Current through Register Vol. 56, No. 18, September 16, 2024
(a) Any person
applying for Medicaid or NJ FamilyCare-Plan A benefits shall be asked if he or
she has unpaid medical bills incurred within the three-month period immediately
prior to the month of application for Medicaid or NJ FamilyCare-Plan A.
1. Medically Needy applicants (see
10:49-2.3(f) )
shall be evaluated for retroactive eligibility by the county welfare agency
(CWA) when they apply for the Medically Needy program.
2. An applicant for NJ FamilyCare-Plan A
whose application was processed by the Statewide eligibility determination
agency has his or her retroactive eligibility processed by that agency. The
applicant must indicate on his or her NJ FamilyCare-Plan A application that
unpaid medical bills exist in the retroactive period or shall contact the
Statewide eligibility determination agency within six months of his or her
application date for NJ FamilyCare-Plan A.
3. Applicants who applied for Medicaid or NJ
FamilyCare-Plan A at a CWA shall have their retroactive eligibility evaluated
and processed at that CWA when they apply for Medicaid or NJ FamilyCare-Plan A.
If the applicant does not indicate to the CWA that unpaid medical bills exist
at the time of application, the applicant shall provide that information to the
CWA within six months of the date of application. If retroactive eligibility is
not requested from the CWA within six months from the date of application,
retroactive eligibility will not be established.
4. Medicaid or NJ FamilyCare-Plan A
Applicants who applied for Supplemental Security Income (SSI) may complete an
FD-74 Form, Application for Payment of Unpaid Medical Bills (see Appendix,
N.J.A.C. 10:49) and forward the application with required verification and all
outstanding unpaid medical bills to the Medicaid Retroactive Eligibility Unit,
Division of Medical Assistance and Health Services, PO Box 712, Mail Code #10,
Trenton, New Jersey 08625-0712. An application for retroactive eligibility may
be obtained by the applicant, or his or her authorized agent, from the CWA, the
Medical Assistance Customer Center (MACC), the Social Security Administration
District Office, or from the Retroactive Eligibility Unit, Division of Medical
Assistance and Health Services. The application shall be received by the
Retroactive Eligibility Unit within six months from the date of application for
public assistance.
5. Applications
for retroactive unpaid medical bills cannot be processed for services rendered
prior to the effective date of the program. For NJ FamilyCare-Plan A, children
eligible under
10:79-3.4(b), the
effective date is February 1, 1998. For NJ FamilyCare parents, the effective
date is September 6, 2000.
(b) If the Division of Medical Assistance and
Health Services Retroactive Eligibility Unit determines that the person was
eligible for Supplemental Security Income (SSI)/Medicaid at the time the
service was provided, providers shall be notified directly that the unpaid
bills for any service covered by the New Jersey Medicaid program may be
reimbursable in accordance with standard Medicaid reimbursement procedures.
1. The provider shall then complete the
appropriate claim and submit it to the Fiscal Agent for consideration and
authorization of payment within 90 days of the date the provider is notified in
writing of the retroactive eligibility.
2. When the Retroactive Eligibility Unit
approves retroactive eligibility more than one year after the date(s) of
service, the Retroactive Eligibility Unit will send a special notification
letter to the provider. The provider shall attach the original notification
letter to the claim and shall manually submit the claim to the Medicaid fiscal
agent at the address listed on the letter. The claim and the attached letter
must be received by the Medicaid fiscal agent within 90 calendar days of the
date on the special notification letter.
3. For any Medically Needy beneficiary, a
retroactive eligibility determination shall be completed by the CWA (see
10:49-2.3, Persons eligible under
the Medically Needy program).