N.J. Admin. Code § 11:24C-2.3 - Carriers responsibility to use designated health care providers for home treatments

(a) No carrier shall arrange with any person for the provision of home treatment of bleeding episodes associated with hemophilia unless that person shall be a designated health care provider of such services.

(b) Carriers with an aggregate enrollment of 50,000 covered persons or more in managed care plans shall arrange for the provision of home treatment of bleeding episodes associated with hemophilia with at least two designated health care providers, unless there are fewer than two designated health care providers designated in New Jersey, in which event, the carrier shall arrange for the provision of home treatment services with the lone designated health care provider, regardless of the carrier's enrollment.

(c) Carriers with aggregate enrollment of fewer than 50,000 covered persons in managed care plans shall arrange for the provision of home treatment of bleeding episodes associated with hemophilia with at least one designated health care provider.

(d) Nothing in this subchapter shall be construed to limit or eliminate any carrier's obligation to credential and re-credential health care providers with which the carrier arranges for the provision of home treatment of hemophilia with respect to such treatments or any other services that the health care provider may render to a carrier's covered persons.

Notes

N.J. Admin. Code § 11:24C-2.3