NJ Medicaid Payment Proposal Violates Federal Law: 3rd Circ. – Law360 (subscription)

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By Ama Sarfo
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Law360, New York (July 09, 2013, 5:48 PM ET) — The Third Circuit ruled Tuesday that a New Jersey Department of Human Services requirement that federally qualified health centers receive payments from managed care organizations before the state processes their Medicaid supplemental payments violates federal law mandating that the supplements are timely and complete.

The circuit court said that while states may rely on MCOs to determine if a claim is Medicaid eligible, New Jersey’s system essentially used MCO payment as a proxy for Medicaid eligibility, which was unfair as MCOs often deny claims for reasons…