N.J. Admin. Code § 10:50-1.3

Current through Register Vol. 56, No. 23, December 2, 2024

Section 10:50-1.3 - General policies for participation

(a) The approval process for becoming an independent transportation service provider is as follows:

1. Each independent transportation provider must be individually approved for each type of service provided. The Division of Medical Assistance and Health Services, Department of Human Services, in conjunction with the Fiscal Agent for the New Jersey Medicaid/NJ FamilyCare program, must approve each provider before reimbursement can be made to that provider for a transportation service.

i. A transportation broker under contract with the Department of Human Services to provide nonemergency transportation shall require that all transportation professionals contracted with the broker be approved by the Division of Medical Assistance and Health Services.

2. The Provider Application (Form FD-20), Provider Agreement (Form FD-62), and Ownership and Control Interest Disclosure Statement (CMS-1513) may be obtained from the Fiscal Agent for the New Jersey Medicaid/NJ FamilyCare program.

3. A ground ambulance company providing service in New Jersey shall possess a provider license and vehicle license(s) issued by the New Jersey State Department of Health.

i. A potential provider seeking approval to provide ground ambulance service shall forward photocopies of the provider license and vehicle license(s) to the Fiscal Agent for the New Jersey Medicaid/NJ FamilyCare program.

4. The completed provider agreement, disclosure statement, and/or provider application shall be submitted to the Fiscal Agent.

5. Once approved, the applicant will receive the following from the Fiscal Agent: a provider number; a Transportation Services Manual; an initial supply of claim forms; and, if applicable, an initial supply of prior authorization forms.

6. In order to be approved as a Medicaid/NJ FamilyCare-participating independent transportation provider, the applicant shall have a valid National Provider Identifier (NPI) obtained from the National Plan and Provider Enumeration System (NPPES) and a valid taxonomy code obtained from the NPPES.

7. Once approved as a Medicaid/NJ FamilyCare provider, the provider shall remain a provider in good standing by successfully completing provider revalidation when requested by DMAHS.

(b) As a condition of participation, the independent transportation provider shall agree to bill the New Jersey Medicaid/NJ FamilyCare program for services provided by the transportation provider submitting the bill only. If the provider seeks reimbursement for services performed by any other organization or entity, whether a franchise, independent contractor, etc., full disclosure in writing of the financial and organizational arrangement between said entities shall be made to, and approved in advance by, the Division of Medical Assistance and Health Services.

(c) An independently enrolled transportation company's Medicaid/NJ FamilyCare provider ID number shall be cancelled, and Provider Agreement terminated due to inactivity based on a review of the New Jersey Medicaid Management Information System (NJMMIS). Inactivity means no services provided for a period of six months. The effective date of cancellation shall correspond to the company's last service date as reflected in the NJMMIS.

(d) Each independent transportation provider shall maintain a New Jersey business location and a telephone dispatch service. The provider shall notify the Division within five working days of any change of address or telephone number or of any cessation or interruption of service.

(e) Notwithstanding the provisions of any other rule or regulation, the Division of Medical Assistance and Health Services may, at its discretion, provide and reimburse any or all nonemergency medical transportation services by means of a contract or agreement with a single transportation broker or a limited number of transportation brokers on either a Statewide, county-by-county, or other basis. For example, the Division may provide all or some non-emergency medical transportation services Statewide, or in any specific county, through a contract with a single transportation broker. In order to utilize a broker, the Division may also take actions including, but not limited to, terminating existing enrollments of providers, declining to utilize services from enrolled providers, MCOs, or any other entities, and/or declining to enroll new providers, for particular transportation provider types, in particular geographic areas, and/or on any other basis on which a broker is used.

N.J. Admin. Code § 10:50-1.3

Amended by R.1980 d.93, effective 3/1/1980.
See: 12 N.J.R. 21(a), 12 N.J.R. 193(e).
Amended by R.1988 d.262, effective 6/6/1988.
See: 19 N.J.R. 2103(a), 20 N.J.R. 1214(a).
Added new (a); recodified old (a)-(b) as (b)-(c); new (d) added; old (d)-(f) recodified to (e)-(g).
Amended by R.1990 d.592, effective 12/3/1990.
See: 22 N.J.R. 1513(a), 22 N.J.R. 3620(c).
Added and revised various sections setting out General policies for participation.
In (a): revised 1-10, adding new 3i. and new 4i.-iii. Revised subsection (b) and deleted subsections (c)-(e), incorporating requirement into new rule N.J.A.C. 10:50-1.4.
Administrative Correction to (a)4.
See: 23 N.J.R. 63(a).
Amended by R.1991 d.167, effective 4/1/1991.
See: 23 N.J.R. 5(a), 23 N.J.R. 1006(a).
In (a): added 4iv-v; deleted (a)5, recodifying 6-8 as 5-7. Restructured old (a)8 and new 7-9.
Amended by R.1992 d.83, effective 2/18/1992.
See: 23 N.J.R. 3619(a), 24 N.J.R. 610(a).
In (a)3 and (a)3i, added "ground" describing ambulance. Also stylistic revisions.
Amended by R.1992 d.447, effective 11/16/1992.
See: 24 N.J.R. 2517(a), 24 N.J.R. 4264(a).
In (a)4iii: added text on vehicle fleet number requirement. In (a)4iv: added text on Certificate of Insurance requirement. In (a)9: revised to specify those items provider will receive from the Fiscal Agent.
Amended by R.1994 d.402, effective 8/1/1994 (operative August 15, 1994).
See: 26 N.J.R. 1425(a), 26 N.J.R. 3211(b).
Amended by R.1999 d.5, effective 1/4/1999.
See: 30 N.J.R. 3625(a), 31 N.J.R. 58(a).
Inserted references to the NJ KidCare program throughout; and in (a), substituted a reference to Provider Applications for a reference to Medicaid Provider Applications in 2, deleted a reference to invalid coach companies in the introductory paragraph of 3, deleted a reference to invalid coach service in 3i, inserted a new 4, recodified former 4 and 5 as 5 and 6, and substituted a reference to provider numbers for a reference to Medicaid provider numbers in the new 6.
Amended by R.1999 d.370, effective 11/1/1999.
See: 31 N.J.R. 847(a), 31 N.J.R. 3325(a).
In (a)3, deleted a reference to Certificates of Need in the introductory paragraph, and deleted a reference to Certificate of Need approval letters in i.
Administrative change.
See: 32 N.J.R. 708(a).
Amended by R.2002 d.170, effective 6/3/2002.
See: 34 N.J.R. 635(a), 34 N.J.R. 1925(a).
In (a) and (b), substituted "FamilyCare" for "KidCare" throughout; added (c) and (d).
Amended by R.2006 d.213, effective 6/19/2006.
See: 37 N.J.R. 4850(a), 38 N.J.R. 2713(a).
Substituted "CMS-1513" for "HCFA-1513" throughout; added (a)4iii; in (b), substituted "shall agree" for "agrees"; added present (c); recodified existing (c) and (d) as (d) and (e); inserted "Information" in (d)1; substituted "(d)1" for "(c)1" in (e); and added (f).
Amended by R.2010 d.179, effective 8/16/2010.
See: 41 N.J.R. 3886(a), 42 N.J.R. 1898(b).
Added (g).

Amended by 54 N.J.R. 620(b), effective 4/4/2022