New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 51 - PHARMACEUTICAL SERVICES MANUAL
Subchapter 2 - PHARMACEUTICAL SERVICES TO MEDICAID OR NJ FAMILYCARE FEE-FOR-SERVICES BENEFICIARIES IN A NURSING FACILITY
Section 10:51-2.7 - Prescription dispensing fee (capitation)
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The New Jersey Medicaid and NJ FamilyCare programs capitate the dispensing fee for each prescription for beneficiaries in Medicaid approved nursing facilities in accordance with the total number of Medicaid and NJ FamilyCare fee-for-service beneficiary days in the facility(ies) serviced by the pharmacy. Additional dispensing fees (add-ons) per prescription shall be given to pharmacy providers who provide the following levels of services: Pharmacies with institutional permits shall be reimbursed as defined in (a) above, except that the daily per beneficiary capitation fee shall be 75 percent of the fee for pharmacies with retail permits.
(b) Price information is supplied from a reference drug file subcontracted for this purpose by the fiscal agent and accepted by the Division as the primary source of pricing information for the New Jersey Medicaid Management Information System. The calculated price shall not exceed the lower of the average wholesale price (AWP) or the Federal Fund Participation Upper Limit (FFPUL) as supplied by the reference drug file contractor.
(c) In order to receive any or all of the above increments, the provider shall certify annually to the Division on Form FD-70, that the services(s) as defined in (a) above, are being provided and/or that the provider is entitled to the impact increment as defined in (a) above.
(d) When a nursing facility changes its servicing pharmacy provider, the new pharmacy provider must notify the fiscal agent so that the provider file of the New Jersey Medicaid Management Information System (NJMMIS) may be updated. The following information is required in writing: