MedicaidAdministrativeMedium impact
Newsletter Vol. 33, No.20
New Jersey Medicaid·NJ·Eligibility
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
New Jersey is removing contract requirements for MCOs to conduct 72-hour continued stay medical necessity reviews for inpatient admissions and authorize ancillary services when continued stay is denied. This removes administrative burdens on hospitals and MCO plans that were causing increased costs.
Action Required
By January 1, 2024: New Jersey hospitals working with NJ FamilyCare MCOs should update their utilization management workflows to reflect that MCOs are no longer required to conduct 72-hour continued stay reviews or authorize ancillary services for denied continued stays. Review current processes with MCO partners to confirm new procedures.