New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 73 - CASE MANAGEMENT SERVICES
Subchapter 4 - YOUTH CASE MANAGEMENT YCM SERVICES
Section 10:73-4.3 - Provider enrollment and participation
Current through Register Vol. 56, No. 18, September 16, 2024
(a) Prior to enrollment as a Medicaid/NJ FamilyCare provider, any agency applying to render youth case management services shall first be under contract with the Children's System of Care, and licensed by DHS as an approved youth case management provider. Such contract and license shall be in full effect and shall not be currently suspended or terminated.
(b) In order to participate as a Medicaid/NJ FamilyCare/CSOC provider of youth case management services, a provider shall apply to, and be approved by, the New Jersey Medicaid/NJ FamilyCare fee-for-service program as a youth case management provider, in accordance with N.J.A.C. 10:49-3 and this subchapter. Providers who are enrolled as other provider types in the Medicaid/NJ FamilyCare program shall complete a separate application to enroll as a youth case management provider.
Gainwell Technologies
Provider Enrollment
PO Box 4804
Trenton, NJ 08650-4804
PO Box 717
Trenton, NJ 08625-0717
Attn: Director, Division of Child Behavioral Health Services
(c) All YCM provider applicants will receive notification of approval or disapproval of provider status. If approved, the applicant will be enrolled as a Medicaid/NJ FamilyCare provider and will be assigned a Medicaid/NJ FamilyCare provider number for seeking reimbursement for the provision of youth case management services. All approved and enrolled providers will receive a copy of the provider manual and the fiscal agent billing supplement.
(d) If a provider's contract for youth case management services with the Department of Human Services or the Department of Children and Families is in default status or has been suspended or terminated for any reason, or if the provider is no longer approved, or licensed, by the Department of Human Services or the Department of Children and Families, as appropriate, the provider shall immediately be disenrolled as a provider of youth case management services until such time as the contract is renewed or reinstated and the Medicaid/NJ FamilyCare program has been notified by the Department of Human Services or the Department of Children and Families, as appropriate, that the provider should be reinstated as a provider of services.
(e) If a provider receives notification that the provider's contract for youth case management services with the Department of Human Services or the Department of Children and Families is in default status or has been suspended or terminated for any reason, or if the provider is no longer approved, or licensed, by the Department of Human Services or the Department of Children and Families, as appropriate, the provider shall notify the Division of Medical Assistance and Health Services at the address below within 10 business days: Division of Medical Assistance and Health Services
Office of Provider Enrollment
PO Box 712
Trenton, NJ 08625-0712
(f) A provider shall be held liable for recoupment of any monies paid for youth case management services rendered during the time that the provider's contract with the Department of Human Services or the Department of Children and Families, as appropriate, is in default status or has been suspended or terminated or when the provider did not meet other requirements of this subchapter.
(g) Providers of youth case management services shall, at all times, maintain compliance with all applicable State and Federal laws, rules and regulations, including, but not limited to, N.J.A.C. 10:3, 10:37H and 10:49 and this chapter.
