New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 49 - ADMINISTRATION MANUAL › Subchapter 1 - GENERAL PROVISIONS › Section 10:49-1.5 - Compliance with the Patient Protection and Affordable Care Act, Health Care and Education Reconciliation Act of 2010, and Federal regulations

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Notwithstanding
				any other provision of N.J.A.C. 10:49 through 10:79A, and except as provided in
				(c) and (d) below, the New Jersey Medicaid/NJ FamilyCare program (including,
				but not limited to, the program's administration, reimbursement, payment,
				provider screening, provider enrollment, provider termination, provider
				exclusion, program integrity, use of managed care, beneficiary enrollment,
				beneficiary services, appeal procedures, and fraud and abuse control), will be
				operated in accordance with all of the mandatory Federal requirements described
				in (a)1 through 6 below that were created under the Patient Protection and
				Affordable Care Act, 111 P.L. 148 (PPACA), as amended and supplemented, the
				Health Care and Education Reconciliation Act of 2010, 111 P.L. 152 (HCERA), as
				amended and supplemented, and the implementing Federal regulations adopted at
				76 FR 5862 through 5971, as amended and supplemented, in order to ensure
				compliance with the mandatory provisions of those Federal Acts and regulations.
1. The program will, as required by section
				6501 of PPACA at
				42 U.S.C. §
											1396a(a), as amended and
				supplemented, or by Federal regulations adopted in the Federal Register on
				February 2, 2011, at 76 FR 5862 through 5971, as amended and supplemented, deny
				enrollment or terminate the participation of any individual or entity in the
				New Jersey Medicaid/NJ FamilyCare program, if (subject to such exceptions as
				are permitted with respect to exclusion under sections 1128(c)(3)(B) and
				1128(d)(3)(B) of the Social Security Act (
				42
				U.S.C. §§
											1320a-7(c)(3)(B) and
				(d)(3)(B) ) participation of such individual
				or entity is terminated under title XVIII, XIX, or XXI of the Social Security
				Act (
				42 U.S.C. §§
											1395 et seq.,
				42 U.S.C.
				1396 et seq., or
				42 U.S.C.
				1397 aa et seq.) or under the Medicaid
				program or Children's Health Insurance program of any other state, and no
				payment shall be made by the program with respect to any item or service
				furnished by such individual or entity during such period.
2. No payment for items or services provided
				under the Medicaid/NJ FamilyCare program shall be made to any financial
				institution or entity located outside of the United States, as required by
				section 6505 of PPACA, at
				42 U.S.C. §
											1396a(a) 80, as amended and
				supplemented.
3. A voluntary
				election to have payment made for hospice care for a child shall not constitute
				a waiver of any rights of the child to be provided with, or to have payment
				made under the Medicaid/NJ FamilyCare program for, services that are related to
				the treatment of the child's condition for which a diagnosis of terminal
				illness has been made, as required by section 2302 of PPACA, at
				42
				U.S.C. §§
											1396d
				(
o
)(1) and 1397jj(a)(23), as amended and
				supplemented.
4. Separate payments
				will be made to providers administering prenatal labor and delivery or
				postpartum care in a freestanding birth center, as required by section 2301 of
				PPACA, at
				42
				U.S.C. §§
											1396d and
				1396a(a)(10)(A),
				as amended and supplemented.
5.
				Medicaid coverage will be provided for counseling and pharmacotherapy to
				pregnant women for cessation of tobacco use, and cost-sharing for these
				services is prohibited, as required by section 4107 of PPACA, at
				42
				U.S.C. §§
											1396d,
				1396r-8,
				and
				1396o,
				as amended and supplemented.
6.
				Payments for primary care services furnished in 2013 and 2014 will be made as
				required by section 1202(a) of HCERA, at
				42 U.S.C. §§
											1396a and
				1396u-2(f),
				as amended and supplemented or by any Federal regulations implementing that
				section, as amended and supplemented.