N.J. Admin. Code § 10:74-3.1

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:74-3.1 - Scope of benefits

(a) The definition of "comprehensive risk contract" found at 42 CFR Part 438, as amended and supplemented, is incorporated herein by reference.

(b) Under the risk contract, all MCO/managed health care contractors shall provide standard service packages as detailed in the managed care contract, which shall exactly equal the services included in the New Jersey Medicaid/NJ FamilyCare program in amount, duration, and scope of services.

(c) The standard service package shall be provided in accordance with medical necessity without any predetermined limits, unless specifically stated; service utilization shall be controlled by the MCO through pre-certification programs and prior authorization for medical necessity.

N.J. Admin. Code § 10:74-3.1

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