NJ FamilyCare Managed Care Contract - State of New Jersey

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CONTRACT BETWEEN STATE OF NEW JERSEY DEPARTMENT OF HUMAN SERVICES DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES AND ______________________________, CONTRACTOR

7/2017 Accepted

STATE OF NEW JERSEY DEPARTMENT OF HUMAN SERVICES DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES AND ________________________ CONTRACT TO PROVIDE SERVICES

This comprehensive risk contract is entered into this _______ day of _________, and is effective on the _______ day of __________ between the Department of Human Services, which is in the executive branch of state government, the state agency designated to administer the Medicaid program under Title XIX of the Social Security Act, 42 U.S.C. 1396 et seq. pursuant to the New Jersey Medical Assistance and Health Services Act, N.J.S.A. 30:4D-1 et seq. and the Children’s Health Insurance Program (CHIP) under Title XXI of the Social Security Act, 42 U.S.C. 1397aa et seq., pursuant to the Children’s Health Care Coverage Act, PL 1997, c.272 (also known as “NJ KidCare”), pursuant to Family Health Care Coverage Act, P.L. 2005, c.156 (also known as "NJ FamilyCare") whose principal office is located at P.O. Box 712, in the City of Trenton, New Jersey hereinafter referred to as the “Department” and __________________________________________, a federally qualified/ state defined health maintenance organization (HMO) which is a New Jersey, profit/non-profit corporation, certified to operate as an HMO by the State of New Jersey Department of Banking and Insurance and whose principal corporate office is located at ________________________________ __________________, in the City of ________________, County of ______________, New Jersey, hereinafter referred to as the “Contractor”. WHEREAS, the Contractor is engaged in the business of providing prepaid, capitated comprehensive health care services pursuant to N.J.S.A. 26:2J-1 et seq.; and WHEREAS, the Department, as the state agency designated to administer a program of medical assistance for eligible persons under Title XIX of the Social Security Act (42 U.S.C. Sec. 1396, et seq., also known as “Medicaid”), for eligible persons under the Family Health Care Coverage Act (P.L. 2005, c.156) and for children under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa, et seq., also known as “Children’s Health Insurance Program”), is authorized pursuant to the federal regulations at 42 C.F.R. 434 and 438 to provide such a program through an HMO and is desirous of obtaining the Contractor’s services for the benefit of persons eligible for Medicaid/NJ FamilyCare; and WHEREAS, the Division of Medical Assistance and Health Services (DMAHS), is the Division within the Department designated to administer the medical assistance program, and the Department’s functions regarding all Medicaid/NJ FamilyCare program benefits provided through the Contractor for Medicaid/NJ FamilyCare eligibles enrolled in the Contractor’s plan. NOW THEREFORE, in consideration of the contracts and mutual covenants herein contained, the Parties hereto agree as follows:

PREAMBLE Governing Statutory and Regulatory Provisions: This contract and all renewals and modifications are subject to the following laws and all amendments thereof: Title XIX and Title XXI of the Social Security Act, 42 U.S.C. 1396 et. seq., 42 U.S.C. 1397aa et seq., the New Jersey Medical Assistance and Health Services Act (N.J.S.A. 30:4D-1 et seq.); the Family Health Care Coverage Act (N.J.S.A. 30:4J-8 et seq.); and the Medicaid, and NJ KidCare and NJ FamilyCare State Plans approved by CMS; federal and state Medicaid, Children’s Health Insurance Program, and NJ FamilyCare regulations, other applicable federal and state statutes, and all applicable local laws and ordinances.

TABLE OF CONTENTS ARTICLE ONE: DEFINITIONS

1-31

ARTICLE TWO: CONDITIONS PRECEDENT

1-3

ARTICLE THREE: MANAGED CARE MANAGEMENT INFORMATION SYSTEM

1-23

3.1

GENERAL OPERATIONAL REQUIREMENTS FOR THE MCMIS .................................... 3.1.1 ONLINE ACCESS ............................................................................................................ 3.1.2 PROCESSING REQUIREMENTS................................................................................... 3.1.3 REPORTING AND DOCUMENTATION REQUIREMENTS ....................................... 3.1.4 OTHER REQUIREMENTS ..............................................................................................

1 1 1-3 3 4

3.2

ENROLLEE SERVICES................................................................................................................ 3.2.1 CONTRACTOR ENROLLMENT DATA........................................................................ 3.2.2 ENROLLEE PROCESSING REQUIREMENTS ............................................................. 3.2.3 CONTRACTOR ENROLLMENT VERIFICATION ....................................................... 3.2.4 ENROLLEE GRIEVANCE TRACKING SYSTEM ........................................................ 3.2.5 ENROLLEE REPORTING ...............................................................................................

4 4-5 5-6 6 6 6-7

3.3

PROVIDER SERVICES ................................................................................................................ 3.3.1 PROVIDER INFORMATION AND PROCESSING REQUIREMENTS ....................... 3.3.2 PROVIDER CREDENTIALING ...................................................................................... 3.3.3 PROVIDER/ENROLLEE LINKAGE .............................................................................. 3.3.4 PROVIDER MONITORING ............................................................................................ 3.3.5 REPORTING REQUIREMENTS.....................................................................................

7 7 7-8 8 8 8

3.4

CLAIMS/ENCOUNTER PROCESSING ..................................................................................... 3.4.1 GENERAL REQUIREMENTS ........................................................................................ 3.4.2 COORDINATION OF BENEFITS .................................................................................. 3.4.3 REPORTING REQUIREMENTS..................................................................................... 3.4.4 REMITTANCE ADVICE AND CAPITATION LISTS ...................................................

8 8-9 10 10 10-12

3.5

PRIOR AUTHORIZATION, REFERRAL AND UTILIZATION MANAGEMENT ............. 12 3.5.1 FUNCTIONS AND CAPABILITIES ............................................................................... 12-13 3.5.2 REPORTING REQUIREMENTS..................................................................................... 13

3.6

FINANCIAL PROCESSING ......................................................................................................... 13

3.7

QUALITY ASSURANCE ............................................................................................................... 13 3.7.1 FUNCTIONS AND CAPABILITIES ............................................................................... 13-15 3.7.2 REPORTING REQUIREMENTS..................................................................................... 15

3.8

MANAGEMENT AND ADMINISTRATIVE REPORTING ..................................................... 3.8.1 GENERAL REQUIREMENTS ........................................................................................ 3.8.2 QUERY CAPABILITIES ................................................................................................. 3.8.3 REPORTING CAPABILITIES.........................................................................................

3.9

ENCOUNTER DATA REPORTING ............................................................................................ 16-17 3.9.1 ENCOUNTER DATA REQUIREMENTS AND SUBMISSION .................................... 17-21 3.9.2 SUBMISSION OF TEST ENCOUNTER DATA ............................................................. 21-22

15 15-16 16 16

3.9.3 3.9.4 3.9.5

REMITTANCE ADVICE ................................................................................................. 22 SUBCONTRACTS AND ENCOUNTER DATA REPORTING FUNCTION................ 22 FUTURE ELECTRONIC ENCOUNTER SUBMISSION REQUIREMENTS ............... 22

3.10

CRITICAL INCIDENT REPORTING......................................................................................... 23

3.11

HEALTH INFORMATION TECHNOLOGY ............................................................................. 23 3.11.1 GENERAL REQUIREMENTS ........................................................................................ 23

ARTICLE FOUR: PROVISION OF HEALTH CARE SERVICES

1-123

4.1

COVERED SERVICES .................................................................................................................. 4.1.1 GENERAL PROVISIONS AND CONTRACTOR RESPONSIBILITIES ...................... 4.1.2 BENEFIT PACKAGE....................................................................................................... 4.1.3 SERVICES REMAINING IN FEE-FOR-SERVICE PROGRAM AND MAY NECESSITATE CONTRACTOR ASSISTANCE TO THE ENROLLEE TO ACCESS THE SERVICES ............................................................................................... 4.1.4 MEDICAID COVERED SERVICES NOT PROVIDED BY CONTRACTOR .............. 4.1.5 INSTITUTIONAL FEE-FOR-SERVICE BENEFITS – NO COORDINATION BY THE CONTRACTOR ....................................................................................................... 4.1.6 BENEFIT PACKAGE FOR NJ FAMILYCARE D ENROLLEES.................................. 4.1.7 SUPPLEMENTAL BENEFITS ........................................................................................ 4.1.8 CONTRACTOR AND DMAHS SERVICE EXCLUSIONS ...........................................

1 1-8 8-15

SPECIAL PROGRAM REQUIREMENTS ................................................................................. 4.2.1 EMERGENCY SERVICES .............................................................................................. 4.2.2 FAMILY PLANNING SERVICES AND SUPPLIES...................................................... 4.2.3 WOMEN’S HEALTH SERVICES ................................................................................... 4.2.4 PRESCRIBED DRUGS AND PHARMACY SERVICES ............................................... 4.2.5 LABORATORY SERVICES ............................................................................................ 4.2.6 EPSDT SERVICES ........................................................................................................... 4.2.7 IMMUNIZATIONS .......................................................................................................... 4.2.8 CLINICAL TRIALS, INVESTIGATIONAL TREATMENT, EXPERIMENTAL TREATMENT ................................................................................................................... 4.2.9 HEALTH PROMOTION AND EDUCATION PROGRAMS ......................................... 4.2.10 MEDICAL HOME – DEVELOPMENT, ESTABLISHMENT, AND ADMINISTRATION ........................................................................................................ 4.2.11 ORTHODONTIC SERVICES .......................................................................................... 4.2.12 HOSPICE SERVICES ......................................................................................................

25 25-29 29 29-30 30-35 35 35-42 42-43

4.2

15-19 20 20-21 21-24 24 24-25

43-44 45-46 46 46-47 47-48

4.3

COORDINATION WITH ESSENTIAL COMMUNITY PROGRAMS ................................... 48

4.4

COORDINATION WITH MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES ... 48-51

4.5

ENROLLEES WITH SPECIAL NEEDS ..................................................................................... 4.5.1 GENERAL REQUIREMENTS ........................................................................................ 4.5.2 CHILDREN WITH SPECIAL HEALTH CARE NEEDS ............................................... 4.5.3 CLIENTS OF THE DIVISION OF DEVELOPMENTAL DISABILITIES .................... 4.5.4 PERSONS WITH HIV/AIDS ...........................................................................................

4.6

QUALITY MANAGEMENT SYSTEM ....................................................................................... 58

51 51-54 54-56 56-57 57-58

4.6.1 4.6.2 4.6.3 4.6.4 4.6.5

QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT PLAN............. QAPI ACTIVITIES........................................................................................................... REFERRAL SYSTEMS ................................................................................................... UTILIZATION MANAGEMENT .................................................................................... CARE MANAGEMENT ..................................................................................................

58-63 63-74 74-76 76-85 85-90

4.7

MONITORING AND EVALUATION ......................................................................................... 4.7.1 GENERAL PROVISIONS ................................................................................................ 4.7.2 EVALUATION AND REPORTING – CONTRACTOR RESPONSIBILITIES............. 4.7.3 MONITORING AND EVALUATION – DEPARTMENT ACTIVITIES....................... 4.7.4 INDEPENDENT EXTERNAL QUALITY REVIEW ORGANIZATION REVIEWS ...

90 90 90-94 94 94-95

4.8

PROVIDER NETWORK ............................................................................................................... 4.8.1 GENERAL PROVISIONS ................................................................................................ 4.8.2 PRIMARY CARE PROVIDER REQUIREMENTS ........................................................ 4.8.3 PROVIDER NETWORK FILE REQUIREMENTS......................................................... 4.8.4 PROVIDER DIRECTORY REQUIREMENTS ............................................................... 4.8.5 CREDENTIALING/RECREDENTIALING REQUIREMENTS/ISSUES ...................... 4.8.6 LABORATORY SERVICE PROVIDERS ....................................................................... 4.8.7 SPECIALTY PROVIDERS AND CENTERS .................................................................. 4.8.8 PROVIDER NETWORK REQUIREMENTS .................................................................. 4.8.9 DENTAL PROVIDER NETWORK REQUIREMENTS ................................................. 4.8.10 MLTSS NETWORK REQUIREMENTS ......................................................................... 4.8.11 GOOD FAITH NEGOTIATIONS .................................................................................... 4.8.12 PROVIDER NETWORK ANALYSIS .............................................................................

95 96-99 99-101 101-102 102 102-103 103 104-106 106-111 111-112 112-113 113 113

4.9

PROVIDER CONTRACTS AND SUBCONTRACTS ................................................................ 4.9.1 GENERAL PROVISIONS ................................................................................................ 4.9.2 CONTRACT SUBMISSION ............................................................................................ 4.9.3 PROVIDER CONTRACT AND SUBCONTRACT TERMINATION............................ 4.9.4 PROHIBITION OF INTERFERENCE WITH CERTAIN MEDICAL COMMUNICATIONS ...................................................................................................... 4.9.5 ANTIDISCRIMINATION ................................................................................................ 4.9.6 SUBCONTRACTS ........................................................................................................... 4.9.7 ASSIGNMENTS ...............................................................................................................

113 113-115 115-118 118-119 119-120 120 120-121 121

4.10

EXPERT WITNESS REQUIREMENTS AND COURT OBLIGATIONS ............................... 121-122

4.11

ADDITIONS, DELETIONS, AND/OR CHANGES .................................................................... 122 4.11.1 NOTIFYING DMAHS OF CHANGES TO REIMBURSEMENT RATES .................... 122 4.11.2 SPECIFIC REQUIREMENTS FOR CHANGES TO POLICY, OPERATIONS, OR FUNCTIONS .................................................................................................................... 122-123

ARTICLE FIVE: ENROLLEE SERVICES

1-42

5.1

GEOGRAPHIC REGIONS............................................................................................................ 1

5.2

AID CATEGORIES ELIGIBLE FOR CONTRACTOR ENROLLMENT .............................. 1-3

5.3

EXCLUSIONS ................................................................................................................................. 3 5.3.1 ENROLLMENT AND AUTO ASSIGNMENT EXCLUSIONS ..................................... 3

5.4

ENROLLMENT OF MANAGED CARE ELIGIBLES .............................................................. 4-5

5.5

ENROLLMENT AND COVERAGE REQUIREMENTS .......................................................... 5-9

5.6

VERIFICATION OF ENROLLMENT ........................................................................................ 9

5.7

MEMBER SERVICES UNIT ........................................................................................................ 9

5.8

ENROLLEE EDUCATION AND INFORMATION ................................................................... 5.8.1 GENERAL REQUIREMENTS ........................................................................................ 5.8.2 ENROLLEE NOTIFICATION/HANDBOOK ................................................................. 5.8.3 ANNUAL INFORMATION TO ENROLLEES ............................................................... 5.8.4 NOTIFICATION OF CHANGES IN SERVICES............................................................ 5.8.5 ID CARD........................................................................................................................... 5.8.6 ORIENTATION ................................................................................................................

5.9

PCP SELECTION AND ASSIGNMENT ..................................................................................... 19 5.9.1 INITIAL SELECTION/ASSIGNMENT........................................................................... 19-20 5.9.2 PCP CHANGES ................................................................................................................ 20-21

5.10

DISENROLLMENT FROM CONTRACTOR’S PLAN ............................................................. 5.10.1 GENERAL PROVISIONS ................................................................................................ 5.10.2 DISENROLLMENT FROM THE CONTRACTOR’S PLAN AT THE ENROLLEE’S REQUEST ................................................................................................ 5.10.3 DISENROLLMENT FROM THE CONTRACTOR’S PLAN AT THE CONTRACTOR’S REQUEST AND REPORTING OF ENROLLEE NONCOMPLIANCE ................................................................................................................. 5.10.4 TERMINATION ...............................................................................................................

9 9-11 11-18 18 18 18-19 19

21 21-22 22-23

23-24 24-25

5.11

TELEPHONE ACCESS ................................................................................................................. 25-27

5.12

APPOINTMENT AVAILABILITY .............................................................................................. 27-28

5.13

APPOINTMENT MONITORING PROCEDURES .................................................................... 28-29

5.14

CULTURAL AND LINGUISTIC NEEDS ................................................................................... 29-31

5.15

ENROLLEE GRIEVANCES AND APPEALS ............................................................................ 5.15.1 GENERAL REQUIREMENTS ........................................................................................ 5.15.2 NOTIFICATION TO ENROLLEES OF GRIEVANCE AND APPEAL PROCEDURES ................................................................................................................. 5.15.3 GRIEVANCE AND APPEAL PROCEDURES ............................................................... 5.15.4 PROCESSING GRIEVANCES AND APPEALS ............................................................ 5.15.5 RECORDS MAINTENANCE ..........................................................................................

5.16

31 31 32 32-33 33-34 34-35

MARKETING ................................................................................................................................. 35 5.16.1 GENERAL PROVISIONS - CONTRACTOR'S RESPONSIBILITIES .......................... 35-40 5.16.2 STANDARDS FOR MARKETING REPRESENTATIVES ........................................... 40-42

ARTICLE SIX: PROVIDER INFORMATION

1-5

6.1

GENERAL ....................................................................................................................................... 1

6.2

PROVIDER PUBLICATIONS ...................................................................................................... 1-2

6.3

PROVIDER EDUCATION AND TRAINING ............................................................................. 2-3

6.4

PROVIDER TELEPHONE ACCESS ........................................................................................... 3-4

6.5

PROVIDER GRIEVANCES AND APPEALS ............................................................................. 4-5

ARTICLE SEVEN: TERMS AND CONDITIONS (ENTIRE CONTRACT)

1-55

7.1

CONTRACT COMPONENTS ...................................................................................................... 1

7.2

GENERAL PROVISIONS ............................................................................................................. 1-4

7.3

STAFFING....................................................................................................................................... 4-6

7.4

RELATIONSHIPS WITH DEBARRED OR SUSPENDED PERSONS PROHIBITED ........ 6-8

7.5

CONTRACTING OFFICER AND CONTRACTOR’S REPRESENTATIVE......................... 8-9

7.6

AUTHORITY OF THE STATE .................................................................................................... 9

7.7

EQUAL OPPORTUNITY EMPLOYER ...................................................................................... 9

7.8

NONDISCRIMINATION REQUIREMENTS ............................................................................. 9-11

7.9

INSPECTION RIGHTS ................................................................................................................. 11

7.10

NOTICES/CONTRACT COMMUNICATION ........................................................................... 12

7.11

TERM ............................................................................................................................................... 12 7.11.1 CONTRACT DURATION AND EFFECTIVE DATE .................................................... 12 7.11.2 AMENDMENT, EXTENSION, AND MODIFICATION ............................................... 12-13

7.12

TERMINATION ............................................................................................................................. 13-15

7.13

CLOSEOUT REQUIREMENTS ................................................................................................... 15-18

7.14

MERGER/ACQUISITION REQUIREMENTS .......................................................................... 19-22

7.15

SANCTIONS ................................................................................................................................... 22-23

7.16

LIQUIDATED DAMAGES PROVISIONS .................................................................................. 7.16.1 GENERAL PROVISIONS .............................................................................................. 7.16.2 MANAGED CARE OPERATIONS, TERMS AND CONDITIONS, AND PAYMENT PROVISIONS.............................................................................................. 7.16.3 TIMELY REPORTING REQUIREMENTS ................................................................... 7.16.4 ACCURATE REPORTING REQUIREMENTS.............................................................

23 23-24 24-25 25 25-30

7.16.5 7.16.6 7.16.7 7.16.8 7.16.8.1 7.16.8.2 7.16.9 7.16.10

TIMELY PAYMENTS TO PROVIDERS ...................................................................... CONDITIONS FOR TERMINATION OF LIQUIDATED DAMAGES ....................... EPSDT & LEAD SCREENING PERFORMANCE STANDARDS .............................. DEPARTMENT OF HEALTH AND HUMAN SERVICES CIVIL MONEY PENALTIES .................................................................................................................... FEDERAL STATUTES .................................................................................................. FEDERAL PENALTIES ................................................................................................. PROVIDER NETWORK COMPLIANCE STANDARDS ............................................ CARE MANAGEMENT COMPLIANCE STANDARDS .............................................

30-31 31-32 32-34 34 34-35 35-36 36-37 37

7.17

STATE SANCTIONS ..................................................................................................................... 37

7.18

APPEAL PROCESS ....................................................................................................................... 37-38

7.19

CONTRACTOR CERTIFICATIONS .......................................................................................... 7.19.1 GENERAL PROVISIONS .............................................................................................. 7.19.2 CERTIFICATION SUBMISSIONS ................................................................................ 7.19.3 ENVIRONMENTAL COMPLIANCE ............................................................................ 7.19.4 ENERGY CONSERVATION ......................................................................................... 7.19.5 INDEPENDENT CAPACITY OF CONTRACTOR ...................................................... 7.19.6 NO THIRD PARTY BENEFICIARIES .......................................................................... 7.19.7 PROHIBITION ON USE OF FEDERAL FUNDS FOR LOBBYING ........................... 7.19.8 CERTIFICATION AND DISCLOSURE OF POLITICAL CONTRIBUTIONS COMPLIANCE WITH N.J.S.A. 19:44A-20.13 ET SEQ ................................................

38 38 38 38 38 39 39 39 39

7.20

REQUIRED CERTIFICATE OF AUTHORITY ........................................................................ 40

7.21

SET-OFF FOR STATE TAXES AND CHILD SUPPORT......................................................... 40

7.22

CLAIMS ........................................................................................................................................... 40

7.23

MEDICARE RISK CONTRACTOR ............................................................................................ 40

7.24

TRACKING AND REPORTING .................................................................................................. 40-42

7.25

FINANCIAL STATEMENTS ........................................................................................................ 42 7.25.1 AUDITED FINANCIAL STATEMENTS ...................................................................... 42 7.25.2 UNAUDITED FINANCIAL STATEMENTS (SAP) ..................................................... 42

7.26

FEDERAL APPROVAL AND FUNDING ................................................................................... 42

7.27

CONFLICT OF INTEREST .......................................................................................................... 42-43

7.28

RECORDS RETENTION .............................................................................................................. 43-44

7.29

WAIVERS ........................................................................................................................................ 44

7.30

CHANGE BY THE CONTRACTOR ........................................................................................... 44

7.31

INDEMNIFICATION..................................................................................................................... 44-46

7.32

INVENTIONS ................................................................................................................................. 46

7.33

USE OF CONCEPTS ...................................................................................................................... 46

7.34

PREVAILING WAGE.................................................................................................................... 46

7.35

DISCLOSURE STATEMENT ....................................................................................................... 46-48

7.36

FRAUD, WASTE AND ABUSE .................................................................................................... 7.36.1 COMPLIANCE PLAN .................................................................................................... 7.36.2 AUDIT ............................................................................................................................. 7.36.3 PROVIDERS ................................................................................................................... 7.36.4 SPECIAL INVESTIGATIONS UNIT............................................................................. 7.36.5 RECOVERIES AND OVERPAYMENTS ...................................................................... 7.36.6 SANCTIONS ................................................................................................................... 7.36.7 COMPLIANCE WITH SECTION 6032 OF THE FEDERAL DEFICIT REDUCTION ACT OF 2005 ..........................................................................................

48-49 49 49-50 50 50-52 52-53 53 54

7.37

EQUALITY OF ACCESS AND TREATMENT/DUE PROCESS ............................................. 54

7.38

CONFIDENTIALITY..................................................................................................................... 54-55

7.39

SEVERABILITY............................................................................................................................. 55

7.40

CONTRACTING OFFICER AND CONTRACTOR’S REPRESENTATIVE......................... 55

ARTICLE EIGHT: FINANCIAL PROVISIONS

1-26

8.1

GENERAL INFORMATION ......................................................................................................... 1

8.2

FINANCIAL REQUIREMENTS ................................................................................................... 8.2.1 COMPLIANCE WITH CERTAIN CONDITIONS .......................................................... 8.2.2 AUDIT REQUIREMENTS............................................................................................... 8.2.3 COMPLIANCE WITH PAYMENT REQUIREMENTS .................................................

8.3

INSURANCE REQUIREMENTS .................................................................................................. 2 8.3.1 INSURANCE CANCELLATION AND/OR CHANGES ................................................ 2 8.3.2 STOP-LOSS INSURANCE .............................................................................................. 2-3

8.4

MEDICAL LOSS RATIO ............................................................................................................... 3 8.4.1 MEDICAL LOSS RATIO STANDARD AND REPORT ................................................ 3-4 8.4.2 MEDICAL LOSS RATIO COMPLIANCE REMITTANCE ........................................... 4-6

8.5

RATE GEOGRAPHIC DISTRICTS, PREMIUM GROUPS, AND SPECIAL PAYMENT PROVISIONS .................................................................................................................................. 8.5.1 RATE GEOGRAPHIC DISTRICTS ................................................................................ 8.5.2 MAJOR PREMIUM GROUPS ......................................................................................... 8.5.2.1 NON-ABD CHILDREN, MEDICAID AND NJ FAMILYCARE A, B & C (
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NJ FamilyCare Managed Care Contract - State of New Jersey

CONTRACT BETWEEN STATE OF NEW JERSEY DEPARTMENT OF HUMAN SERVICES DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES AND _____________________________...

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