N.J. Admin. Code § 10:49-3.1

Current through Register Vol. 56, No. 19, October 7, 2024

Section 10:49-3.1 - Provider types eligible to participate

(a) Effective July 1, 2006, P.L. 2006, c. 45 and P.L. 2007, c. 111, as amended by P.L. 2007, c. 336, require the Division to institute a moratorium on new Medicaid/NJ FamilyCare providers of chiropractic services, medical supplies except those sold in a pharmacy, partial care services and podiatry services.

1. Any provider that was not an approved Medicaid or NJ FamilyCare fee-for-service provider of chiropractic services, medical supplies except those sold in a pharmacy, partial care services or podiatry services prior to July 1, 2006 is ineligible to become an approved fee-for-service provider of such services for Medicaid or NJ FamilyCare, unless the Division affirmatively determines that the provider's services are necessary to meet special needs.

2. Situations not subject to the moratorium for fee-for-service providers of medical supply services are as follows:

i. A change of ownership only;

ii. A change of location only. A provider that has not changed ownership on or after July 1, 2006, which changes location on or after July 1, 2006, and continues to operate as a Medicaid or NJ FamilyCare provider at the new location, continues to provide the same level of services and delivery and meets all applicable State and Federal rules and regulations; and

iii. Medicare as the primary payer. Situations in which Medicare is the primary payer and the provider bills for cross-over claims and wraparound Medicare Part D payments.

(b) Subject to the moratorium set forth in (a) above, the following provider types shall be eligible to apply to participate as Medicaid/NJ FamilyCare-Plan A providers:

1. Advanced practice nurses;

2. Case managers;

3. Chiropractors and/or chiropractic groups;

4. Clinics (independent outpatient health care facilities);

5. Clinical laboratories;

6. Dentists and/or dentist groups;

7. Hearing aid dealers;

8. Health maintenance organizations/managed care organizations;

9. Home health agencies;

10. Homemaker agencies;

11. Hospices;

12. Hospitals;

i. General;

ii. Psychiatric; and

iii. Special;

13. Local health departments;

14. Nursing facilities, including intermediate care facilities for the mentally retarded;

15. Medical suppliers;

16. Mental health rehabilitation providers:

i. Residential child care facilities (see N.J.A.C. 10:77 and 10:127);

ii. Children's group homes (see N.J.A.C. 10:77 and 10:128);

iii. Psychiatric community residences for youth (see N.J.A.C. 10:37B and 10:77);

iv. Providers of behavioral assistance services for children/youth or young adults (see N.J.A.C. 10:77-4);

v. Mobile response agencies (see N.J.A.C. 10:77-6);

vi. Providers of intensive in-community mental health rehabilitation services (see N.J.A.C. 10:77-5);

vii. Programs for Assertive Community Treatment (PACT) Agencies/Teams (see N.J.A.C. 10:37J and 10:76); and

viii. Community residences for mentally ill adults (see N.J.A.C. 10:37A and 10:77A).

17. Medical day care centers;

18. Nurse-midwives;

19. Opticians;

20. Optometrists;

21. Orthotists;

22. Pharmacies;

23. Physicians and/or physician groups;

24. Podiatrists and/or podiatric groups;

25. Prosthetists;

26. Psychologists and/or psychologist groups;

27. Residential treatment facilities;

28. Transportation providers; and

29. State and county agencies that have agreed to provide personal care assistant services.

(c) In order for professional practices to be eligible to participate in the Medicaid and NJ FamilyCare programs as specific provider entities, such practices shall comply with all applicable State licensing statutes and rules governing their ownership and direction.

N.J. Admin. Code § 10:49-3.1

Amended by R.1997 d.354, effective 9/2/1997.
See: 29 N.J.R. 2512(a), 29 N.J.R. 3856(a).
Inserted new (a)1; recodified former (a)1 through 25 as (a)2 through 26; in (a)7, inserted reference to managed care organizations.
Amended by R.1998 d.116, effective 1/30/1998 (operative February 1, 1998; to expire July 31, 1998).
See: 30 N.J.R. 713(a).
In (a), inserted a reference to NJ KidCare--Plan A in the introductory paragraph.
Amended by R.1998 d.143, effective 3/16/1998.
See: 29 N.J.R. 543(a), 30 N.J.R. 1081(a).
In (a), inserted a new 12, and recodified former 12 through 26 as 13 through 27.
Adopted concurrent proposal, R.1998 d.426, effective 7/24/1998.
See: 30 N.J.R. 713(a), 30 N.J.R. 3034(a).
Readopted provisions of R.1998 d.116 without change.
Amended by R.2000 d.309, effective 8/7/2000.
See: 32 N.J.R. 1342(a), 32 N.J.R. 2900(a).
In (a), inserted a new 1, and recodified former 1 through 27 as 2 through 28.
Amended by R.2001 d.144, effective 5/7/2001.
See: 32 N.J.R. 4387(a), 33 N.J.R. 1378(b).
Inserted new (a)16 and recodified former (a)16 through 28 as new (a)17 through 29.
Amended by R.2003 d.82, effective 2/18/2003.
See: 34 N.J.R. 2650(a), 35 N.J.R. 1118(a).
Added (b).
Amended by R.2003 d.89, effective 3/3/2003.
See: 34 N.J.R. 1593(a), 35 N.J.R. 1281(a).
Rewrote (a)16.
Amended by R.2003 d.479, effective 12/15/2003.
See: 35 N.J.R. 2146(a), 35 N.J.R. 5584(a).
In (a)16, inserted a new iv and recodified former iv as new v.
Amended by R.2004 d.8, effective 1/5/2004.
See: 35 N.J.R. 2620(a), 35 N.J.R. 4204(a), 36 N.J.R. 189(a).
In (a)16, added vi.
Amended by R.2005 d.68, effective 2/22/2005.
See: 36 N.J.R. 379(a), 37 N.J.R. 659(a).
In (a), added 16v, recodified existing v to vi as vi to vii.
Amended by R.2005 d.98, effective 4/4/2005.
See: 36 N.J.R. 1158(a), 37 N.J.R. 1022(a).
In (a), added a new vi, recodified existing vi, vii as vii, viii in 16.
Amended by R.2007 d.238, effective 8/6/2007.
See: 39 N.J.R. 1388(a), 39 N.J.R. 3377(a).
Added new (a), recodified former (a) and (b) as (b) and (c); and in the introductory paragraph of (b), substituted "Subject to the moratorium set forth in (a) above, the" for "The" and inserted "apply to".
Amended by R.2008 d.230, effective 8/4/2008.
See: 40 N.J.R. 984(a), 40 N.J.R. 4531(a).
Added new (b)1; recodified former (b)1 as new (b)2; and deleted former (b)2.
Amended by R.2008 d.277, effective 9/15/2008.
See: 40 N.J.R. 2186(a), 40 N.J.R. 5238(a).
In the introductory paragraph of (a), substituted "and P.L. 2007, c. 111, as amended by P.L. 2007, c. 336, require" for "requires"; in the introductory paragraph of (a) and in (a)1, inserted "except those sold in a pharmacy" and deleted ", pharmaceutical services" following "partial care services"; and in the introductory paragraph of (a)2, deleted "pharmacy services or" preceding "medical".