Medicaid regulations are, for the most part, regulated by the federal government and all states are required to follow the rules and laws set forth by the federal body in order to receive the funding from the Medicare/Medicaid trust fund. However, these federal regulations don’t restrict the states from instating their own laws and regulations above and beyond the federal requirements.
What this means is that, instead of say a bi-annual licensure requirement to maintain federal standards, a state can require licensure twice as often. They can also make record accessibility more of a priority than what federal requirements ask for and states can also further regulate other aspects of the billing processes that are used after services are rendered to the patient(s).
Unfortunately, this can create more havoc and cause more confusion than those states that choose to abide only by federal regulations. In New Jersey these additional regulations are well defined under Chapters 39-49 of Title 10 of the New Jersey Administration Code. These are the regulation codes regarding public health and the laws and Medicaid regulations that help determine whether a particular practice is in compliance with not only the state laws but also the federal statutes governing the use of the Medicaid and Medicare systems.
While title 10 does contain the bulk of New Jersey’s Medicaid regulatory information that deviates from federal law it is not the only section in the New Jersey penal code that adds stipulations to Medicaid compliance. However, most other laws (those outside of title 10) are simply regulations that are geared to a more specific type of facility or type of care provider. Many of these more secondary regulations are even designed simply to regulate the facility itself. When combined with the federal mandates, the state of New Jersey has created a very thorough system for Medicaid providers and recipients.