N.J. Admin. Code § 10:55-1.3

Current through Register Vol. 56, No. 12, June 17, 2024

Section 10:55-1.3 - Requirements for approval as a provider of prosthetic and orthotic services

(a) In order to be a fully approved New Jersey Medicaid and NJ FamilyCare fee-for-service provider of prosthetic and orthotic services, the applicant shall:

1. Submit a completed application (see 10:49-3.2 ) together with a copy of the facility and personnel accreditation/certification by the American Board for Certification in Orthotics, Prosthetics and Pedorthics. (The applicant may be applying for either orthotics or prosthetics or both); and

2. Meet the following criteria:

i. Appliances shall be fabricated in the facility and not sent out to another facility;

ii. The facility shall employ personnel (owner and/or employee(s)) certified in the field of specialty of the appliance(s) being produced by that facility; and

iii. Facilities and their qualified personnel shall maintain current accreditation/certification by the American Board for Certification in Orthotics, Prosthetics and Pedorthics, Incorporated.

(b) In order to be granted "provisional" approval by the New Jersey Medicaid and NJ FamilyCare fee-for-service programs, facilities and/or personnel whose application for accreditation/certification is pending with the American Board for Certification in Orthotics, Prosthetics and Pedorthics, Incorporated, the applicant shall:

1. Submit a letter requesting "provisional" provider status together with a copy of the American Board for Certification in Orthotics, Prosthetics and Pedorthics, Incorporated accreditation/certification acceptance letter; and

2. Meet the following criteria:

i. Appliances shall be fabricated in the facility and not sent out to another facility;

ii. The facility may be noncertified and may employ certified or noncertified personnel (owner and/or employee(s)).

(c). "Provisional" status shall be approved for a period of one year commencing with the date of the letter of acceptance by the American Board for Certification in Orthotics, Prosthetics and Pedorthics, Incorporated, and shall expire, without further notification, if certification has not been obtained.

(d) If a certified facility loses its certified prosthetist(s), orthotist(s) and/or pedorthist(s), the fiscal agent shall be notified within five working days of the loss. A grace period of 180 days from the date of such loss shall be granted for demonstrating recertification before provider eligibility is terminated. In the interval between the loss and recertification of personnel, the minimum requirement for continuing acceptable Medicaid and NJ FamilyCare fee-for-service provider eligibility is that fabricated appliances must be fabricated by personnel whose board eligibility is established.

N.J. Admin. Code § 10:55-1.3

Amended by R.2000 d.134, effective 4/3/2000.
See: 31 N.J.R. 3964(a), 32 N.J.R. 1206(a).
Substituted references to Medicaid and NJ KidCare fee-for-service providers for references to providers and inserted references to the Board of Certification in Pedorthics throughout; and in (b), substituted a reference to Medicaid and NJ KidCare fee-for-service programs for a reference to programs in the introductory paragraph.
Amended by R.2004 d.406, effective 11/1/2004.
See: 35 N.J.R. 4417(a), 36 N.J.R. 4963(a).
Amended by R.2011 d.080, effective 3/7/2011.
See: 42 N.J.R. 2179(a), 43 N.J.R. 622(a).
In (a)1, (a)2iii, the introductory paragraph of (b) and in (b)1, substituted a comma for "and" following "Orthotics" and inserted "and Pedorthics"; in (a)1 and (b)1, substituted "; and" for "and:"; in (a)2ii, inserted "and" at the end; deleted (a)2ii(1); in (a)2iii, deleted "or the Board for Certification in Pedorthics, as appropriate" following "Incorporated"; recodified former (b)3 and (c) as (c) as (d); and in (c), substituted a comma for "and" following "Orthotics", inserted "and Pedorthics", and deleted "or the Board for Certification in Pedorthics, as appropriate" following "Incorporated".