N.J. Admin. Code § 10:49-2.16

Current through Register Vol. 56, No. 11, June 3, 2024

Section 10:49-2.16 - Validation form (FD-34) Validation of Eligibility

(a) The FD-34 Form, Validation of Eligibility (see Appendix, N.J.A.C. 10:49) identifies a Medicaid beneficiary who resides in a State or county institution.

1. The validation form shall be prepared and completed by the authorized Medicaid representative at the State or County institution. It is valid for the calendar month it is issued (up to a period of 31 days) to a Medicaid beneficiary (patient/resident) in a State or county governmental psychiatric hospital or an intermediate care facility/mental retardation, and is used to obtain Medicaid covered services outside of the institutional setting. The form shall be returned with the Medicaid beneficiary.

2. Form FD-34 requires the signature, title, and telephone number of the authorized representative at the institution.

3. The Medicaid beneficiary or patient of a State or county institution receiving covered health services in the community is identified by the 12-digit Medicaid Eligibility Identification Number in which the first two digits identifies the institution. (See 10:49-2.11(b)2 ).

(b) The New Jersey Medicaid and the NJ FamilyCare programs have designated specific Medical Assistance Customer Centers (MACCs) to handle prior authorization requests for services for patients/residents/beneficiaries from each institution and family care residents/beneficiaries who are under the jurisdiction of the Division of Developmental Disabilities. If the patient/beneficiary's Medicaid or NJ FamilyCare Eligibility Identification Number begins with any of the following numbers, providers shall contact the MACC indicated (for MACC Directory, see Appendix N.J.A.C. 10:49).

31 Morris MACC

32 Burlington MACC

33 Monmouth MACC

34 Camden MACC

35 Middlesex MACC

36 Monmouth MACC

37 Passaic MACC

37 Hudson MACC (Applicable only to 600,000 series)

38 Essex MACC

39 Camden MACC

41 Atlantic MACC

42 Passaic MACC

43 Middlesex MACC

44 Atlantic MACC

45 Burlington MACC

47 Middlesex MACC

48 Middlesex MACC

51 Middlesex MACC--Menlo Park Veterans Home

51 Middlesex MACC--Vineland Veterans Home

90 MACC in county in which beneficiary resides.

N.J. Admin. Code § 10:49-2.16

Amended by R.1997 d.354, effective 9/2/1997.
See: 29 New Jersey Register 2512(a), 29 New Jersey Register 3856(a).
Substituted "beneficiary" for "recipient" or "resident" throughout; in (a)3 and (b), substituted "Medicaid Eligibility Identification Number" for "HSP (Medicaid) Case Number"; in (b), inserted references to beneficiaries, amended MDO references, and inserted the two 51--Middlesex references.
Recodified from N.J.A.C 10:49-2.15 by R.1998 d.116, effective 1/30/1998 (operative February 1, 1998; to expire July 31, 1998).
See: 30 New Jersey Register 713(a).
Former N.J.A.C. 10:49-2.16, Medicaid application, recodified to N.J.A.C. 10:49-2.17.
Adopted concurrent proposal, R.1998 d.426, effective 7/24/1998.
See: 30 New Jersey Register 713(a), 30 New Jersey Register 3034(a).
Readopted provisions of R.1998 d.116 without change.
Amended by R.2003 d.82, effective 2/18/2003.
See: 34 New Jersey Register 2650(a), 35 New Jersey Register 1118(a).