New Jersey § 30:4d-7ss

necessary to secure federal financial participation for State Medicaid expenditures.> a. As used in this section: “ Division ” means the Division of Medical Assistance and Health Services in the Department of

Human Services. “ Local education agency ” means a public authority legally constituted by the State as an administrative agency

to provide control of and direction for kindergarten through grade 12 public educational

institutions. “ Medicaid ” means the program established pursuant to P.L.1968, c. 413 ( C.30:4D-1 et seq. ). b. The division, or a managed care organization contracted with the division to provide

benefits to Medicaid beneficiaries, shall reimburse a local education agency for behavioral

health services covered under Medicaid, delivered in-person or via telehealth, and

provided to a student who is an eligible Medicaid beneficiary. Services provided under this subsection shall be: (1) reimbursable by Medicaid regardless of the following: whether the student participates

in an Individualized Education program, 504 Accommodation Plan, Individualized Health

Care Plan, or Individualized Family Service Plan; or whether the covered services

are provided at no charge to the student; and (2) provided by a licensed medical practitioner approved as a Medicaid provider or

a local education agency approved as a Medicaid provider. c. Any local education agency claiming reimbursement under this section shall take

all reasonable measures to ascertain and pursue any claims for reimbursement for services

under this section against legally liable third parties in accordance with section

1902(a)(25) of the federal Social Security Act ( 42 U.S.C.s.1396a(a)(25) ). If there is no response to a claim submitted by a local educational agency to a

legally liable third party within 45 days, the local educational agency may bill Medicaid. The local educational agency shall retain a copy of the claim submitted to the legally

liable third party for a period of three years. d. A local education agency shall utilize Medicaid reimbursement payments issued under

this section to provide behavioral health services for students and their families. e. The provisions of this section shall not be construed to: (1) prohibit a Medicaid beneficiary from receiving behavioral health services covered

under Medicaid from a Medicaid provider who is not a local education agency, provided

that the services provided comply with all State and federal laws and regulations;

and (2) require Medicaid reimbursement for behavioral health services covered under Medicaid

provided to a Medicaid beneficiary by a local education agency in tandem with duplicative

behavioral health services provided by another approved Medicaid provider located

in the community to the same beneficiary, to the extent that State or federal law

or regulation prohibit the provision of such duplicative services. f. The division, in conjunction with the Department of Education and the Department

of the Treasury, shall assist a local education agency in implementing a plan to submit

Medicaid claims for covered behavioral health services and obtain Medicaid reimbursements

under this section. To the extent possible, this system shall overlap with the claims, reimbursement,

and administrative procedures associated with the Special Education Medicaid Initiative

as a means to streamline all school-based Medicaid claims, which system shall include

the requirement for a local education agency to obtain parental or guardian consent

prior to billing Medicaid for any service provided under this section. A local education agency may enter into an agreement with one or more other local

education agencies in the State for the purposes of contracting with a third-party

entity to process and submit Medicaid claims for covered behavioral health services

provided under this section.