N.J. Admin. Code § 10:90-13.3

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

Section 10:90-13.3 - Obtaining medical services for WFNJ/GA recipients residing in a nursing facility

(a) The county/municipality shall provide the WFNJ/GA recipient residing in a nursing facility with a current validation card or letter which will be utilized to obtain treatment by a Medicaid participating provider/vendor. The agency shall supply a validation card or letter to each WFNJ/GA recipient at time of opening or reopening of the case and monthly thereafter to ensure validity through all periods of assistance eligibility. The size and layout of the validation card or letter are optional. Each card or letter must contain, at a minimum:

1. The name, address, phone number and four-digit municipality code of the agency;

2. The first and last name(s) of the client(s) for whom the card or letter applies;

3. The required six-digit case number and two-digit person number. If the case number does not contain six digits, zeros are to be placed in the front of the case number to accommodate the entry. A two-digit person number (that is, 01, 02, and so forth) must be used to identify the person in the eligible unit for whom the services are to be provided. The person number 01 should be used to reflect the person whose name appears on the case name and person number 02 reflects the person who resides with the case name person in a marital relationship or who represents themselves as a couple to the community;

4. The expiration date;

5. A notice to client as follows: This validation form indicates eligibility for WFNJ/GA benefits and is to be presented to the Medicaid participating provider when you require medical services; and

6. A notice to Medicaid participating provider/vendor as follows: Please complete the appropriate claim form according to Medicaid policies and procedures and forward the claim directly to the Medicaid fiscal agent for claim processing and payment.

(b) Claims for medical services eligible under the WFNJ/GA program shall be processed and paid by the fiscal agent when such services are provided by Medicaid approved providers.

1. When a WFNJ/GA recipient residing in a nursing home requires medical services from a provider and an appropriate clinic is not available to provide such services without charge, the client shall have the opportunity to select a Medicaid participating provider of his or her own choice. A representative of the agency may assist the client in obtaining an appropriate Medicaid participating provider.

N.J. Admin. Code § 10:90-13.3

Amended by R.1998 d.42, effective 1/20/1998.
See: 29 New Jersey Register 3971(b), 30 New Jersey Register 389(a).
Specially recodified from N.J.A.C. 10:90-13.2 and specially amended by R.2000 d.392, effective 9/1/2000 (to expire March 1, 2001).
See: 32 New Jersey Register 3615(a).
In (a), inserted "residing in a nursing facility" in the first sentence of the introductory paragraph; and in (b)1, inserted "residing in a nursing home" in the first sentence. Former N.J.A.C. 10:90-13.3, Travel costs for medical care, specially recodified to N.J.A.C. 10:90-13.4.
Recodified from N.J.A.C. 10:90-13.2 and amended by R.2001 d.42, effective 12/27/2000.
See: 32 New Jersey Register 3615(a), 33 New Jersey Register 564(a).
Former N.J.A.C. 10:90-13.3, Travel costs for medical care, specially recodified to N.J.A.C. 10:90-13.4.