N.J. Admin. Code § 11:24C-3.5
Current through Register Vol. 56, No. 24, December 18, 2024
Section 11:24C-3.5 - Termination of the agreement for services and supplies for home treatment of bleeding episodes associated with hemophilia(a) In the event that a carrier or a designated health care provider terminate their agreement for, or which includes among its terms, the provision of services and supplies to a carrier's covered person for home treatment of bleeding episodes associated with hemophilia, the carrier shall continue to provide services or benefits to or on behalf of a covered person at an in-network level until the end of four months following the date of termination, or until arrangements are made for the covered person to obtain home treatment services and supplies from another in-network designated health care provider, whichever occurs first.(b) The requirements of (a) above shall not apply when the agreement terminates on the basis of breach, fraud, or a determination by the carrier's medical director that the health care provider is an imminent danger to one or more covered persons, whether such breach, fraud or imminent harm is related to the provision of services or supplies for home treatment of bleeding episodes associated with hemophilia, or other services and supplies for which the carrier and health care provider have an agreement. 1. The carrier shall arrange to pay for services through another designated health care provider.(c) Nothing in this subchapter shall be construed to limit the statutory or other regulatory obligations that may apply to an agreement between a carrier and a hospital, physician or other health care provider, pursuant to N.J.S.A. 26:2J-11.1 and 26:2S-9.1, for instance, as appropriate to the type of carrier and the type of health care provider.(d) Nothing in this section shall be construed to require a carrier to provide more extensive benefits for covered services than that which is specified in the underlying health benefits plan.N.J. Admin. Code § 11:24C-3.5