New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 74 - MANAGED HEALTH CARE SERVICES FOR MEDICAID/NJ FAMILYCARE BENEFICIARIES
Subchapter 3 - BENEFITS
Section 10:74-3.1 - Scope of benefits

Universal Citation: NJ Admin Code 10:74-3.1

Current through Register Vol. 56, No. 18, September 16, 2024

(a) The definition of "comprehensive risk contract" found at 42 CFR Part 438, as amended and supplemented, is incorporated herein by reference.

(b) Under the risk contract, all MCO/managed health care contractors shall provide standard service packages as detailed in the managed care contract, which shall exactly equal the services included in the New Jersey Medicaid/NJ FamilyCare program in amount, duration, and scope of services.

(c) The standard service package shall be provided in accordance with medical necessity without any predetermined limits, unless specifically stated; service utilization shall be controlled by the MCO through pre-certification programs and prior authorization for medical necessity.

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