New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 74 - MANAGED HEALTH CARE SERVICES FOR MEDICAID/NJ FAMILYCARE BENEFICIARIES
Subchapter 12 - REIMBURSEMENT
Section 10:74-12.3 - Adjustment of capitation rates

(a) Capitation rates are prospective in nature and will not be adjusted retroactively.

(b) Capitation rates shall not be subject to renegotiation during the contract period, except when any changes in Federal and/or State laws, rules, regulations or covered services so require.

(c) Capitation rates will be paid only for eligible beneficiaries enrolled during the period for which the adjusted capitation payments are being made.

(d) Payments provided for under the contract will be denied for new enrollees when, and for so long as, payments for those enrollees are denied by CMS in accordance with 42 CFR 438.730.