NJ A3592

NJ FamilyCare would be required to reimburse federally qualified health centers (FQHCs) for multiple medical encounters on the same day for an enrollee, provided each visit is with a different specialty provider and the referring provider documents medical necessity for each referral.

FQHCs are defined as community-based health care providers delivering integrated primary care services in medically underserved areas that meet federal Social Security Act criteria.

Specialty providers must meet specific qualifications, including board certification or eligibility through the American Board of Medical Specialties or American Osteopathic Association, or recognition as a specialist by peers in the community.

The Commissioner of Human Services must apply for necessary federal Medicaid waivers or state plan amendments to implement the bill and secure federal matching funds.

The bill takes effect on the first day of the fourth month following enactment and explicitly cannot override federal statutes or existing state reimbursement methodologies for FQHCs.