N.J. Admin. Code § 10:73-3.7

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:73-3.7 - Processing eligibility applications

(a) All CMO providers shall:

1. Complete a presumptive eligibility (PE) application for each child, youth and young adult who is not otherwise covered under Medicaid/NJ FamilyCare at the time of the referral to the CMO, if the PE process has not already been initiated by another entity;

2. Submit all PE applications to DMAHS;

3. Assure that provider case management staff and other appropriate staff complete DMAHS PE training;

4. Assist the child, youth or young adult and/or his or her family in collecting the documentation required to complete and submit a Medicaid/NJ FamilyCare application within 30 days of enrollment, if this process has not already been initiated by another entity;

5. As family circumstances indicate, review eligibility factors for each beneficiary and assist the beneficiary and/or his or her family in applying for any and all benefits for which they may be eligible, including, but not limited to, Medicaid/NJ FamilyCare; and

6. Assist the beneficiary and/or his or her family in maintaining eligibility for Medicaid/NJ FamilyCare and other benefits.

(b) All records supporting determinations of eligibility or ineligibility made in accordance with this section shall be maintained by the CMO provider and available for audit.

N.J. Admin. Code § 10:73-3.7

Amended by R.2006 d.421, effective 5/21/2007.
See: 38 N.J.R. 2585(a), 39 N.J.R. 2096(a).
Section was "Processing presumptive eligibility applications". Rewrote the section.

Amended by 53 N.J.R. 1492(a), effective 9/7/2021