New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 74 - MANAGED HEALTH CARE SERVICES FOR MEDICAID/NJ FAMILYCARE BENEFICIARIES
Subchapter 3 - BENEFITS
Section 10:74-3.9 - General Medicaid/NJ FamilyCare program limitations
Universal Citation: NJ Admin Code 10:74-3.9
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The following service requirements and limitations shall apply in the standard service package or capitation payments, even if provided by the MCO:
1. Although services of podiatrists shall be
provided, New Jersey Medicaid/NJ FamilyCare does not ordinarily cover routine
foot care or treatment of flat foot conditions. These services shall be
provided only when medical necessity is determined.
2. Occupational therapy and treatment for
speech, language or hearing disorders shall be covered only when provided to an
enrollee by a nursing facility, an approved home health agency, a hospital
inpatient and outpatient department or an independent outpatient
clinic.
3. Elective/induced
abortions are not covered under an MCO program but will continue to be paid on
a fee-for-service basis by the Medicaid/NJ FamilyCare program.
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