N.J. Admin. Code § 10:67-1.3

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:67-1.3 - Conditions of participation

(a) To be approved as a Medicaid/NJ FamilyCare provider by the New Jersey Medicaid/NJ FamilyCare program, the psychologist or psychologist specialist shall:

1. Complete and submit the Medicaid/NJ FamilyCare "Provider Application" (FD-20) and the "Medicaid/NJ FamilyCare Provider Agreement" (FD-62).

i. The documents, referenced at (a)1 above, are located as Forms #8 and #10 in the Appendix of the Administration Chapter (N.J.A.C. 10:49--Appendix) at the end of the chapter, and may be obtained from and submitted to:

Gainwell Technologies

Provider Enrollment

PO Box 4804

Trenton, New Jersey 08650-4804

A provider application can also be requested by calling 609-588-6036 or downloaded from the DMAHS fiscal agent website at njmmis.com.

ii. Provider agreements are approved by the: Chief, Provider Enrollment Unit

Division of Medical Assistance and Health Services

PO Box 712

Trenton, New Jersey 08625-0712

2. To be approved by the New Jersey Medicaid/NJ FamilyCare program as a psychological specialist, the psychological specialist shall enclose with the provider application, documentation that he or she:

i. Is a Diplomate of the American Board of Professional Psychology (Diplomate Qualified); or

ii. Has been notified of admissibility to the examination by the American Board of Professional Psychology (Diplomate Eligible).

(b) If the psychologist is providing psychological services to a Medicaid/NJ FamilyCare recipient residing in a nursing facility (NF), or residential health care facility, or a residential treatment center, these facilities shall be Medicaid/NJ FamilyCare approved facilities.

(c) Upon approval as a psychological services provider, the psychologist shall be assigned a Medicaid/NJ FamilyCare provider number.

(d) In order to be approved as a Medicaid/NJ FamilyCare-participating 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 for "psychologist" or "psychologist specialist" obtained from the NPPES.

(e) 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.

N.J. Admin. Code § 10:67-1.3

Amended by R.1998 d.89, effective 2/17/1998.
See: 29 N.J.R. 4615(a), 30 N.J.R. 734(a).
In (a)1i and ii, updated the address.
Amended by R.2006 d.348, effective 10/2/2006.
See: 38 N.J.R. 2007(a), 38 N.J.R. 4219(b).
Inserted "/NJ FamilyCare" throughout; and deleted (d).

Amended by 53 N.J.R. 2224(a), effective 12/20/2021

Amended by 56 N.J.R. 37(a), effective 1/2/2024