Current through Register Vol. 56, No. 18, September 16, 2024
(a) Effective July
1, 2006, P.L. 2006, c.
45 and P.L. 2007, c. 111, as amended by
P.L.
2007, c. 336, require
the Division to institute a moratorium on new Medicaid/NJ FamilyCare providers
of chiropractic services, medical supplies except those sold in a pharmacy,
partial care services and podiatry services.
1. Any provider that was not an approved
Medicaid or NJ FamilyCare fee-for-service provider of chiropractic services,
medical supplies except those sold in a pharmacy, partial care services or
podiatry services prior to July 1, 2006 is ineligible to become an approved
fee-for-service provider of such services for Medicaid or NJ FamilyCare, unless
the Division affirmatively determines that the provider's services are
necessary to meet special needs.
2.
Situations not subject to the moratorium for fee-for-service providers of
medical supply services are as follows:
i. A
change of ownership only;
ii. A
change of location only. A provider that has not changed ownership on or after
July 1, 2006, which changes location on or after July 1, 2006, and continues to
operate as a Medicaid or NJ FamilyCare provider at the new location, continues
to provide the same level of services and delivery and meets all applicable
State and Federal rules and regulations; and
iii. Medicare as the primary payer.
Situations in which Medicare is the primary payer and the provider bills for
cross-over claims and wraparound Medicare Part D payments.
(b) Subject to the moratorium set
forth in (a) above, the following provider types shall be eligible to apply to
participate as Medicaid/NJ FamilyCare-Plan A providers:
1. Advanced practice nurses;
2. Case managers;
3. Chiropractors and/or chiropractic
groups;
4. Clinics (independent
outpatient health care facilities);
5. Clinical laboratories;
6. Dentists and/or dentist groups;
7. Hearing aid dealers;
8. Health maintenance organizations/managed
care organizations;
9. Home health
agencies;
10. Homemaker
agencies;
11. Hospices;
12. Hospitals;
i. General;
ii. Psychiatric; and
iii. Special;
13. Local health departments;
14. Nursing facilities, including
intermediate care facilities for the mentally retarded;
15. Medical suppliers;
16. Mental health rehabilitation providers:
i. Residential child care facilities (see
N.J.A.C. 10:77 and 10:127);
ii.
Children's group homes (see N.J.A.C. 10:77 and 10:128);
iii. Psychiatric community residences for
youth (see N.J.A.C. 10:37B and 10:77);
iv. Providers of behavioral assistance
services for children/youth or young adults (see N.J.A.C. 10:77-4);
v. Mobile response agencies (see N.J.A.C.
10:77-6);
vi. Providers of
intensive in-community mental health rehabilitation services (see N.J.A.C.
10:77-5);
vii. Programs for
Assertive Community Treatment (PACT) Agencies/Teams (see N.J.A.C. 10:37J and
10:76); and
viii. Community
residences for mentally ill adults (see N.J.A.C. 10:37A and 10:77A).
17. Medical day care
centers;
18.
Nurse-midwives;
19.
Opticians;
20.
Optometrists;
21.
Orthotists;
22.
Pharmacies;
23. Physicians and/or
physician groups;
24. Podiatrists
and/or podiatric groups;
25.
Prosthetists;
26. Psychologists
and/or psychologist groups;
27.
Residential treatment facilities;
28. Transportation providers; and
29. State and county agencies that have
agreed to provide personal care assistant services.
(c) In order for professional practices to be
eligible to participate in the Medicaid and NJ FamilyCare programs as specific
provider entities, such practices shall comply with all applicable State
licensing statutes and rules governing their ownership and direction.
