 and 12 of this act as they relate to payments from the Health Care Subsidy Fund to disproportionate share hospitals.
L.1992,c.160,s.38.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7f - Access fees charged by fiscal agent; establishment; use

30:4D-7f. Access fees charged by fiscal agent; establishment; use
1. Notwithstanding the provisions of the "New Jersey Medical Assistance and Health Services Act," P.L.1968, c.413 (C.30:4D-1 et seq.) or any other law to the contrary, an intermediary vendor under contract with the Division of Medical Assistance and Health Services' fiscal agent, which vendor has direct access to the Medical Assistance Eligibility System, shall be charged an access fee by the fiscal agent. The Commissioner of Human Services shall, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) adopt regulations establishing the access fee.
Receipts from access fees in excess of development and operational costs incurred by the division's fiscal agent shall be appropriated annually to the division.
L.1994,c.60,s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7g - Findings, declarations relative to pediatric rehabilitation hospitals.

30:4D-7g. Findings, declarations relative to pediatric rehabilitation hospitals.
1. The Legislature finds and declares that:
a. Currently, there are two pediatric rehabilitation hospitals in the State that provide pediatric inpatient and ambulatory rehabilitation and pediatric long-term care services to children throughout the State. These hospitals offer a variety of medical, developmental and educational services to children with severe disabilities and chronic illnesses; and
b. There is a tremendous need in the State for the unique services provided by these facilities, and few providers within the health care community have the capability and expertise to properly treat the special needs of these children.
L.2001,c.393,s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7i - Exemption from close proximity requirements, notification as to off-site location.

30:4D-7i Exemption from close proximity requirements, notification as to off-site location.
3. A pediatric rehabilitation hospital licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) shall not be subject to the close proximity requirements established pursuant to N.J.A.C.10:52-1.3(b)(1) for the purposes of receiving Medicaid fee-for-service reimbursement for outpatient hospital services.
A pediatric rehabilitation hospital which establishes an off-site location to provide outpatient services shall notify the Division of Medical Assistance and Health Services in the Department of Human Services in accordance with the requirements of N.J.A.C.10:52-1.3.
L.2001,c.393,s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7j - Annual cost report to receive reimbursement from Medicaid for personal care assistant services.

30:4D-7j Annual cost report to receive reimbursement from Medicaid for personal care assistant services.
1. As a condition of receiving reimbursement from the State Medicaid program, pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), for personal care assistant services, as described in N.J.A.C.10:60-3.3, which are provided to Medicaid recipients, a health care service firm, as defined in N.J.A.C.13:45B-13.2, shall file an annual cost report with the Division of Disability Services in the Department of Human Services.
The Division of Disability Services shall develop the form of the annual cost report, which shall include information on costs and revenues. The cost report shall be filed on an annual basis, beginning January 1, 2010, in a form and manner specified by the division.
L.2009, c.181, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7k - Definitions relative to reimbursement for family planning services.

30:4D-7k Definitions relative to reimbursement for family planning services.
1. a. The reimbursement rate for an office visit for family planning services billed by a health care facility, which is licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) and receives funding under Title X of the Public Health Service Act (42 U.S.C. s.300 et seq.), to the State Medicaid program shall be an amount that equals at least 90% of the amount of the actual cost of services provided during an office visit, as such rate is in effect on the date of enactment of this act.
b. As used in this section:
"Family planning services" means comprehensive reproductive health care services, including: contraception; pregnancy detection; options counseling; diagnosis or treatment, or both, of sexually transmitted diseases; routine gynecological and cancer screening services; health promotion activities; and Level I infertility services such as an interview, education, physical examination, laboratory testing, counseling, and appropriate referral. The term does not include termination of pregnancy.
Family planning services may also include: prenatal and postpartum care; other gynecological services, including colposcopy and cryotherapy; menopausal services; Level II infertility services, which include semen analysis, assessment of ovulatory function, and post coital testing; and Level III infertility services, which include more sophisticated and complex infertility testing and procedures than Levels I and II.
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Office visit" means a procedure billed under a common procedure terminology code that includes a family planning modifier in the description of the code.
L.2009, c.268, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7l - Department to facilitate implementation of C.30:4D-7k.

30:4D-7l Department to facilitate implementation of C.30:4D-7k.
2. The Department of Health shall adjust the Family Planning Services Grant-in-Aid appropriation and transfer the appropriate amount of State funds to the Division of Medical Assistance and Health Services in the Department of Human Services to facilitate the implementation of section 1 of this act. The Department of Health shall notify the Legislative Budget and Finance Officer as to the amount that is transferred.
L.2009, c.268, s.2; amended 2012, c.17, s.362.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7m - Certain HMOs, changes in certain reimbursement rates; procedure.

30:4D-7m Certain HMOs, changes in certain reimbursement rates; procedure.
1. Notwithstanding any law, rule, or regulation to the contrary, a health maintenance organization that contracts with the Division of Medical Assistance and Health Services in the Department of Human Services to provide benefits under a managed care plan to persons who are eligible for Medicaid shall not reduce reimbursement rates for personal care assistant services or home based supportive care services, as those services are defined by regulation or in the contract with the division, under the health maintenance organization's Medicaid managed care plan, unless the health maintenance organization notifies the division, in writing, at least 90 days before the effective date of such changes. Such notice shall be accompanied by written assurance that the reduction will not reduce sufficient provider access or quality of service as required by the contract with the division.
L.2015, c.234, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7n - Hourly reimbursement rate for Medicaid personal care services.

30:4D-7n Hourly reimbursement rate for Medicaid personal care services.
1. The hourly reimbursement rate for personal care services within the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), whether the services are provided in the Medicaid fee-for-service delivery system or through a managed care delivery system, shall be no less than the established State Medicaid fee-for-service rate. On July 1, 2019, the reimbursement rate shall be $18 per hour.
L.2017, c.239, s.1; amended 2019, c.275, s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7o - Report.

30:4D-7o Report.
2. Every provider that receives reimbursement for personal care services pursuant to a Medicaid managed care contract shall annually provide a report to the Division of Medical Assistance and Health Services in the Department of Human Services regarding the use of funds received as reimbursement for personal care services, including detailed data on any salary increases resulting from section 1 of P.L.2017, c.239 (C.30:4D-7n); including the prior salary, current salary, and other changes to the salary of the workers who directly provide personal care services.
L.2017, c.239, s.2; amended 2019, c.275, s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7p - Medicaid reimbursement for certain emergency services.

30:4D-7p Medicaid reimbursement for certain emergency services.
1. a. A hospital licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) providing emergency services to patients enrolled in the State Medicaid fee-for-service program shall accept as final payment an emergency room triage reimbursement fee of $140.00 when the emergency services provided are for low acuity emergency room encounters. The Commissioner of Human Services shall publish a list of diagnostic codes that would be considered low acuity emergency room encounters for the purpose of applying this fee.
b. As used in this section:
"Acuity" means the measurement of the intensity of nursing care required by a patient.
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
L.2018, c.51, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7q - Rules, regulations.

30:4D-7q Rules, regulations.
3. The Commissioner of Human Services shall adopt rules and regulations pursuant to the "Administrative Procedure Act" P.L.1968, c.410 (C.52:14B-1 et seq.) to effectuate the purposes of this act.
L.2018, c.51, s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7s - Definitions relative to "The County Option Hospital Fee Pilot Program Act."

30:4D-7s Definitions relative to "The County Option Hospital Fee Pilot Program Act."
2. As used in this act:
"Commissioner" means the Commissioner of Human Services.
"Department" means the Department of Human Services.
"Fee" means the local healthcare-related fee authorized pursuant to this act.
"Hospital" means a hospital that is licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) and is located within the borders of a participating county.
"Medicaid program" means the "New Jersey Medical Assistance and Health Services Program" established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Participating county" means, notwithstanding the provisions of any other law or regulation to the contrary, a county that chooses to participate in the program, has a population greater than 250,000, according to the federal decennial census immediately preceding the effective date of P.L.2018, c.136 (C.30:4D-7r et seq.), and contains a municipality which: (1) is classified, pursuant to N.J.S.40A:6-4, as a First or Second Class municipality, or a Fourth Class municipality whose population exceeds 20,000, and (2) has a Municipal Revitalization Index Distress score, as last calculated by the New Jersey Department of Community Affairs prior to the effective date of P.L.2018, c.136 (C.30:4D-7r et seq.), that exceeds 60; or, based on the 2019 ACS 5 Year Survey Data, a county that chooses to participate in the program and contains a municipality with a population greater than 30,000 whose 2020 Municipal Revitalization Index Distress score is greater than or equal to 35 (1) excluding counties with a municipality with a population greater than 125,000, (2) excluding counties with a population less than 150,000, and (3) excluding counties with a median household income greater than $110,000.
"Program" means "The County Option Hospital Fee Program" established pursuant to this act.
"Proposed fee and expenditure report" means a written report by a participating county that describes how the fee will be imposed in the participating county; how the funds collected from the fee will be used by the participating county, including the amount and services the participating county plans to provide with the funds; and how the plan satisfies paragraph (1) of subsection b. of section 3 of this act.
L.2018, c.136, s.2; amended 2022, c.61, s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7u - Transfer of funds to commissioner, uses; fee.

30:4D-7u Transfer of funds to commissioner, uses; fee.
4. a. A participating county may transfer funds collected from the fee imposed pursuant to subsection c. of section 3 of this act to the commissioner. The commissioner shall use funds transferred from a participating county, and any matching amount of federal Medicaid funds or other federal funds generated therefrom, for the following purposes: to increase Medicaid payments to hospitals in the jurisdiction from which the funds are received; for payments to managed care organizations that have contracted with Medicaid serving the jurisdiction from which the funds are received for increased hospital or hospital-related payments; and for direct costs related to administrative purposes to implement the program.
The commissioner shall seek to minimize the length of time between the collection of the fee by the participating county and the distribution of payments pursuant to this subsection.
Notwithstanding any other law to the contrary, the commissioner and a participating county are authorized to enter into an intergovernmental transfer agreement as may be necessary to transfer funds under this subsection or to otherwise satisfy the requirements of this act.
b. A participating county may retain the funds collected from the imposition of the fee, in which case the participating county shall generate the same level of funding, in addition to the funds collected from the imposition of the fee, that would be generated by the department through any matching amount of federal Medicaid funds or other federal funds, and use the total funding amount to satisfy paragraph (1) of subsection b. of section 3 of this act.
c. At least 90 percent of the funds collected from imposition of the fee shall be used by a participating county or the department for the benefit of local hospitals within the participating county's borders to ensure that the hospitals continue to provide necessary services to low-income citizens. The participating counties shall transfer at least one percent of funds collected from the imposition of the fee to the department for administration of the program.
L.2018, c.136, s.4; amended 2022, c.61, s.4.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7v - Imposition of fee.

30:4D-7v Imposition of fee.
5. a. The fee imposed pursuant to subsection c. of section 3 of this act shall be imposed in relation to health care items or services provided only during the effective period of this act, and shall not be collected until the commissioner notifies the appropriate governmental entities that any State plan amendment or waivers submitted pursuant to section 6 of this act have been approved.
b. No hospital subject to the fee shall pass on the cost of the fee to any patient, insurer, self-insured employer program, or other responsible party, nor list it separately on any invoice or statement sent to a patient, insurer, self-insured employer program, or other responsible party.
c. Unless otherwise prohibited by the federal government, no managed care organization operating in the State that has contracted with Medicaid shall retain any funds generated by the fee, other than to offset any increased administrative costs incurred as a result of the program.
d. Funds generated by the fee shall not supplant or offset any current or future State funds allocated to a county participating in the program.
e. Payments distributed to hospitals pursuant to this act shall not supplant or offset any current or future funds paid to hospitals through other State or federal funding mechanisms or pools.
L.2018, c.136, s.5; amended 2022, c.61, s.5.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7w - Application by commissioner, approval prior to collection of fee.

30:4D-7w Application by commissioner, approval prior to collection of fee.
6. 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 receive approval for such State plan amendments or waivers prior to collection of a fee authorized pursuant to subsection c. of section 3 of this act.
L.2018, c.136, s.6.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7x - Rules, regulations.

30:4D-7x Rules, regulations.
7. The commissioner shall promulgate, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), rules and regulations necessary for the implementation of this act which shall include appropriate methodologies for the county proposed fee and expenditure report. Participating counties shall not submit the proposed fee and expenditure plan to the department prior to the adoption of rules and regulations.
L.2018, c.136, s.7.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7y - Perinatal Risk Assessment form for certain pregnant women.

30:4D-7y Perinatal Risk Assessment form for certain pregnant women.
1. An obstetrical provider, nurse midwife, or other licensed health care professional, approved as a provider under the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), shall complete the Perinatal Risk Assessment form, as used by the Division of Medical Assistance and Health Services in the Department of Human Services, for each pregnant Medicaid recipient and for each individual eligible for Emergency Medical Services for Non-Qualified Aliens who receives prenatal care from the provider. The Perinatal Risk Assessment form shall be the uniform document used by all providers and Medicaid managed care plans. The form shall be completed by the provider during the first prenatal visit with the pregnant Medicaid recipient or other eligible individual and updated by the provider in the third trimester of the recipient or other eligible individual.
L.2019, c.88, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7z - Submission of form to division.

30:4D-7z Submission of form to division.
2. The division shall require providers to submit each Perinatal Risk Assessment form completed pursuant to section 1 of this act to the division, or to a nonprofit entity contracted by the division to process, distribute to appropriate Medicaid managed care plans, and maintain the Perinatal Risk Assessment data. A provider shall not receive authorization for reimbursement for prenatal services provided to a pregnant Medicaid recipient until a Perinatal Risk Assessment form is submitted for that recipient.
L.2019, c.88, s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7aa - Analysis of data.

30:4D-7aa Analysis of data.
3. The division, in collaboration with the Department of Health, Medicaid managed care organizations, and any nonprofit entity contracted by the division to process, distribute, and maintain the Perinatal Risk Assessment data, shall analyze the Perinatal Risk Assessment data in order to identify trends in the risk factors associated with Medicaid recipients and individuals eligible for Emergency Medical Services for Non-Qualified Aliens during pregnancy. Commencing no later than 18 months after the effective date of this act, and annually thereafter, the division shall submit a written report to the Governor, and to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), providing a summary of its findings and any proposals for legislative action needed to improve the maternal outcomes of Medicaid recipients and individuals eligible for Emergency Medical Services for Non-Qualified Aliens.
L.2019, c.88, s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7bb - Rules, regulations.

30:4D-7bb Rules, regulations.
4. The Commissioners of Health and Human Services, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations necessary to implement the provisions of this act.
L.2019, c.88, s.4.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7dd - Risk reduction model to prescription drug services, third party contract.

30:4D-7dd Risk reduction model to prescription drug services, third party contract.
1. The Division of Medical Assistance and Health Services in the Department of Human Services shall contract with a third party entity to apply a risk reduction model to prescription drug services provided under the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), for the purpose of identifying and reducing simultaneous, multi-drug medication-related risk and adverse drug events, enhancing compliance and quality of care, and improving health-related outcomes while reducing total cost of care in a measurable and reportable manner. In carrying out this purpose, the model, at a minimum, shall leverage Medicaid prescription drug claims data, pharmacokinetic and pharmacodynamic sciences, appropriate technologies, clinical call centers located in New Jersey and staffed by board-certified pharmacists licensed pursuant to P.L.2003, c.280 (C.45:14-40 et seq.), and include coordination of services with a network of local community pharmacies located throughout the State. For the duration of the contract, the division shall share the medical and pharmacy claims data for all Medicaid beneficiaries with the third party administering the model for the purposes of effectuating the model, which claims data shall include historical data.
L.2021, c.151.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7ee - Pharmacy benefits management services, information disclosure

30:4D-7ee Pharmacy benefits management services, information disclosure
1. a. Any contract or other arrangement entered into by a managed care organization, or by the Division of Medical Assistance and Health Services in the Department of Human Services, for the provision of pharmacy benefits management services under the Medicaid program shall require the pharmacy benefits manager to disclose to the department:
(1) all sources and amounts of income, payments, and financial benefits received by the pharmacy benefits manager in relation to the provision and administration of pharmacy benefits management services on behalf of the managed care organization, including, but not limited to, any pricing discounts, rebates of any kind, inflationary payments, credits, clawbacks, fees, grants, chargebacks, reimbursements, or other benefits;
(2) all ingredient costs and dispensing fees or similar payments made by the pharmacy benefits manager to any pharmacy in connection with the contract or other arrangement; and
(3) the pharmacy benefits manager's payment model for administrative fees.
b. Information disclosed by a pharmacy benefits manager to the division pursuant to subsection a. of this section shall be confidential and not be subject to public disclosure under P.L.1963, c.73 (C.47:1A-1 et seq.), or P.L.2001, c.404 (C.47:1A-5 et al.). In addition to any other penalty provided by law, a person who is authorized to access information submitted by a pharmacy benefits manager to the division who knowingly discloses such information to any person or entity who is not authorized to access the information shall be guilty of a crime of the fourth degree and shall be subject to a civil penalty in an amount not to exceed $10,000. A civil penalty imposed under this subsection shall be collected by the director pursuant to the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.).
c. As used in this section:
"Pharmacy benefits manager" means a corporation, business, or other entity, or unit within a corporation, business, or other entity, that administers prescription drug benefits on behalf of a managed care organization.
"Pharmacy benefits management services" mean the provision of any of the following services on behalf of a managed care organization: the procurement of prescription drugs at a negotiated rate for dispensation within this State; the processing of prescription drug claims; or the administration of payments related to prescription drug claims.
L.2021, c.257.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7gg - Rules, regulations.

30:4D-7gg Rules, regulations.
2. The Commissioner of Human Services shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to effectuate the purposes of this act.
L.2021, c.276, s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7hh - Per diem reimbursement rate compared to established State Medicaid fee-for-service rate.

30:4D-7hh Per diem reimbursement rate compared to established State Medicaid fee-for-service rate.
1. a. Notwithstanding the provisions of any law or regulation to the contrary, the per diem reimbursement rate for providers of adult medical day care services within the Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), whether the services are provided in the Medicaid fee-for-service delivery system or through a managed care delivery system, shall be no less than the established State Medicaid fee-for-service rate.
b. As used in this section:
"Provider of adult medical day care services" means an adult day health services facility licensed by the Department of Health, which provides preventive, diagnostic, therapeutic, and rehabilitative services under medical and nursing supervision to meet the needs of functionally impaired adult participants for a period of time that does not exceed 12 hours during any calendar day.
L.2021, c.452, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7ii - Restricting modification, termination of existing provider network contract.

30:4D-7ii Restricting modification, termination of existing provider network contract.
2. A managed care organization contracted with the Division of Medical Assistance and Health Services within the Department of Human Services to provide benefits under the Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), shall not terminate or modify an existing provider network contract solely due to a change of provider ownership or ownership structure.
L.2021, c.452, s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7jj - Findings, declarations.

30:4D-7jj Findings, declarations.
1. The Legislature funds and declares:
a. An acquired brain injury is an injury caused by an event, either internal or external to the injured individual, and does not include congenital or degenerative disorders, or those injuries induced by birth trauma. An acquired brain injury can either be categorized as a traumatic brain injury or non-traumatic brain injury. A traumatic brain injury is an alteration in brain function caused by an external force and may be caused by falls, assaults, motor vehicle accidents, or sports injuries. A non-traumatic brain injury is damage to the brain caused by internal factors, such as stroke, aneurysm, tumor, infectious disease, or anoxia.
b. A severe acquired brain injury can produce an altered or diminished state of consciousness and result in an impairment of cognitive abilities or physical functioning. It can also effect behavioral or emotional functioning. These impairments may be permanent and cause partial or total functional disability, leading to the injured individual requiring long-term care supports.
c. The State's Medicaid program provides brain injury services under the Managed Long-Term Supports and Services program, with the goal of providing community alternatives for individuals with brain injuries residing in nursing facilities or who are in the community and at risk for placement in nursing facilities.
d. Unlike other Medicaid community-based services, reimbursement rates for brain injury services have remained static in recent years despite growing costs, which threatens the ability of providers to meet the complex health needs of individuals with brain injuries and provide services within a safe and fulfilling community environment.
e. Despite the similar model of care, reimbursement rates for services provided to Medicaid beneficiaries with intellectual and developmental disabilities have not only increased, but have been restructured to account for adequate consideration for acuity, increased minimum wage requirements, and other inflationary trends that assert pressure on providers' cost structures.
f. By failing to receive reimbursement rates that adequately support services, brain injury providers are being forced to return this fragile population to more costly institutional care in nursing home facilities.
g. It is imperative that the Legislature take action and increase Medicaid rates for these essential services and ensure that individuals with brain injuries can continue to thrive and reach their optimal recoveries in community settings.
L.2022, c.78, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7ll - State plan amendments, waivers, brain injury services, application; implementation of provisions.

30:4D-7ll State plan amendments, waivers, brain injury services, application; implementation of provisions.
3. The Commissioner of Human Services shall apply for such State plan amendments or waivers specific to brain injury services, that currently exist or may arise in the future which affect reimbursement rates, as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
L.2022, c.78, s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7ll.1 - Definitions.

30:4D-7ll.1 Definitions.
1. As used in this act:
"Division" mean the Division of Medical Assistance and Health Services in the Department of Human Services.
"NJ FamilyCare" means the program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), which includes the State's Medicaid Program and the Children's Health Insurance Program.
"Nursing facility" means a long-term care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.), which has been approved by the Department of Human Services to provide care to NJ FamilyCare beneficiaries who require conventional nursing facility services.
"Special care nursing facility" means a nursing facility or a separate and distinct unit within a conventional nursing facility, licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.), which has been approved by the Department of Human Services to provide care to NJ FamilyCare beneficiaries who require specialized health care services beyond the scope of conventional nursing facility services.
"Traumatic brain injury" means an acquired injury to the brain, but does not include brain dysfunction caused by congenital or degenerative disorders, or birth trauma, but may include brain injuries caused by anoxia due to trauma.
"Traumatic brain injury unit" means an inpatient unit in special care nursing facility that provides services to NJ FamilyCare beneficiaries who require treatment for traumatic brain injuries.
L.2023, c.181, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7ll.2 - Special care nursing facility, reimbursement, traumatic brain injury, NJ FamilyCare beneficiary.

30:4D-7ll.2 Special care nursing facility, reimbursement, traumatic brain injury, NJ FamilyCare beneficiary.
2. The division shall reimburse a special care nursing facility for services provided to a NJ FamilyCare beneficiary residing in a traumatic brain injury unit at a base per diem reimbursement rate that is $400 above the special care nursing facility's FY 2022 base per diem reimbursement rate in order to cover the higher staffing ratios required, and abundance of therapy services provided, in a traumatic brain injury unit. Issuance of the reimbursement rate established in this section shall require the special care nursing facility to be in compliance with all applicable State and federal laws and regulations concerning licensure, patient safety, and quality of care.
L.2023, c.181, s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7ll.3 - Nursing facility, reimbursement, traumatic brain injury, NJ FamilyCare beneficiary, single-occupancy room.

30:4D-7ll.3 Nursing facility, reimbursement, traumatic brain injury, NJ FamilyCare beneficiary, single-occupancy room.
3. a. The division shall reimburse a nursing facility for services provided to a NJ FamilyCare beneficiary residing in a single-occupancy room at an enhanced per diem reimbursement rate equal to 150 percent of the nursing facility's base per diem reimbursement rate, provided that, on any date after the effective date of this act, the nursing facility voluntarily delicensed beds in order to establish the single-occupancy room in which the beneficiary resides.
b. Reimbursements received under this section by a nursing facility that are in excess of the facility's base per diem reimbursement rate shall be utilized by the facility for the following purposes:
(1) renovation costs to convert multiple-occupancy rooms to single-occupancy rooms;
(2) establishment and implementation of infection control policies and infrastructure, particularly for any remaining multiple-occupancy rooms; and
(3) compensation for revenue losses due to the facility's decreased census.
c. Issuance of the enhanced reimbursement per diem rate established in subsection a. of this section shall be contingent upon the following:
(1) The nursing facility submits a proposed plan to, and receives approval from, the Department of Human Services and the Department of Health regarding the voluntary delicensing of beds. The plan shall include a description of the facility's use of reimbursement payments received under this section in excess of the facility's base rate; and
(2) The nursing facility is in compliance with all applicable State and federal laws and regulations concerning licensure, patient safety, and quality of care.
d. The Commissioners of Human Services and Health shall establish a method and manner for nursing facilities to submit plans, as required under paragraph (1) of subsection c. of this section. The evaluation of a nursing facility's plan shall include metrics for ensuring that the voluntary delicensing of beds at a nursing facility does not negatively affect the ability of the NJ FamilyCare program to provide nursing facility services to enrollees.
L.2023, c.181, s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7ll.4 - State plan amendments, waivers.

30:4D-7ll.4 State plan amendments, waivers.
5. The Commissioner of Human Services shall apply for such State plan amendments or waivers as shall be necessary to implement the provisions of this act and to ensure federal financial participation for State expenditures under the federal Medicaid program and the Children's Health Insurance Program.
L.2023, c.181, s.5.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7nn - State plan amendments, waivers, provisions, implementation.

30:4D-7nn State plan amendments, waivers, provisions, implementation.
2. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
L.2023, c.80, s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7oo - Per diem reimbursement rate, pediatric medical day care services, on-site.

30:4D-7oo Per diem reimbursement rate, pediatric medical day care services, on-site.
1. a. Notwithstanding any other provision of law or regulation to the contrary, the per diem reimbursement rate for pediatric medical day care services delivered by a pediatric medical day care provider offering on-site services shall be as follows:
Beginning July 1, 2023, and annually adjusted in each subsequent fiscal year, the per diem reimbursement rate shall be equal to 45 percent of the average prevailing Medicaid fee-for-service per diem rate for all pediatric skilled care nursing facilities in the State.
b. The provisions of this act shall apply to pediatric medical day care services provided under the Medicaid fee-for-service and managed care delivery systems.
c. As used in this section,
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Pediatric medical day care services" means a health care service designed to meet the medical, developmental, educational, nutritional and psycho-social needs of medically complex or technology-dependent children whose medical condition requires treatment and services beyond the scope provided to children with special health care needs by day care centers or preschool programs.
L.2023, c.85, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7pp - State plan amendments, waivers, provisions, implementation.

30:4D-7pp State plan amendments, waivers, provisions, implementation.
2. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
L.2023, c.85, s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7qq - Homemaker-home health aide certification program, family member; definition; report to Governor, Legislature.

30:4D-7qq Homemaker-home health aide certification program, family member; definition; report to Governor, Legislature.
1. a. As used in this section, "family member" means a child, parent, parent-in-law, sibling, grandparent, grandchild, spouse, domestic partner, or one partner in a civil union couple, or any other individual related by blood, and any other individual with a close association that is the equivalent of a family relationship.
b. No later than nine months after the effective date of this act and receipt of federal approval for the program, the Division of Medical Assistance and Health Services in the Department of Human Services shall establish a program under which a family member of an enrollee in Medicaid or NJ FamilyCare may seek to be certified by the New Jersey Board of Nursing as a homemaker-home health aide and, after receiving that certification, may, under the direction of a registered nurse, provide homemaker-home health aide services to the enrollee through a home care services agency, provided that the enrollee is under 21 years of age and otherwise qualifies to receive those services under Medicaid or NJ FamilyCare. The division shall develop an assessment tool that will allow the division to readily identify enrollees who meet these eligibility criteria.
c. The program established pursuant to this section shall require the family member to complete all the training, testing, and other qualification criteria as are required under State and federal law for certification as a homemaker-home health aide. The home care services agency that will employ the family member to provide homemaker-home health aide services to the enrollee shall pay all costs for the family member to become certified as a homemaker-home health aide, and to receive certification as a homemaker-home health aide from the New Jersey Board of Nursing, before providing services under the program established pursuant to this section. In no case shall a family member who becomes a certified homemaker-home health aide under the program established pursuant to this section be required to repay or reimburse the home care services agency for the costs of the family member becoming certified as a homemaker-home health aide under the program.
d. The Director of the Division of Medical Assistance and Health Services in the Department of Human Services shall, no later than three years after the date the program is established pursuant to this section, prepare and submit a report to the Governor and, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), to the Legislature, concerning the viability of the program and the director's recommendations concerning the program.
L.2023, c.90, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7rr - State plan amendments, waivers, apply, Commissioner, Human Services.

30:4D-7rr State plan amendments, waivers, apply, Commissioner, Human Services.
3. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
L.2023, c.90, s.3.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7tt - State plan amendments, waivers, application, implementation, secure financial participation.

30:4D-7tt State plan amendments, waivers, application, implementation, secure financial participation.
2. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
L.2023, c.108, s.2.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7.2a - Encumbrances, recovery limited against certain estates.

30:4D-7.2a Encumbrances, recovery limited against certain estates.
1. No encumbrance or recovery shall be imposed against or sought from the estate of a deceased recipient for assistance correctly paid under:
a. The "New Jersey Medical Assistance and Health Services Act," P.L.1968, c.413 (C.30:4D-1 et seq.), under any of the following circumstances: (1) the amount sought to be recovered is less than $500, the gross estate is less than $3,000 or there is a surviving spouse or a surviving child who is under the age of 21 or is blind or permanently and totally disabled, except for assistance incorrectly or illegally paid, or for third party liability recovery sought under P.L.1968, c.413 (C.30:4D-1 et seq.); (2) in the case of a recipient who became deceased on or after the effective date of P.L.1995, c.289, if there is a surviving spouse or a surviving child who is under the age of 21 or is blind or permanently and totally disabled, except for assistance incorrectly or illegally paid, or for third party liability recovery sought under P.L.1968, c.413 (C.30:4D-1 et seq.); or (3) in the case of a recipient who has been afforded asset protection under a long-term care insurance partnership in accordance with the provisions of the federal "Deficit Reduction Act of 2005," Pub.L.109-171, up to the amount of assets disregarded at the time of eligibility determination; or
b. The "Pharmaceutical Assistance to the Aged and Disabled" program, P.L.1975, c.194 (C.30:4D-20 et seq.), except for assistance incorrectly or illegally paid, or for third party liability recovery sought under P.L.1968, c.413 (C.30:4D-1 et seq.).
L.1981, c.217, s.1; amended 1983, c.371; 1992, c.115, s.2; 1995, c.289, s.2; 2009, c.321, s.1.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7.3 - Form; liens and certificates of debt

30:4D-7.3. Form; liens and certificates of debt
All liens and certificates of debt under section 7 of this amendatory and supplementary act shall be in a form to be prescribed by the commissioner, and shall be signed by the commissioner or director, or by such person designated by the commissioner or director.
L.1979, c. 365, s. 8, eff. Feb. 4, 1980.
2023 New Jersey Revised Statutes › Title 30 - Institutions and Agencies › Section 30:4D-7.4 - Filing liens; attachment to property

30:4D-7.4. Filing liens; attachment to property
All liens or certificates of debt under section 7 of this amendatory and supplementary act shall be filed with the clerk or register of deeds and mortgages of the county wherein the affected property is located, or with the clerk of the superior court, and shall immediately attach to and become binding upon all the property whether real or personal of the party against whom said lien or certificate of debt is filed. If it is believed that said party chargeable under said lien or certificate of debt has an interest or estate whether vested or contingent in property within the State, but the exact location of said property is not known, then said liens or certificates of debt may be filed with the clerk of the Superior Court and shall become binding upon all said property of said party chargeable under said lien or certificate of debt wherever situated within the State.
L.1979, c. 365, s. 9, eff. Feb. 4, 1980.