NJ S3769

NJ FamilyCare must reimburse federally qualified health centers (FQHCs) for multiple medical encounters per day for an enrollee when each visit is with a different specialty provider and the referring provider documents medical necessity for each referral.

Federally qualified health centers are defined as community-based providers delivering integrated primary care in medically underserved areas meeting federal Social Security Act criteria under 42 U.S.C. s.1396(d).

Specialty providers must meet specific qualifications including board certification, fellowship status, completion of approved residency, hospital staff privileges, or peer recognition as a specialist.

The Commissioner of Human Services must apply for necessary federal Medicaid waivers or state plan amendments and adopt implementing regulations.

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