State Overview: New Jersey

State law or statute prohibits or limits the use of prior authorization for buprenorphine containing products by either the state Medicaid plan or private insurance companies.

The benefits for outpatient prescription drugs to treat substance use disorder shall be provided when determined medically necessary by the covered person's physician, psychologist or psychiatrist without the imposition of any prior authorization or other prospective utilization management requirements. N.J. Stat. Ann. §17B:26-2.1hh(i)

Medicaid must cover methadone, buprenorphine, naltrexone, combination buprenorphine/naloxone medications and other FDA-approved medications if approved by the Dept. of Human Services, without prior authorization. N.J. Stat. Ann. §30:4D-6m

New Jersey credentials two types of addiction counselors. A Certified Alcohol and Drug Counselor requires a bachelor's degree, 270 hours of relevant education courses and 3,000 hours of supervised experience. A Licensed Clinical Alcohol and Drug Counselor requires a master's degree, 270 hours of relevant education courses and 3,000 hours of supervised experience. N.J. Rev. Stat. §45:2D and Addiction Professionals Certification Board of New Jersey

A licensed professional counselor provides services to an individual or group through a counseling relationship to develop an understanding of interpersonal and intrapersonal problems and to plan and act on a course of action to restore optimal functioning to that individual or group. Diagnostic ability is not outlined in statute. N.J. Stat. Ann. §45:8B-36

The standards for the certification of peer recovery specialists, including experience, training, and supervision requirements, are developed and administered by a third-party, non-profit certification provider.

Physician relationship required.

A) Certified nurse midwife and certified midwife practice shall include the provision of maternity care and well woman care within a health care system which provides for consultation, referral and collaboration, and:

1. For licensees without prescriptive authority, administering or dispensing those medications listed in the clinical guidelines; or
2. For licensees with prescriptive authority pursuant to N.J.A.C. 13:35-2A.14, prescribing, ordering, administering or dispensing medications.

B) Certified nurse midwives and certified midwives shall conduct their practice pursuant to standards set forth by the ACNM in Standards for the Practice of Midwifery 2003, as amended and supplemented, available from the American College of Nurse-Midwives.

CONSULTING PHYSICIANS; CLINICAL GUIDELINES

Prior to beginning practice as a midwife, a licensee shall enter into a consulting agreement with a physician who is licensed in New Jersey and who:

1. Holds hospital privileges in operative obstetrics/gynecology;
2. Has a binding agreement with a physician who holds operative privileges in operative obstetrics/gynecology; or
3. Holds hospital privileges in gynecology, if a licensee limits his or her practice to nonobstetrical.

The licensee shall establish written clinical guidelines with the consulting physician which outlines the licensee's scope of practice.

The clinical guidelines shall set forth:

1. An outline of routine care;
2. Procedures the licensee will perform or provide;
3. Procedures to follow if one of the risk factors from N.J.A.C. 13:35-2A.9 and 2A.11 is encountered;
4. The circumstances under which consultation, collaborative management, referral and transfer of care of women between the licensee and the consulting physician are to take place, and the manner by which each is to occur;
5. If the licensee is a certified nurse midwife with prescriptive authority pursuant to N.J.A.C. 13:35-2A.12, a formulary listing the categories of drugs, which may include controlled dangerous substances, the certified nurse midwife may order, prescribe, administer or dispense;
6. If the licensee does not hold prescriptive authority pursuant to N.J.A.C. 13:35-2A.14, a list of all medications the licensee may dispense or administer pursuant to the directions of the consulting physician;
7. A mechanism for determining the availability of the consulting physician, or a substitute physician, for consultation and emergency assistance or medical management when needed; and
8. The manner by which emergency care for newborns will be provided.

N.J. Admin. Code §13:35-2A.5; N.J. Admin. Code §13:35-2A.6

Full independent practice but physician relationship required to prescribe.

a. In addition to all other tasks which a registered professional nurse may, by law, perform, an advanced practice nurse (APN) may manage preventive care services and diagnose and manage deviations from wellness and long-term illnesses, consistent with the needs of the patient and within the scope of practice of the advanced practice nurse, by:

1. initiating laboratory and other diagnostic tests;
2. prescribing or ordering medications and devices, as authorized by subsections b and c of this section;
3. prescribing or ordering treatments, including referrals to other licensed health care professionals and performing specific procedures in accordance with the provisions of this subsection.

b. An advanced practice nurse may order medications and devices in the inpatient setting, subject to the following conditions:

1. the collaborating physician and APN shall address in the joint protocols whether prior consultation with the collaborating physician is required to initiate an order for a controlled dangerous substance;
2. the order is written in accordance with standing orders or joint protocols developed in agreement between a collaborating physician and the APN, or pursuant to the specific direction of a physician;
3. the APN authorizes the order by signing the nurse's own name, printing the name and certification number and printing the collaborating physician's name;
4. the physician is present or readily available through electronic communications;
5. the charts and records of the patients treated by the APN are reviewed by the collaborating physician and the APN within the period of time specified by the rule adopted by the commissioner of health.
6. the joint protocols developed by the collaborating physician and the APN are reviewed, updated, and signed at least annually by both parties; and
7. the advanced practice nurse has completed six contact hours of continuing professional education in pharmacology related to controlled substances, including pharmacologic therapy, addiction prevention and management, and issues concerning prescription opioid drugs, including responsible prescribing practices, alternatives to opioids for managing and treating pain, and the risks and signs of opioid abuse, addiction, and diversion, in accordance with regulations adopted by the New Jersey Board of Nursing. The six contact hours shall be in addition to New Jersey Board of Nursing pharmacology education requirements for advanced practice nurses related to initial certification and recertification of an advanced practice nurse

An advanced practice nurse may prescribe medications and devices in all other medically appropriate settings if certain conditions are met. N.J. Stat. Ann. §45:11-49(c)

NPs are authorized to sign POLST forms. N.J. Rev. Stat. §26:2H-131

NPs are recognized in state policy as a primary care provider. Primary care provider includes the following licensed individuals: physicians, physician assistants, advanced practice nurses and nurse midwives whose professional practice involves the provision of primary care, including internal medicine, family medicine, geriatric care, pediatric care or obstetrical/gynecological care. N.J. Rev. Stat. §30:4D-8.2

Optometrists may only perform procedures related to foreign body removal and the examination, evaluation, diagnosis and treatment of the human eye. N.J. Rev. Stat. §45:12-1

Optometrists may use injections to counter anaphylactic reactions as well as the administration of the COVID-19 vaccine. N.J. Rev. Stat. §45:12-1 and N.J. Rev. Stat. §45:12-1.1

Optometrists may prescribe Schedule III-V controlled substances and also Schedule II hydrocodone or hydrocodone combination medications. N.J. Rev. Stat. §45:12-9.11 and N.J. Admin. Code §13:38-2.4(h)

New Jersey does not allow dental hygienists to practice with direct access.

Statute does not identify dental therapists as an oral health provider.

New Jersey does not explicitly allow for the practice of teledentistry.

New Jersey has not enacted legislation allowing pharmacists to administer the COVID-19 vaccine. However, the federal PREP Act allowed pharmacists to administer the COVID-19 vaccine through the duration of the public health emergency.

New Jersey does not allow pharmacists to modify prescriptions.

New Jersey allows pharmacists to prescribe hormonal contraceptives.

A pharmacist shall be authorized to furnish self-administered hormonal contraceptives to a patient, in accordance with standardized procedures and protocols to be jointly developed and approved by the Board of Pharmacy and the State Board of Medical Examiners. Pharmacists will need to complete a training program, administer a questionnaire developed by the Department of Health to the patient informing them of any risks associated with self-administered hormonal contraceptives and offer to provide counseling. N.J. Stat. Ann. §45:14-67.9

New Jersey does not allow pharmacists to prescribe tobacco cessation aids.

Supervision by a physician required for practice and prescriptive authority.

The PA performs medical services within the PA's education, training and experience under the supervision of a physician. N.J. Stat. Ann. §45:9-27.15(a)(1) and (2)

A PA may order, prescribe, dispense and administer medications and medical devices and issue written instructions to registered qualifying patients for medical cannabis to the extent delegated by a supervising physician. A supervising physician may authorize a PA to order or prescribe Schedule II, III, IV or V controlled dangerous substances. N.J. Stat. Ann. §45:9-27.19

Statute limits the number of PAs a physician may supervise.

The supervisory ratio shall be no more than four PAs to one physician at any one time. N.J. Admin. Code §13:35-2B.10(c)

Chart co-signatures may be determined at the practice level.

The delegation agreement shall include, but need not be limited to, the following provisions: A determination of whether the supervising physician requires personal review of all charts and records of patients and countersignature by the supervising physician of all medical services performed under the delegation agreement, including prescribing and administering medication. N.J. Stat. Ann. §45:9-27.17

Statute allows adaptable proximity.

A PA shall be under the supervision of a physician at all times during which the PA is working in an official capacity. Supervision of a PA shall be continuous but shall not be construed as necessarily requiring the physical presence of the supervising physician, provided that the supervising physician and PA maintain contact through electronic, or other means of, communication. N.J. Stat. Ann. §45:9-27.18

A PA may perform duties and responsibilities delegated by the supervising physician when the service is within the PA's skills and under supervision. N.J. Rev. Stat. §45:9-27.16