N.J. Admin. Code § 11:24B-2.1

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

Section 11:24B-2.1 - CODS: who must file for certification

(a) The obligation to submit an application for certification arises when a person otherwise meeting the definition of an ODS elects to enter into contracts with one or more carriers directly, rather than solely contracting with carriers through another ODS, and the ODS assumes no financial risk under the rules adopted by the Department at N.J.A.C. 11:22-3, or ceases to assume a financial risk under the rules at N.J.A.C. 11:22-4.

(b) The obligation to submit an application for certification arises when an ODS assuming financial risk is granted an exemption by the Department from the licensing requirement in accordance with N.J.A.C. 11:22-4.

(c) Notwithstanding (a) above, a person otherwise meeting the definition of an ODS shall not be obligated to obtain certification if:

1. The person contracts with one or more carriers directly solely for the provision of health care services that will be performed by only the health care professionals that are shareholders or employees of the ODS, within the scope of the health care professionals' individual licenses;

2. The person is a carrier regulated under Title 17 of the Revised Statutes, Title 17B of the New Jersey Statutes, or 26:2J-1 et seq., and amendments thereto;

3. The person is regulated by 18A:64G-1 et seq. (Medical and Dental Education Act of 1970, establishing the University of Medicine and Dentistry of New Jersey);

4. The person solely provides or arranges to provide pharmaceutical services;

5. The person solely provides or arranges to provide case management services;

6. The person solely provides employee assistance plans; or

7. The person provides the services set forth at 11:24B-2.4(a)3 through 9, but does not also provide the services set forth at 11:24B-2.4(a)1 or 2.

N.J. Admin. Code § 11:24B-2.1