N.J. Admin. Code § 10:52-3.3

Current through Register Vol. 56, No. 8, April 15, 2024

Section 10:52-3.3 - HealthStart provider participation criteria

(a) The following Medicaid/NJ FamilyCare fee-for-service-enrolled provider types shall be eligible to participate as HealthStart providers:

1. Independent clinics;

2. Federally qualified health centers;

3. Hospital outpatient departments;

4. Local health departments;

5. Physician groups; and

6. Certified nurse midwives meeting the New Jersey Department of Health's Improved Pregnancy Outcome criteria.

(b) In addition to New Jersey Medicaid/NJ FamilyCare fee-for-service programs' rules applicable to provider participation, HealthStart providers shall:

1. Sign an Addendum to the New Jersey Medicaid /NJ FamilyCare fee-for-service programs' Provider Agreement;

2. Have a valid HealthStart Provider Certificate for HealthStart Comprehensive Maternity Care, HealthStart Obstetrical Care, HealthStart Health Support Services; and

3. Provide maternity care in accordance with the requirements for issuance of a "HealthStart Certificate," and in accordance with the New Jersey State Department of Health's "HealthStart Comprehensive Maternity Care Services Program Guidelines."

(c) In addition to (a) and (b) above, HealthStart maternity care providers with more than one care site or more than one maternity clinic at the same site that use different staff shall apply for a separate HealthStart Comprehensive Maternity Provider Certificate for each separate clinic. Only those sites which hold a HealthStart Comprehensive Maternity Provider Certificate shall be reimbursed for HealthStart services. Such sites:

1. Shall participate in program evaluation and training activities, including, but not limited to, site monitoring, agency and patient record review, and submission of required summary information on each patient according to the New Jersey Department of Health's "HealthStart Comprehensive Maternity Care Services Program Guidelines"; and

2. May determine presumptive eligibility for New Jersey Medicaid/NJ FamilyCare fee-for-service programs, if approved by the Division of Medical Assistance and Health Services.

(d) In addition to (a) and (b) above, HealthStart pediatric care providers shall participate in program evaluation and training activities including, but not limited to, documentation of outreach and follow-up activities in the patient's record.

(e) A site review may be required to ascertain an applicant's ability to meet the standards for a HealthStart Comprehensive Maternity Provider Certificate and to provide services in accordance with the New Jersey State Department of Health's "HealthStart Comprehensive Maternity Care Services Program Guidelines."

(f) A HealthStart Comprehensive Maternity Provider Certificate shall be reviewed by the New Jersey State Department of Health at least every 18 months from the date of issuance.

(g) An application for a HealthStart Comprehensive Maternity Provider Certificate is available from:

HealthStart Program

New Jersey State Department of Health

PO Box 364

Trenton, NJ 08625-0364

(h) A HealthStart Program Provider Agreement is available from:

Chief, Provider Enrollment Unit

Division of Medical Assistance

and Health Services

Mail Code #9

PO Box 712

Trenton, New Jersey 08625-0712

N.J. Admin. Code § 10:52-3.3

Amended by 50 N.J.R. 1261(a), effective 5/21/2018