New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 73 - CASE MANAGEMENT SERVICES
Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES
Section 10:73-3.7 - Processing eligibility applications
Universal Citation: NJ Admin Code 10:73-3.7
Current through Register Vol. 56, No. 18, September 16, 2024
(a) All CMO providers shall:
1. Complete a presumptive
eligibility (PE) application for each child, youth and young adult who is not
otherwise covered under Medicaid/NJ FamilyCare at the time of the referral to
the CMO, if the PE process has not already been initiated by another
entity;
2. Submit all PE
applications to DMAHS;
3. Assure
that provider case management staff and other appropriate staff complete DMAHS
PE training;
4. Assist the child,
youth or young adult and/or his or her family in collecting the documentation
required to complete and submit a Medicaid/NJ FamilyCare application within 30
days of enrollment, if this process has not already been initiated by another
entity;
5. As family circumstances
indicate, review eligibility factors for each beneficiary and assist the
beneficiary and/or his or her family in applying for any and all benefits for
which they may be eligible, including, but not limited to, Medicaid/NJ
FamilyCare; and
6. Assist the
beneficiary and/or his or her family in maintaining eligibility for Medicaid/NJ
FamilyCare and other benefits.
(b) All records supporting determinations of eligibility or ineligibility made in accordance with this section shall be maintained by the CMO provider and available for audit.
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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.