N.J. Admin. Code § 11:24-13.2

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

Section 11:24-13.2 - Medicaid marketing representatives

(a) Notwithstanding N.J.A.C. 11:24-13.1, an HMO under contract with the Division of Medical Assistance and Health Services of the New Jersey Department of Human Services to enroll Medicaid recipients shall register its marketing representatives employed solely for the purpose of enrolling Medicaid recipients in accordance with N.J.A.C. 11:17-2.1 1 as Medicaid marketing representatives, unless such person is an insurance producer and is appointed by the HMO as its agent pursuant to N.J.A.C. 11:24-13.1.

(b) An HMO shall register each Medicaid marketing representative with the Department in accordance with N.J.A.C. 11:17-2.1 1 prior to the representative commencing any marketing activities. Any HMO already enrolling Medicaid recipients using persons who are not licensed insurance producers as required pursuant to N.J.A.C. 11:24-13.1 on July 1, 1997 shall register such persons as Medicaid marketing representatives (if the HMO does not otherwise intend to comply with N.J.A.C. 11:24-13.1 with respect to its Medicaid business) by September 29, 1997 and shall otherwise comply with this chapter. Registrations shall be sent to the following:

Attn: License Processing

New Jersey Department of Banking and Insurance

20 West State Street

PO Box 327

Trenton, NJ 08625-0327

(c) Every HMO that uses or intends to use Medicaid marketing representatives shall submit to the Departments of Human Services and Banking and Insurance, at the addresses specified at N.J.A.C. 11:24-11.6(i) and (j), a pre-registration training program for Medicaid marketing representatives.

1. The materials submitted shall include the form the HMO shall issue to Medicaid marketing representatives evidencing satisfactory completion by the Medicaid marketing representative of the HMO's pre-registration training program.

2. An HMO enrolling Medicaid recipients with persons not registered as either insurance producers or as Medicaid marketing representatives on the effective date of this subchapter shall submit a pre-registration training program no later than September 29, 1997.

(d) Every HMO shall submit for filing with the Departments of Human Services and Banking and Insurance a description of the organizational structure involving the marketing of the Medicaid product, which shall include an explanation of the method by which the HMO shall supervise the Medicaid marketing representatives and evaluate their effectiveness.

(e) Every HMO shall assure the continued education of Medicaid marketing representatives in the manner set forth in this subsection.

1. The HMO shall develop or otherwise arrange for continuing education programs for Medicaid marketing representatives, with programs available no less than semiannually.

2. The HMO shall submit a description of its continuing education program to the Departments of Human Services and Banking and Insurance by August 30, 1997 or within 60 days following the date that it first registers Medicaid marketing representatives, whichever date is later.

i. Submission of a description of a continuing education program by an HMO in accordance with (e)2 above shall in no way serve as a substitute for the submission and approval process set forth for the continuing education requirements of N.J.A.C. 11:17-3.4.

3. Submissions shall be made to the addresses set forth at N.J.A.C. 11:24-11.6(i) and (j) with respect to the Departments of Banking and Insurance and Human Services.

(f) Every HMO shall maintain records for each Medicaid marketing representative specifying the registration of the Medicaid marketing representative, certification of completion of all initial and continuing education programs, and a copy of the notice of termination of registration filed with the Department, which records shall be available for inspection by the Departments of Human Services and Banking and Insurance within a reasonable time following request.

1. HMOs shall maintain records of terminated Medicaid marketing representatives for no less than three years following the date of termination of their registration.

(g) The requirements set forth in this section are in addition to any standards and requirements which may be established by the Department of Human Services for the Medicaid program.

(h) The requirements set forth herein in this section in addition to the requirements of N.J.A.C. 11:17-2.9.

N.J. Admin. Code § 11:24-13.2