New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN
Subchapter 4 - BEHAVIORAL ASSISTANCE SERVICES
Section 10:77-4.3 - Provider participation

Universal Citation: NJ Admin Code 10:77-4.3

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

(a) Providers of behavioral assistance services shall be providers that are licensed in New Jersey to provide medical/mental health services, a medical/mental health practice, or other service provider that includes the appropriate licensed practitioners who can provide, or supervise the provision of, services. Examples of provider agencies include, but are not limited to, acute care or psychiatric hospitals, Joint Commission-accredited residential treatment centers, licensed group homes, or child care residential providers, psychiatric community residences for youth, home health agencies, mental health clinics, or any other licensed clinic, Federally Qualified Health Centers, or other entities licensed by a New Jersey government agency to provide physical or mental/behavioral health services in New Jersey.

(b) Individual group practices or other individual service provider entities rendering behavioral assistance services shall employ at least one of the following licensed practitioners who can provide the services directly or supervise the provision of services:

1. Psychiatrist (N.J.A.C. 13:35);

2. Psychologist (N.J.A.C. 13:42);

3. Advance Practice Nurse (mental health) (N.J.A.C. 13:37);

4. Licensed Clinical Social Worker (N.J.A.C. 13:44G); or

5. A professional licensed in accordance with the Board of Marriage and Family Therapy Examiners (N.J.A.C. 13:34) including, but not limited to:
i. A Licensed Marriage and Family Therapist (N.J.A.C. 13:34-4);

ii. A Licensed Professional Counselor (N.J.A.C. 13:34-11 or 12);

iii. A Clinical Mental Health Counselor (N.J.A.C. 13:34-14); or

iv. A Rehabilitation Counselor (N.J.A.C. 13:34-21).

(c) Agencies providing behavioral assistance services shall have demonstrated experience, or shall employ sufficient staff with demonstrated experience of, providing services to children with serious emotional or behavioral health challenges and their families, including, but not limited to, appropriate qualifications and training to provide behavioral assistance in the context of other presenting problems. All agencies shall first be certified by CSOC as meeting these criteria prior to being enrolled as a Medicaid/NJ FamilyCare provider.

(d) Provider entities shall employ appropriate staff necessary to provide administrative oversight, clinical supervision, management, plan development, evaluation and monitoring requirements.

(e) All providers of behavioral assistance services shall be enrolled in the New Jersey Medicaid/NJ FamilyCare fee-for-service program as a provider of behavioral assistance services. Providers enrolled in the NJ Medicaid/NJ FamilyCare fee-for-service program as any other provider type shall submit a separate application and shall first be approved as a provider of behavioral assistance services by CSOC prior to receiving reimbursement for rendering these services.

(f) All applicants shall submit a completed Medicaid/NJ FamilyCare provider application to:

Department of Children and Families

PO Box 717

Trenton, NJ 08625-0717

Attn: CSOC Provider Enrollment Unit

(g) The applicant shall include a current and valid copy of their license(s) with the provider application.

(h) If a behavioral assistance provider loses their license, and is unable to provide services, the provider shall notify the Department of Children and Families, at the address in (f) above, within 10 business days of losing the license.

1. The provider will be disenrolled as a Medicaid/NJ FamilyCare provider until such time as the license is restored. Once the provider's license is restored, the provider will be reinstated as a Medicaid/NJ FamilyCare provider as long as any and all applicable licensure requirements and the requirements of this chapter are met and continue to be met.

(i) The applicant will receive written notification of approval or disapproval of provider status. If approved, the applicant will be assigned a provider number and will receive a copy of the Medicaid/NJ FamilyCare provider manual for Rehabilitative Services. The manual will include N.J.A.C. 10:49 (the DMAHS Administration Manual), this chapter (Rehabilitative Services), relevant non-regulatory information and the fiscal agent billing supplement.

(j) Upon approval as a Medicaid/NJ FamilyCare provider, the provider shall conform to all the requirements of N.J.A.C. 10:49, this subchapter and any applicable rules of the Department of Children and Families.

(k) In order to participate in the New Jersey Medicaid/NJ FamilyCare Program, a provider shall:

1. Have a valid National Provider Identifier (NPI) number obtained from the National Plan and Provider Enumeration System (NPPES);

2. Have a valid taxonomy code obtained from the NPPES; and

3. Remain a provider in good standing by successfully completing provider revalidation, when requested by DMAHS.

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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