Statutes, codes, and regulations
New Jersey Administrative Code
Title 10 - HUMAN SERVICESChapter 73 - CASE MANAGEMENT SERVICES
Subchapter 4 - YOUTH CASE MANAGEMENT YCM SERVICES
Section 10:73-4.3 - Provider enrollment and participation

N.J. Admin. Code § 10:73-4.3

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Current through Register Vol. 56, No. 9, May 6, 2024
Section 10:73-4.3 - Provider enrollment and participation
(a) Prior to enrollment as a Medicaid/NJ FamilyCare provider, any agency applying to render youth case management services shall first be under contract with the Children's System of Care, and licensed by DHS as an approved youth case management provider. Such contract and license shall be in full effect and shall not be currently suspended or terminated.
(b) In order to participate as a Medicaid/NJ FamilyCare/CSOC provider of youth case management services, a provider shall apply to, and be approved by, the New Jersey Medicaid/NJ FamilyCare fee-for-service program as a youth case management provider, in accordance with N.J.A.C. 10:49-3 and this subchapter. Providers who are enrolled as other provider types in the Medicaid/NJ FamilyCare program shall complete a separate application to enroll as a youth case management provider.
1. All applicants shall obtain the Medicaid "Provider Application" (FD-20), the Medicaid "Provider Agreement" (FD-62) and the CMS 1513 form at www.njmmis.com, or from:

Gainwell Technologies

Provider Enrollment

PO Box 4804

Trenton, NJ 08650-4804

2. All applicants shall complete and submit the forms to: Department of Children and Families

PO Box 717

Trenton, NJ 08625-0717

Attn: Director, Division of Child Behavioral Health Services

3. The Director, Children's System of Care, will review the contract status of the applicant and will forward the application, if approved, to the Medicaid/NJ FamilyCare program for further processing.
(c) All YCM provider applicants will receive notification of approval or disapproval of provider status. If approved, the applicant will be enrolled as a Medicaid/NJ FamilyCare provider and will be assigned a Medicaid/NJ FamilyCare provider number for seeking reimbursement for the provision of youth case management services. All approved and enrolled providers will receive a copy of the provider manual and the fiscal agent billing supplement.
(d) If a provider's contract for youth case management services with the Department of Human Services or the Department of Children and Families is in default status or has been suspended or terminated for any reason, or if the provider is no longer approved, or licensed, by the Department of Human Services or the Department of Children and Families, as appropriate, the provider shall immediately be disenrolled as a provider of youth case management services until such time as the contract is renewed or reinstated and the Medicaid/NJ FamilyCare program has been notified by the Department of Human Services or the Department of Children and Families, as appropriate, that the provider should be reinstated as a provider of services.
(e) If a provider receives notification that the provider's contract for youth case management services with the Department of Human Services or the Department of Children and Families is in default status or has been suspended or terminated for any reason, or if the provider is no longer approved, or licensed, by the Department of Human Services or the Department of Children and Families, as appropriate, the provider shall notify the Division of Medical Assistance and Health Services at the address below within 10 business days: Division of Medical Assistance and Health Services

Office of Provider Enrollment

PO Box 712

Trenton, NJ 08625-0712

(f) A provider shall be held liable for recoupment of any monies paid for youth case management services rendered during the time that the provider's contract with the Department of Human Services or the Department of Children and Families, as appropriate, is in default status or has been suspended or terminated or when the provider did not meet other requirements of this subchapter.
(g) Providers of youth case management services shall, at all times, maintain compliance with all applicable State and Federal laws, rules and regulations, including, but not limited to, N.J.A.C. 10:3, 10:37H and 10:49 and this chapter.

N.J. Admin. Code § 10:73-4.3

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 "Provider participation". Rewrote (a); in the introductory paragraph of (b), substituted "N.J.A.C. 10:49-3 and" for "the provisions of"; added (b)1, recodified (c) as (b)2; added (b)3; recodified (d) as (c) and rewrote (c); added new (d) through (f); recodified former (e) as new (g) and rewrote (g); and deleted former (f) through (h).
Amended by 53 N.J.R. 1492(a), effective 9/7/2021