N.J. Admin. Code § 10:54-1.4 - Reimbursement based on specialist designation

(a) Reimbursement rates for physician services are differentiated as specialist or non-specialist according to the criteria for specialist designation listed in (b) below.

(b) An applicant for specialist designation by the New Jersey Medicaid/NJ FamilyCare program, except as noted in (c) below, shall be a licensed physician who:

1. Is a diplomate of a specialty board approved by the American Board of Medical Specialties or the Advisory Board of the American Osteopathic Association; or

2. Is currently admissible to the examination administered by a specialty board approved by the American Board of Medical Specialties or the Advisory Board of the American Osteopathic Association, and/or has evidence of completion of an appropriate qualifying residency approved by the American Medical Association or American Osteopathic Association.

(c) For any physician who was an approved physician provider in the New Jersey Medicaid/NJ FamilyCare program with "specialist" status prior to the effective date of the adoption of this chapter, any of the following three criteria are permissible to define the term "specialist":

1. Is a fellow of the appropriate American specialty college or a member of an osteopathic specialty college;

2. Holds an active staff appointment with specialty privileges in a voluntary or governmental hospital which is approved for training in the specialty in which the physician has privileges; or

3. Is recognized in the community as a specialist by his or her peers.

Notes

N.J. Admin. Code § 10:54-1.4

Amended by R.2012 d.124, effective 7/2/2012.
See: 43 N.J.R. 1477(a), 44 N.J.R. 1884(a).
In the introductory paragraph of (b) and of (c), inserted "/NJ FamilyCare"; and in the introductory paragraph of (c), substituted "chapter" for "Chapter" and a colon for a period.