New Jersey Statutes 26:2J-4.21. HMO to provide continuing nursing home care, certain
Terms Used In New Jersey Statutes 26:2J-4.21
- Contract: A legal written agreement that becomes binding when signed.
- State: extends to and includes any State, territory or possession of the United States, the District of Columbia and the Canal Zone. See New Jersey Statutes 1:1-2
b. If an enrollee is a resident of a skilled nursing facility, continuing care retirement community, or a retirement community which operates a skilled nursing facility on the premises of the community, regardless of whether the health maintenance organization is under contract with the skilled nursing facility or the skilled nursing facility at the continuing care retirement community or retirement community, the enrollee’s primary care physician shall refer the enrollee to the skilled nursing facility or the community’s Medicare-certified skilled nursing unit, as applicable, rather than to a skilled nursing facility separate from the facility or the community of origin, if:
(1) the skilled nursing facility or the continuing care retirement community or retirement community with a skilled nursing facility has the capacity to provide the services the enrollee needs;
(2) the primary care physician, in consultation with the enrollee or a representative of the enrollee’s family, determines that the referral is in the best interest of the enrollee;
(3) the skilled nursing facility or the continuing care retirement community or retirement community with a skilled nursing facility agrees to be reimbursed at the same contract rate negotiated by the health maintenance organization with similar providers for the same services and supplies in the same geographic area; and
(4) the skilled nursing facility or the continuing care retirement community or retirement community with a skilled nursing facility meets all applicable State licensing and certification requirements.
c. For the purposes of this act, “continuing care retirement community” means a continuing care facility operating under a certificate of authority issued by the Department of Community Affairs pursuant to P.L.1986, c.103 (C. 52:27D-330 et seq.), and “retirement community” means a retirement community which is registered with the Department of Community Affairs pursuant to P.L.1977, c.419 (C. 45:22A-21 et seq.).
L.1999, c.332, s.1; amended 2012, c.17, s.272.