New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 50 - TRANSPORTATION SERVICES MANUAL
Subchapter 1 - GENERAL PROVISIONS
Section 10:50-1.17 - Auditing

Universal Citation: NJ Admin Code 10:50-1.17

Current through Register Vol. 56, No. 18, September 16, 2024

(a) The Division may review and evaluate the care and services provided to Medicaid/NJ FamilyCare beneficiaries to ensure that independent transportation providers comply with the provisions of their contracts with the Division and with applicable Federal and State laws, rules, and regulations. Post-service reviews may be on a pre-payment or post-payment basis.

(b) A provider shall comply with a request by the Division for any documentation within three business days. Such documentation shall include, but shall not be limited to: photocopies of licenses, registrations, insurance documents, prior authorization forms, claims, transportation certification forms, complaint logs, and daily log sheets.

(c) At the Division's request, vehicle service and maintenance records shall be made available for immediate on-site inspection by any representative(s) of the Division.

(d) An independent transportation provider shall permit spot checks and on-site inspections for the purpose of monitoring and evaluating the work performed.

(e) An independent transportation provider and its drivers and attendants shall cooperate fully during any spot checks and on-site inspections conducted by representatives of the State of New Jersey for the purpose of inspecting, investigating, monitoring, or otherwise evaluating the work performed under the terms of the Provider Agreement.

(f) The Division, the U.S. Department of Health and Human Services, the General Accounting Office (GAO), the New Jersey Department of Law and Public Safety, and any other Federal, State, county, or local agency with appropriate jurisdiction, or their authorized representative(s), shall, at reasonable times, have the right to enter an independent transportation provider's premises, or such other places where duties under the contract are being performed, to inspect, investigate, monitor, or otherwise evaluate the work being performed and all related financial records.

(g) A transportation provider shall provide reasonable access to all facilities and shall cooperate with any Federal, State, county, and local representative(s) conducting spot checks, on-site inspection visits, audits, and investigations.

(h) Independent transportation providers that provide modified livery transport services shall provide monthly reports to the Division which shall include the following information regarding each modified livery transport service provided:

1. The beneficiary's HBID number;

2. The beneficiary's name;

3. The beneficiary's destination (name of facility and address);

4. The fleet number of the vehicle used;

5. The date and hours of service;

6. The provider-supplied attendant's name; and

7. The driver's name.

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