N.J. Admin. Code § 10:74-3.4

Current through Register Vol. 56, No. 24, December 18, 2024

Section 10:74-3.4 - Fee-for-service program services requiring MCO assistance to Medicaid/NJ FamilyCare-Plans A, B, C, and D enrollees to access the services

(a) The following services shall be provided to Plans A, B, C, and D enrollees through the Medicaid/NJ FamilyCare fee-for-service program and may necessitate contractor assistance to the enrollee (such as, for example, providing medical orders) to access the services:

1. Personal care assistant services (not covered for Medicaid/NJ FamilyCare-Plans B, C, and D unless enrolled in MLTSS);

2. Medical day care (not covered for Medicaid/NJ FamilyCare-Plans B, C, and D unless enrolled in MLTSS);

3. Outpatient rehabilitation services, including physical, occupational, and speech/language therapy;

4. Elective/induced abortions and related services, including surgical procedure, cervical dilation, insertion of cervical dilator, anesthesia including para cervical block, history and physical exam on day of surgery; PT, PTT, OB panel of lab tests, pregnancy test, urinalysis and urine drug screen, glucose and electrolytes; routine venipuncture, ultrasound, pathological examination of aborted fetus; Rhogam and its administration;

5. Transportation, lower mode;

6. Sex abuse examinations;

7. Services provided by DHS mental health/substance abuse residential facilities or group homes;

8. Family planning services and supplies when furnished by a non-MCO-participating provider;

9. Home health agency services for the aged, blind and disabled; and

10. Prescription drugs (legend and non-legend covered by the Medicaid/NJ FamilyCare program) for the aged, blind, or disabled.

N.J. Admin. Code § 10:74-3.4

Amended by 51 N.J.R. 1359(a), effective 8/19/2019