§ 30:4D-7vv — Definitions.

New Jersey § 30:4D-7vv

• Jurisdiction: New Jersey
• Title 30: INSTITUTIONS AND AGENCIES

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2. As used in sections 2 through 6 of this act: "Division" means the Division of Medical Assistance and Health Services in the Department of Human Services. "Health care provider" means an individual or entity which, acting within the scope of its licensure or certification, provides a covered service. Health care provider includes, but is not limited to, a physician and other health care professionals licensed pursuant to Title 45 of the Revised Statutes and a hospital and other health care facilities licensed pursuant to Title 26 of the Revised Statutes. "Managed care organization" means a health maintenance organization contracted with the division to provide benefits to Medicaid beneficiaries. "Medicaid" means the program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.). "Medical necessity" or "medically necessary" means the same as those terms are defined in section 4 of P.L.2023, c.296 (C.17B:30-55.3). "Step therapy exception" means the overriding of a step therapy protocol in favor of immediate coverage of the health care provider's selected prescription drug. "Step therapy protocol" means a protocol, policy, or program that establishes the specific sequence in which prescription drugs for a specified medical condition, and medically appropriate for a particular patient, are required to be administered in order to be covered by the division or a managed care organization. L.2025, c.50, s.2.