New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 58A - ADVANCED PRACTICE NURSE SERVICES
Subchapter 1 - GENERAL PROVISIONS
Section 10:58A-1.3 - Provider participation

Universal Citation: NJ Admin Code 10:58A-1.3

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

(a) In order to participate in the Medicaid and NJ FamilyCare fee-for-service programs as an APN practitioner, the APN shall apply to, and be approved by, the New Jersey Medicaid/NJ FamilyCare fee-for-service program. Application for approval by the New Jersey Medicaid/NJ FamilyCare fee-for-service program as an advanced practice nurse (APN) requires completion and submission of the "Medicaid Provider Application" (FD-20) and the "Medicaid Provider Agreement" (FD-62).

1. The FD-20 and FD-62 may be obtained from and submitted to: Molina Medicaid Solutions

Provider Enrollment

PO Box 4804

Trenton, New Jersey 08650-4804

(b) In order to be approved as a Medicaid/NJ FamilyCare fee-for-service participating provider, the APN shall be a registered professional nurse and have a current certification as an APN, pursuant to N.J.A.C. 13:37-7.

1. An out-of-State APN shall have comparable documentation under the applicable state requirements of the state in which the services are provided.

(c) An applicant shall provide a photocopy of the current professional registered nurse license and current APN certification at the time of the application for enrollment.

(d) In addition to the requirements specified in (a) through (c) above, the following requirements shall be met, in accordance with Federal requirements (CMS State Medicaid Manual, Section 4415, "Nurse Practitioner Services").

1. In order to participate in the Medicaid/NJ FamilyCare fee-for-service program as a certified pediatric advanced practice nurse, a pediatric advanced practice nurse shall be licensed at the time of participation in accordance with the standards for pediatric advanced practice nurse established by the New Jersey Board of Nursing, N.J.A.C. 13:37-7.

2. In order to participate in the Medicaid/NJ FamilyCare fee-for-service program as a certified family advanced practice nurse, a family advanced practice nurse shall be licensed at the time of participation in accordance with the standards for family advanced practice nurse established by the New Jersey Board of Nursing, N.J.A.C. 13:37-7.

(e) Upon signing and returning the Medicaid Provider Application, the Provider Agreement and other enrollment documents to Molina Medicaid Solutions, the fiscal agent for the New Jersey Medicaid and NJ FamilyCare fee-for-service programs, the advanced practice nurse (APN) will receive written notification of approval or disapproval. If approved, the APN will be assigned a provider identifier number. Molina Medicaid Solutions will furnish the provider identifier number and provider number.

(f) In order to participate as a provider of HealthStart services, the APN practicing independently or as part of a group shall be a Medicaid/NJ FamilyCare fee-for-service provider, and shall meet the HealthStart requirements as specified at N.J.A.C. 10:66-3, and at N.J.A.C. 10:58A-3, including the provider participation criteria specified in 10:58A-3.3. The APN shall also possess a HealthStart Certificate, issued by the New Jersey Department of Health and Senior Services.

(g) A HealthStart provider shall have a valid HealthStart Provider Certificate. An application for a HealthStart Provider Certificate is available from: HealthStart Program

The New Jersey Department of Health and Senior Services

50 East State Street, PO Box 364

Trenton, New Jersey 08625-0364

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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