N.J. Admin. Code § 10:77-5.3 - Provider participation requirements

Current through Register Vol. 54, No. 7, April 4, 2022

(a) Providers of intensive in-community mental health rehabilitation services shall be providers that are licensed in New Jersey to provide medical/mental health services or a medical/mental health practice or other agency that includes the appropriate licensed practitioners who can provide, or supervise the provision of, services. Examples of appropriate provider agencies, include, but are not limited to:
1. Acute care or psychiatric hospitals;
2. Joint Committee on Accreditation of Healthcare Organization (JCAHO)-accredited residential treatment centers (see 10:77-5.6(f) );
3. Licensed group homes or childcare residential providers;
4. Psychiatric community residences for youth;
5. Home health agencies;
6. Mental health clinics or any other licensed clinics;
7. Federally qualified health centers; or
8. Other entities licensed by a State of New Jersey governmental agency to provide physical or mental health services in New Jersey.
(b) Provider entities rendering intensive in-community mental health rehabilitation services shall employ at least one of the following practitioners licensed in accordance with the following specified rules:
1. A psychiatrist (N.J.A.C. 13:35);
2. A psychologist (N.J.A.C. 13:42);
3. An advance practice nurse (mental health) (N.J.A.C. 13:37-7 );
4. A 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 or 22).
(c) Providers of intensive in-community services shall have demonstrated experience, or shall employ individuals with demonstrated experience, in 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 services in the context of other presenting problems. All providers shall first be certified by the DCF Children's System of Care as meeting these criteria prior to being enrolled as a Medicaid/NJ FamilyCare provider of intensive in-community services.
(d) Provider entities rendering intensive in-community mental health rehabilitation services shall employ appropriate and sufficient staff to comply with the administrative oversight, clinical supervision and service provision and monitoring requirements of this subchapter and of all appropriate licensing requirements.
(e) In order to participate as a Medicaid/NJ FamilyCare/Children's System of Care provider of intensive in-community mental health rehabilitation services, a provider must apply to, and be approved by, the New Jersey Medicaid/NJ FamilyCare fee-for-service program as a provider of intensive in-community mental health rehabilitation services. Providers who are enrolled as other provider types in the Medicaid/NJ FamilyCare program shall complete a separate application for this service. A provider with multiple locations shall submit a separate application for each county in which an office is located.
(f) All applicants shall complete and submit a 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 all staff and provider license(s) with the provider application.
(h) The applicant shall receive written notification of approval or disapproval of provider status. If approved, the applicant shall be enrolled as a Medicaid/NJ FamilyCare provider and shall be assigned a unique provider number for each approved application to use when requesting reimbursement for the provision of intensive in-community mental health rehabilitation services. Providers shall receive a copy of the provider manual and the fiscal agent billing supplement.
(i) Upon approval as a Medicaid/NJ FamilyCare provider, providers of intensive in-community services shall, at all times, maintain compliance with all applicable State and Federal laws, rules and regulations, including, but not limited to, all provisions of this subchapter, N.J.A.C. 10:49, and any applicable rules of the Department of Children and Families.
(j) If a provider receives notification that they are no longer approved by the DCF Children's System of Care, 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

(k) If the provider is no longer approved by the DCF Children's System of Care, the provider shall be immediately disenrolled as a Medicaid/NJ FamilyCare provider of intensive in-community mental health rehabilitation services until such time as the Division has been notified by the Director of the Children's System of Care that the provider should be reinstated as a Medicaid/NJ FamilyCare provider of intensive in-community mental health rehabilitation services.
(l) The provider shall forward updates or changes regarding provider information to the Department and the Medicaid Provider Enrollment Office at the addresses in (f) and (j) above, respectively, within 10 days of the provider's receipt of the updated information. Updated information shall include, but shall not be limited to: change of provider name and/or address; any change in the licensed staff employed by an agency; any action against licensure of the agency or of any individual staff member or any criminal charges against the agency or any individual staff member. The agency shall provide the Department of Children and Families' Children's System of Care and the Department of Human Services' Division of Medical Assistance and Health Services copies of the new license as part of this notification.
(m) An intensive in-community provider may be held liable for recoupment of any monies paid for services rendered during the time that the provider of services did not possess a valid license or did not meet any other qualifications as outlined in this subchapter.

Notes

N.J. Admin. Code § 10:77-5.3
Amended by 48 N.J.R. 81(a), effective 1/4/2016

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