Title 30, Title 30: INSTITUTIONS AND AGENCIES

30:4D-4. Division of medical assistance and health services There is hereby created in the Department of Human Services a Division of Medical Assistance and Health Services. The division shall perform those administrative and operational functions vested in the department pursuan…

30:4D-4.1 Process for reviewing NJ FamilyCare provider applications. 1. a. Within 365 days of the effective date of this act, the Division of Medical Assistance and Health Services in the Department of Human Services and the State Board of Medical Examiners shall develop and impl…

30:4D-40. Payment system; eligibility determination The Commissioner of Human Services shall by regulation establish a system for issuing payments to eligible persons and a system for determining eligibility which includes provisions for submitting proof of an applicant's actual …

30:4D-41. Rules, regulations The Commissioner of Human Services shall, pursuant to the "Administrative Procedure Act," P.L.1968, c. 410 (C. 52:14B-1 et seq.) adopt rules and regulations necessary to carry out the purposes of this act. L. 1987, c. 298, s. 6.

30:4D-42. Casino revenue funding The Hearing Aid Assistance for the Aged and Disabled Program shall be funded by the Casino Revenue Fund created pursuant to section 145 of P.L.1977, c. 110 (C. 5:12-145). L. 1987, c. 298, s. 7.

30:4D-43. Short title 1. This act shall be known and may be cited as the "Senior Gold Prescription Discount Act." L.2001,c.96,s.1.

30:4D-44 Definitions regarding the "Senior Gold Prescription Discount Act." 2. As used in this act: "Commissioner" means the Commissioner of Human Services. "Department" means the Department of Human Services. "PAAD" means the program of pharmaceutical assistance to the aged and …

30:4D-45 "Senior Gold Prescription Discount Program." 3. a. There is established the "Senior Gold Prescription Discount Program" in the Department of Human Services. b. A resident of this State shall be eligible for the program if the person is: (1) either 65 years of age or olde…

30:4D-45.1 "Senior Gold Prescription Discount Program," notification as to error in estimated annual income. 3. a. Notwithstanding the provisions of any other law to the contrary, a recipient of benefits under the "Senior Gold Prescription Discount Program," established pursuant …

30:4D-45.2 Payment to pharmacy for certain forged, fraudulent prescriptions under State Medicaid program. 3. a. A pharmacy shall receive full payment and shall not be penalized for dispensing a forged or fraudulent prescription that has been approved by the State Medicaid program…

30:4D-45.3 Community retail pharmacy practice site, display, Senior Gold Prescription Discount Program information. 3. Notwithstanding any other provision of law to the contrary, a community retail pharmacy practice site shall prominently display at the point of sale for pharmace…

30:4D-45a Senior Gold Prescription Discount Program, reimbursement, prescription drug costs, remainder. 5. In addition to the reimbursement required pursuant to subsection g. of section 3 of P.L.2001, c.96 (C.30:4D-45), any eligible person under the Senior Gold Prescription Disco…

30:4D-46. Report to Governor, Legislature 4. The commissioner shall annually report to the Governor and the Legislature on the operations of the program and shall include with that report any recommendations for legislative action that the commissioner deems appropriate. L.2001,c…

30:4D-47. Violations of act; program identification cards 5. a. A person violating any provision of this act shall be subject to the applicable civil and criminal penalties provided in P.L.1968, c.413 (C.30:4D-1 et seq.). An eligible person who violates any provision of this act …

30:4D-48. New Jersey EASE program, provide information on prescription program 6. The New Jersey EASE program established by the department shall provide information and assistance to members of the public and potential or actual applicants to the program, including, but not limi…

30:4D-48.1 Senior Gold prescription program information displayed on tax return instructions. 1. The Director of the Division of Taxation in the Department of the Treasury shall prominently display the eligibility qualifications for and benefits available under the "Senior Gold P…

30:4D-49. Funding of Senior Gold Prescription Discount Program 7. The program shall be funded from the monies made available to the State from tobacco companies under the nationwide settlement of the respective actions by state governments against those companies, entered into by…

30:4D-5. Medical assistance program The department, which is hereby designated the single State agency to administer the provisions of this act, through the Division of Medical Assistance and Health Services, by rules and regulations, shall implement and administer the program of…

30:4D-50 Rules, regulations. 8. The Commissioner of Human Services, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations to effectuate the purposes of this act. L.2001, c.96, s.8; amended 2012, c.17, s.389.

30:4D-51 Conditions on expending funds. 9. Notwithstanding the provisions of any law to the contrary, no funds appropriated for the Senior Gold Prescription Discount Program established pursuant to this act shall be expended unless participating pharmaceutical manufacturing compa…

30:4D-52 Rebates to DHS for program. 10. Amounts received as rebates under rebate payment contracts executed pursuant to section 9 of this act are appropriated to the Department of Human Services for the support of the Senior Gold Prescription Discount Program. L.2001, c.96, s.10…

30:4D-53 Short title. 1. This act shall be known and may be cited as the "Medicaid Program Integrity and Protection Act." L.2007,c.58,s.1.

30:4D-54 Findings, declarations relative to the Office of Medicaid Inspector General. 2. The Legislature finds and declares that: a. The State of New Jersey expends more than $9 billion in taxpayer funds to fund the Medicaid program each year; b. The State has a continuing respon…

30:4D-55 Definitions relative to the Office of the Medicaid Inspector General. 3. As used in this act: "Abuse" means provider practices that are inconsistent with sound fiscal, business, or medical practices and result in unnecessary costs to Medicaid or in reimbursement for serv…

30:4D-57 Functions, duties, powers, responsibilities of Medicaid Inspector General. 5. a. The Medicaid Inspector General shall have the following general functions, duties, powers, and responsibilities: (1) To appoint such deputies, directors, assistants, and other officers and e…

30:4D-58 Additional authority of the Medicaid Inspector General. 6. a. In addition to the authority otherwise provided by this act, the Medicaid Inspector General is authorized to request, and shall be entitled to receive, such information, assistance, and cooperation from any fe…

30:4D-59 Transfer of certain functions, powers, employees. 7. a. The Medicaid audit, program integrity, fraud, and abuse prevention and recovery functions, all officers and employees that the Medicaid Inspector General deems qualified and substantially engaged therein, and any do…

30:4D-6 Medical assistance for qualified applicants. 6. a. Subject to the requirements of Title XIX of the federal Social Security Act, the limitations imposed by this act, and by the rules and regulations promulgated pursuant thereto, the department shall provide medical assista…

30:4D-6.1. Abortions; payment of claims No payments for medical assistance shall be made under the act hereby supplemented for the termination of a woman's pregnancy for any reason except where it is medically indicated to be necessary to preserve the woman's life. In any case wh…

30:4D-6.10 Conditions for reimbursement to providers; educational materials; terms defined. 2. a. No provider shall be approved for reimbursement by the Division of Medical Assistance and Health Services in the Department of Human Services under Medicaid for a non-medically indic…

30:4D-6.2 Definitions. 1. For the purposes of this act: a. "Certified trained personnel" means one or more individuals directly providing mobility assistance vehicle services possessing and carrying upon their persons a current certificate of completion of an advanced medical tra…

30:4D-6.3. Provider of mobility assistance vehicle services; conditions for approval for reimbursement 2. No provider of mobility assistance vehicle services shall be approved for reimbursement by the Division of Medical Assistance and Health Services for services rendered to Med…

30:4D-6.4 Minimum requirements, liability insurance, personnel; rules, regulations. 3. After consulting with the Commissioner of Human Services, the Commissioner of Health is authorized and empowered to issue and enforce, or cause to be issued and enforced through the division, a…

30:4D-6.5. Inapplicability of act to services by volunteer first aid, rescue and ambulance squads The provisions of this act shall not apply to services provided by volunteer first aid, rescue and ambulance squads as defined in the "New Jersey Highway Safety Act of 1971," P.L.197…

30:4D-6.6. Rules and regulations; application of Medical Assistance and Health Services Act a. After consulting with the Commissioner of Human Services, the Commissioner of Health is authorized and empowered to adopt such rules and regulations as are necessary to carry out his fu…

30:4D-6.7. Resident of skilled or intermediate care nursing facility discharged to general or psychiatric hospital; coverage by medical assistance program A resident of a skilled or intermediate care nursing facility who is a recipient of medical assistance payments under P.L.196…

30:4D-6.8. Period of maintenance of bed for eligible resident; certification for payment Every skilled or intermediate care nursing facility in this State shall maintain a bed for an eligible resident for a period not to exceed 10 days. The facility shall notify the Division of M…

30:4D-6.9. Inability of discharged resident to return within period; priority for next available bed If the discharged resident is unable to return to the nursing facility before the end of the 10 day period, the discharged resident shall have priority for the next available bed …

30:4D-60 Reports, recommendations. 8. a. The Medicaid Inspector General shall report the findings of audits, investigations, and reviews performed by the office, and issue recommendations for corrective or remedial action, to the Governor, the President of the Senate and the Spea…

30:4D-61 Confidentiality of information. 9. a. The Medicaid Inspector General shall not publicly disclose information that is specifically prohibited from disclosure by any provision of federal or State law. b. Whenever a person requests access to a government record that the Med…

30:4D-62 "Medicaid Fraud Control Fund"; use. 10. a. There is established the "Medicaid Fraud Control Fund" as a nonlapsing, revolving fund in the Department of the Treasury. The fund shall be comprised of monies credited or accruing to the fund pursuant to this section. b. Beginn…

30:4D-63 Rules, regulations. 11. The Medicaid Inspector General may adopt rules and regulations, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), necessary to accomplish the objectives and carry out the duties prescribed by this act. L.2007,c.…

30:4D-64 Annual appropriation, minimum required. 13. For each fiscal year beginning after the fiscal year in which this act takes effect, the Governor shall recommend and the Legislature shall appropriate at least $3,000,000 from the General Fund to the Office of the Medicaid Ins…

30:4D-65 Findings, declarations relative to the "iPHD Project." 1. The Legislature finds and declares that: a. Many New Jersey administrative departments and agencies, including, but not limited to, the Departments of Health, Human Services, Community Affairs, Corrections, and Ag…

30:4D-66 Definitions relative to the "iPHD Project." 2. As used in this act: "Aggregated data" means information that has been combined into groups showing averages or other summary statistics, and that is not individually identifiable information as defined in this act. "De-iden…

30:4D-67 iPHD project governing board. 3. a. The iPHD Project Governing Board is hereby established in, but not of, the Department of Health. The Governing Board shall consist of 10 members: one of whom shall be the Director of the Rutgers Center for State Health Policy, who shal…