Common use of Provider Network Requirements Clause in Contracts

Provider Network Requirements. When a mobile dental van’s use is associated with health fairs or other one-time events, services will be limited to oral screenings, exams, fluoride varnish, prophylaxis and palliative care to treat an acute condition. State Board regulations must still be followed. The MCO must maintain documentation for all locations served to include schedule of time and days. Multilingual--at a minimum, English and Spanish and any other language which is spoken by 200 enrollees or five percent of the enrolled Medicaid population of the Contractor’s plan, whichever is greater. NCQA--the National Committee for Quality Assurance. Newborn--an infant born to a mother enrolled in a Contractor’s plan at the time of birth. New Jersey State Plan or State Plan--the DHS/DMAHS document, filed with and approved by CMS, that describes the New Jersey Medicaid/NJ FamilyCare program. N.J.A.C.--New Jersey Administrative Code. NJ Choice Assessment System--consists of the interRAI Home Care, Version 9.1 assessment form with NJ specific revisions (NJ Choice), Home Care Clinical Assessment Protocols (CAPS), Home Care case mix categories (RUG-III/HC), and the NJ specific Interim Plan of Care (IPOC) form. This standardized assessment system is used to determine clinical eligibility for MLTSS services pursuant to N.J.A.C. 8:85 NJ FamilyCare Program Eligibility Groups Include:

Provider Network Requirements. When a mobile dental van’s use is associated with health fairs or other one-time events, services will be limited to oral screenings, exams, fluoride varnish, prophylaxis and palliative care to treat an acute condition. State Board regulations must still be followed. The MCO must maintain documentation for all locations served to include schedule of time and days. Multilingual--at a minimum, English and Spanish and any other language which is spoken by 200 enrollees or five percent of the enrolled Medicaid population of the Contractor’s plan, whichever is greater. NCQA--the National Committee for Quality Assurance. Newborn--an infant born to a mother enrolled in a Contractor’s plan at the time of birth. New Jersey State Plan or State Plan--the DHS/DMAHS document, filed with and approved by CMS, that describes the New Jersey Medicaid/NJ FamilyCare program. N.J.A.C.--New Jersey Administrative Code. NJ Choice Assessment System--consists of the interRAI Home Care, Version 9.1 assessment form with NJ specific revisions (NJ Choice), Home Care Clinical Assessment Protocols (CAPS), Home Care case mix categories (RUG-III/HC), and the NJ specific Interim Plan of Care (IPOC) form. This standardized assessment system is used to determine clinical eligibility for MLTSS services pursuant to N.J.A.C. 8:85 NJ FamilyCare Program Eligibility Groups Include: