N.J. Admin. Code § 10:74-3.5

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

Section 10:74-3.5 - Fee-for-service services for Medicaid/NJ FamilyCare-Plans A, B, C, and D enrollees not requiring case management by the MCO

(a) The following services shall be provided to Plans A, B, C, and D enrollees through the Medicaid/NJ FamilyCare fee-for-service program without requiring case management by the MCO:

1. Inpatient psychiatric hospital services for individuals under 21 and for individuals 65 years of age and over

2. Outpatient mental health services for non-DDD clients, non-MLTSS clients, and non-Fully Integrated Dual Eligible Special Needs Program (FIDE-SNP) clients;

3. Outpatient substance use disorder services for non-DDD clients, non-MLTSS clients, and non-Fully Integrated Dual Eligible Special Needs Program (FIDE-SNP) clients:

i. Diagnosis;

ii. Treatment; and

iii. Detoxification;

4. Drugs paid fee-for-service by the Medicaid/NJ FamilyCare program:

i. Costs for methadone maintenance and its administration;

ii. Atypical antipsychotic drugs;

iii. Suboxone and Subutex or any other drug within this category when used for the treatment of opioid dependence; and

iv. Generically-equivalent drug products of the drugs listed above; and

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

(b) The following services shall be provided to NJ FamilyCare beneficiaries enrolled in Plan A and/or the Alternative Benefit Program through the Medicaid/NJ FamilyCare fee-for-service program without requiring case management by the MCO:

1. Intermediate care facilities/individuals with intellectual disabilities (ICF/IID) services;

2. Waiver and demonstration program services; and

3. Division of Developmental Disabilities Community Care Program (DDD/CCP) services.

N.J. Admin. Code § 10:74-3.5

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