10:49-20.6 GSHP Services
(a) The following services are covered under the GSHP. Those services in (a)18 through 23 below do not require prior authorization from a PCM.
1. Chiropractic services;
2. Clinical laboratory services;
3. Clinic services at free-standing clinics;
4. Drugs (prescription);
5. EPSDT;
6. Hearing aids;
7. Home health services;
8. Hospital services, including
i. Emergency room service;
(1) True life- or organ-threatening conditions may be treated, with notification to the PCM as soon as possible;
ii. Inpatient hospitalization; and
iii. Outpatient clinic;
9. Medical equipment;
10. Medical supplies;
11. Mental health services including psychologist services: only one mental health service every six months (requires prior authorization by the PCM;
12. Optical appliances;
13. Optometric services;
14. Physician services, including inpatient physician services;
15. Podiatric services;
16. Radiological services;
17. Rehabilitative services (physical therapy, occupational therapy, audiology and speech-language pathology services);
18. Second surgical opinion consultations;
19. Physician fee for routine in-hospital newborn care;
20. Pediatrician attendance at at-risk vaginal deliveries or caesarian sections;
21. Practitioner fee for normal prenatal, delivery and post partum services;
22. Certified nurse midwife services; and
23. Certified nurse practitioner/Clinical nurse specialist.
(b) The following services are non-covered services under the GSHP. Non-covered GSHP services are still available to the GSHP client, outside of the Plan, as long as the beneficiary retains his/her Medicaid eligibility. Such services must be provided in accordance with policies described in the appropriate manual.
1. Dental services;
2. Medical day care;
3. Nursing facility care;
4. Prosthetics and orthotics; and
5. Transportation services.
Amended by R. 1997 d. 354, effective September 2, 1997. See: 29 N.J.R. 2512(a), 29 N.J.R. 3856(a). Added (a)23 and made conforming amendments; and in (b), substituted "beneficiary" for "client".