New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 53A - HOSPICE SERVICES MANUAL
Subchapter 2 - PROVIDER REQUIREMENTS
Section 10:53A-2.1 - Hospice enrollment requirements and billing processes

Universal Citation: NJ Admin Code 10:53A-2.1

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

(a) To be approved by the Division as a hospice provider, a hospice must:

1. Be licensed by the Department of Health and Senior Services as a provider of hospice services in accordance with N.J.A.C. 8:42C. A copy of the license must be submitted to the Division of Medical Assistance and Health Services;

2. Be enrolled as a Medicare (Title XVIII) hospice provider. A copy of the Medicare provider enrollment agreement must be submitted to the Division of Medical Assistance and Health Services;
i. As stated in the Social Security Act, Section 1861(d)(d)(2)(A)(ii) (42 U.S.C. § 1395x(dd)) on Medicare certification, the term "hospice program" means a public or private organization which provides for such care in individuals' homes, on an outpatient basis, and on a short-term inpatient basis. Thus, a Medicare certified hospice shall not limit or market hospice services exclusively to a long term care facility population; and

3. Complete and submit the Medicaid "Provider Application" (FD-20); "Ownership and Controlling Interest Statement" (CMS-1513); and the "Medicaid Provider Agreement" (FD-62).
i. Documents specific to provider enrollment, referenced in (a)3 above, are located as Forms #8, #9, and #10 in the Appendix of the Administration chapter (N.J.A.C. 10:49--Appendix), and may be obtained from and submitted to:

Molina Medicaid Solutions

Provider Enrollment

PO Box 4804

Trenton, New Jersey 08650-4804

ii. Hospice provider agreements are approved by:

Molina Medicaid Solutions

Provider Enrollment

PO Box 4804

Trenton, New Jersey 08650-4804

iii. A change in the ownership of a hospice is not considered a change in the individual's designation of a hospice and requires no action on the Medicaid/NJ FamilyCare FFS hospice beneficiary's part. The hospice shall notify the Division in writing of a change in ownership and shall submit a new application package.

(b) If the hospice is providing hospice services to a Medicaid/NJ FamilyCare FFS beneficiary residing in a nursing facility (NF), the nursing facility must be a Medicaid/NJ FamilyCare FFS-approved nursing facility. The hospice must also have a written contract with the nursing facility under which the hospice takes full responsibility for the professional management of the individual's hospice services and the nursing facility agrees to provide room and board services to the individual.

1. Room and board services include the performance of personal care services, assistance in activities of daily living, provision of patient social activities, the administration of medications, the maintenance of the cleanliness of a resident's room, and supervision and assistance in the use of durable equipment and prescribed therapies provided to hospice beneficiaries in an NF (identical to those provided to non-hospice beneficiaries in an NF).

(c) If the hospice is already a Medicaid ACCAP hospice provider, in lieu of the process listed in (a) above, the hospice shall send a letter citing its ACCAP provider status to the Provider Enrollment Unit of the Division whose address is listed in (a)2ii above, requesting approval as a hospice provider of room and board services and/or as a provider of the comprehensive hospice benefit.

(d) Upon approval as a hospice provider, the hospice shall be assigned a provider number. In the event the hospice provider is also an ACCAP hospice provider, the hospice provider number will be the same for both programs.

(e) For the purposes of reimbursement, if a physician provides direct patient care services to a hospice beneficiary he or she must be an approved Medicaid/NJ FamilyCare FFS physician provider (see Physician Services chapter, N.J.A.C. 10:54).

(f) The fiscal agent shall furnish a provider manual to the hospice enrolled as a Medicaid/NJ FamilyCare FFS provider.

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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