Sponsored by:
Assemblyman LOUIS D. GREENWALD
District 6 (Burlington and Camden)
Assemblyman ALEXANDER "AVI" SCHNALL
District 30 (Monmouth and Ocean)
Assemblywoman SHANIQUE SPEIGHT
District 29 (Essex and Hudson)
Co-Sponsored by:
Assemblyman Tully, Assemblywomen Murphy, Park, Donlon and Peterpaul
SYNOPSIS
Requires NJ FamilyCare payment for multiple medical encounters per day for enrollee at federally qualified health center.
CURRENT VERSION OF TEXT
As reported by the Assembly Health Committee with technical review.
An Act concerning federally qualified health centers and supplementing Title 30 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. To the extent not otherwise prohibited by federal statute, the NJ FamilyCare program shall reimburse for multiple medical encounters per day at a federally qualified health center for an enrollee, provided:
(1) the referring health care provider documents, in a manner to be determined by the Commissioner of Human Services, the medical necessity of each referral to a specialty provider; and
(2) each of the enrollee’s medical encounters in a given day is with a different specialty provider.
b. Nothing in this act shall be construed to authorize the Commissioner of Human Services to waive or limit any provisions of federal statute or any other State reimbursement methodologies governing NJ FamilyCare reimbursement for services provided by federally qualified health centers.
c. As used in this section:
“Federally qualified health center” means a community-based health care provider that delivers integrated primary care services in medically underserved areas and meets the criteria established under section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. s.1396d).
“NJ FamilyCare” means the program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), which includes the Medicaid program and the Children’s Health Insurance Program.
“Specialty provider” means a licensed physician who:
(1) is a diplomate of a specialty board approved by the American Board of Medical Specialties or the Bureau of Osteopathic Specialists of the American Osteopathic Association;
(2) is a fellow of the appropriate American specialty college or a member of an osteopathic specialty college;
(3) is currently admissible to take the examination administered by a specialty board approved by the American Board of Medical Specialties or the Bureau of Osteopathic Specialists of the American Osteopathic Association, or has evidence of completion of an appropriate qualifying residency approved by the American Medical Association or American Osteopathic Association;
(4) holds an active staff appointment with specialty privileges in a hospital which is licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) and which is approved for training in the specialty in which the physician has privileges; or
(5) is recognized in the community as a specialist by the physician’s peers.
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.
3. The Commissioner of Human Services, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations necessary to implement the provisions of this act.
4. This act shall take effect on the first day of the fourth month next following the date of enactment.