Statutes, codes, and regulations
New Jersey Administrative Code
Title 10 - HUMAN SERVICESChapter 58A - ADVANCED PRACTICE NURSE SERVICES
Subchapter 1 - GENERAL PROVISIONS
Section 10:58A-1.3 - Provider participation

N.J. Admin. Code § 10:58A-1.3

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Current through Register Vol. 57, No. 1, January 6, 2025
Section 10:58A-1.3 - Provider participation
(a) In order to participate in the Medicaid/NJ FamilyCare fee-for-service programs as an APN practitioner, the APN shall apply to, and be approved by, the New Jersey Medicaid/NJ FamilyCare fee-for-service program. Application for approval by the New Jersey Medicaid/NJ FamilyCare fee-for-service program as an advanced practice nurse (APN) requires completion and submission of the "Medicaid Provider Application" (FD-20) and the "Medicaid Provider Agreement" (FD-62).
1. The FD-20 and FD-62 may be obtained from and submitted to the DMAHS fiscal agent:

Gainwell Technologies

Provider Enrollment

PO Box 4804

Trenton, New Jersey 08650-4804

2. An applicant may download a copy of the provider application from the fiscal agent's website: www.njmmis.com.
(b) In order to be approved as a Medicaid/NJ FamilyCare fee-for-service participating provider, the APN shall be a registered professional nurse and have a current certification as an APN, pursuant to N.J.A.C. 13:37-7.
1. An out-of-State APN shall have comparable documentation under the applicable state requirements of the state in which the services are provided.
(c) An applicant shall provide a photocopy of the current professional registered nurse license and current APN certification at the time of the application for enrollment.
(d) In addition to the requirements specified in (a) through (c) above, the following requirements shall be met, in accordance with Federal requirements (CMS State Medicaid Manual, Section 4415, "Nurse Practitioner Services").
1. In order to participate in the Medicaid/NJ FamilyCare fee-for-service program as a certified pediatric advanced practice nurse, a pediatric advanced practice nurse shall be licensed at the time of participation in accordance with the standards for pediatric advanced practice nurse established by the New Jersey Board of Nursing, N.J.A.C. 13:37-7.
2. In order to participate in the Medicaid/NJ FamilyCare fee-for-service program as a certified family advanced practice nurse, a family advanced practice nurse shall be licensed at the time of participation in accordance with the standards for family advanced practice nurse established by the New Jersey Board of Nursing, N.J.A.C. 13:37-7.
(e) Upon signing and returning the Medicaid Provider Application, the Provider Agreement, and other enrollment documents to the fiscal agent for the New Jersey Medicaid/NJ FamilyCare fee-for-service programs, the advanced practice nurse (APN) will receive written notification of approval or disapproval. If approved, the APN will be assigned a provider identifier number. The fiscal agent will furnish the provider identifier number and provider number.
(f) In order to participate as a provider of HealthStart services, the APN practicing independently or as part of a group shall be a Medicaid/NJ FamilyCare fee-for-service provider, and shall meet the HealthStart requirements as specified at N.J.A.C. 10:66-3, and at N.J.A.C. 10:58A-3, including the provider participation criteria specified at N.J.A.C. 10:58A-3.3. The APN shall also possess a HealthStart Certificate, issued by the New Jersey Department of Health.
(g) A HealthStart provider shall have a valid HealthStart Provider Certificate. An application for a HealthStart Provider Certificate is available from:

HealthStart Program

New Jersey Department of Health

50 East State Street, PO Box 364

Trenton, New Jersey 08625-0364

N.J. Admin. Code § 10:58A-1.3

Amended by R.2000 d.265, effective 7/3/2000.
See: 32 N.J.R. 1127(a), 32 N.J.R. 2483(a).
Inserted references to NJ KidCare fee-for-service throughout; in (e), added 14 through 17; and in (h), inserted a reference to the HealthStart Program and deleted a reference to the Division of Family Health Services.
Amended by R.2004 d.334, effective 9/7/2004.
See: 36 N.J.R. 312(a), 36 N.J.R. 4136(a).
Amended by R.2004 d.409, effective 11/1/2004.
See: 35 N.J.R. 4977(a), 36 N.J.R. 4968(a).
In (d)2, substituted "advanced practice nurse" for "practice nurse practitioner" following "in accordance with the standards for family".
Amended by R.2005 d.406, effective 11/21/2005.
See: 37 N.J.R. 2329(a), 37 N.J.R. 4445(a).
Deleted (e); recodified former (f)-(h) as (e)-(g).
Amended by R.2011 d.119, effective 4/18/2011.
See: 42 N.J.R. 2890(a), 43 N.J.R. 1015(a).
In the address in (a)1, substituted "Molina Medicaid Solutions" for "Unisys Corporation"; in (c), inserted "professional registered nurse" and "APN"; and in (e), substituted "Molina Medicaid Solutions" for "Unisys" twice.
Amended by 56 N.J.R. 2191(a), effective 11/4/2024