New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 61 - INDEPENDENT CLINICAL LABORATORIES
Subchapter 1 - GENERAL PROVISIONS
Section 10:61-1.4 - Requirements for provider participation; general

Universal Citation: NJ Admin Code 10:61-1.4

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

(a) To qualify for participation as a clinical laboratory under the Medicaid/NJ FamilyCare program, the following requirements must be met:

1. Licensure and/or approval by the New Jersey State Department of Health or comparable agency in the state in which the facility is located. This includes meeting certificate of need and licensure requirements, when required, and all applicable laboratory provisions of the New Jersey State Sanitary Code (see N.J.A.C. 8:45);

2. Enrollment as an independent laboratory under the Title XVIII Medicare program (see 42 CFR 493.1 );

3. Meet the requirements of an independent clinical laboratory under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) (see 42 USC 1396(a)(9)) . (See 10:61-2.1(a)5.)

(b) In order to participate in the Medicaid/NJ FamilyCare program as an independent laboratory provider, the following documents shall be submitted to Gainwell Technologies, Provider Enrollment, PO Box 4804, Trenton, NJ 08650-4804:

1. Form FD-20, Medicaid Provider Application Form;

2. Form FD-62, Medicaid Provider Agreement;

3. A copy of CMS 1513, Disclosure of Ownership, Control and Interest Statement;

4. A copy of the Medicare certification; and

5. A copy of the documents to certify the lab meets the CLIA requirements.

(c) The provider will be notified by Gainwell Technologies as to whether their application for participation was approved or disapproved by the Medicaid/NJ FamilyCare Program.

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