N.J. Admin. Code § 10:74-3.9

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

Section 10:74-3.9 - General Medicaid/NJ FamilyCare program limitations

(a) The following service requirements and limitations shall apply in the standard service package or capitation payments, even if provided by the MCO:

1. Although services of podiatrists shall be provided, New Jersey Medicaid/NJ FamilyCare does not ordinarily cover routine foot care or treatment of flat foot conditions. These services shall be provided only when medical necessity is determined.

2. Occupational therapy and treatment for speech, language or hearing disorders shall be covered only when provided to an enrollee by a nursing facility, an approved home health agency, a hospital inpatient and outpatient department or an independent outpatient clinic.

3. Elective/induced abortions are not covered under an MCO program but will continue to be paid on a fee-for-service basis by the Medicaid/NJ FamilyCare program.

N.J. Admin. Code § 10:74-3.9

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