Current through Register Vol. 56, No. 24, December 18, 2024
(a) A pharmacy with
a retail or institutional permit may participate in the Medicaid or NJ
FamilyCare program as a provider of pharmaceutical services and as a medical
supplier providing medical supplies and durable medical equipment and as a
provider of parenteral nutrition or intravenous therapy. The requirements for
approval as a provider of these services are listed in (b) through (d)
below.
(b) To be approved as a
provider of pharmaceutical services, the pharmacy shall:
1. Operate under a valid retail and/or
institutional permit issued by the Board of Pharmacy of the State of New Jersey
or by the board of pharmacy of the state in which the pharmacy is located. A
pharmacy operating under an out-of-State institutional permit and applying for
approval as a retail pharmacy may not participate as an approved provider in
the Medicaid or NJ FamilyCare program; and
2. File an application and sign an agreement
with the Division of Medical Assistance and Health Services.
i. Upon sale or other change of ownership of
an approved pharmacy, the agreement is automatically terminated. To execute a
new agreement to participate in the Medicaid and NJ FamilyCare programs, the
new owner(s) shall apply to the Division of Medical Assistance and Health
Services, Department of Human Services, by contacting the Provider Enrollment
Unit (see N.J.A.C. 10:49, Administration Chapter, Enroll ment
Process) or the fiscal agent Provider Enrollment Unit (see Appendix D, Fiscal
Agent Billing Supplement).
(c) To enroll as a Medicaid and NJ FamilyCare
provider of pharmaceutical services, a pharmacy shall contact the fiscal agent
Provider Enrollment Unit.
(d) A
pharmacy may also apply to the Division to participate as a medical supplier.
The Medical Supplier chapter, N.J.A.C. 10:59, available from
the fiscal agent, provides information concerning the provision of and
reimbursement for covered medical supplies and durable medical equipment
provided by a medical supplier.
1. A pharmacy
may apply to participate as a medical supplier by contacting the Provider
Enrollment Unit or the fiscal agent Provider Enrollment Unit.
(e) Requirements for approval as a
provider of parenteral nutrition and/or intravenous therapy are as follows:
1.In addition to the requirements for
approval as a pharmacy provider listed in this section, a pharmacy that
supplies parenteral nutrition and/or intravenous therapy shall:
i. Comply with all the requirements of
N.J.A.C. 13:39; or
ii. Comply with similar applicable
requirements of the state in which the applicant is located and submit a copy
of the requirements of that state when applying for participation.
2. Parenteral nutrition and/or
intravenous therapy may be provided by either a pharmacy/medical supplier or a
medical supplier approved to provide these services by the Medicaid and NJ
FamilyCare program; however, billing for the ancillary supplies associated with
parenteral nutrition and/or intravenous therapy are subject to the requirements
of the Medical Supplier Chapter (
N.J.A.C. 10:59).
i. "Ancillary supplies" means medical
supplies and/or durable medical equipment which are medically necessary to
facilitate administration of parenteral or intravenous therapy.
