N.J. Admin. Code § 11:24B-3.2

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

Section 11:24B-3.2 - Carriers: limitations on delegation

(a) Carriers shall only delegate the performance of those functions set forth at 11:24B-2.4(a), as further described in this subchapter, to a CODS certified for those functions.

(b) A carrier may contract with an entity to perform less than a majority of the duties specified for a function as set forth within this subchapter, in which event, the entity performing those specific duties need not be certified to perform the function in order to contract with the carrier, and the carrier will not be considered to have delegated that function in accordance with this chapter.

1. Nothing in (b) above shall be construed to relieve the carrier from complying with any requirements of other laws that may require notice of delegation of major functions or submission of contracts by carriers to the Department, including N.J.A.C. 11:24, or 11:24A or N.J.A.C. 11:4-37 or 11:22-5.

(c) Use by a carrier of an ODS' network shall not relieve the carrier of any obligation it may have regarding nondiscrimination against specified providers, inclusion of specified providers within its network(s), or accessibility of specified providers to covered persons pursuant to statute or regulation.

1. Either the carrier or the ODS may demonstrate that the carrier shall be in compliance with all applicable statutes and regulations addressing specific provider inclusion within the network, or payment of benefits for services performed by specified providers acting within the scope of their licenses whose services are otherwise covered under the terms of the carrier's health benefits plan.

N.J. Admin. Code § 11:24B-3.2