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.

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