N.J. Admin. Code § 10:77A-1.3 - Provider participation

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

(a) In order to participate in the Medicaid/NJ FamilyCare programs, all applicants shall be licensed by and under contract with the Division of Mental Health and Addiction Services (DMHAS) as a community residence for mentally ill adults in accordance with N.J.A.C. 10:37A.
(b) All providers shall complete and submit the following documents, and shall update the documents when the information contained therein changes, for example, when a new license is issued and/or when any information on the FD-20 changes:
1. "Medicaid Provider Application" (FD-20);
2. "Medicaid Provider Agreement" (FD-62);
3. A copy of a current and valid license from the Division of Mental Health and Addiction Services; and
4. "Disclosure of Ownership and Control Interest Statement" (CMS 1513).
(c) Providers shall submit the documents listed in (b) above to:

Division of Medical Assistance and Health Services

Office of Provider Enrollment

PO Box 712, Mail Code #9

Trenton, New Jersey 08625-0712

(d) A separate application shall be submitted for each county in which the provider renders services.
(e) The applicant will receive written notification of approval or disapproval of Medicaid/NJ FamilyCare provider status from the Division of Medical Assistance and Health Services (DMAHS). If approved, the applicant will be assigned a Medicaid/NJ FamilyCare Provider Number and will receive a copy of this chapter as part of the provider manual. Each provider agency shall be assigned a unique provider number for each county in which services are provided.
(f) DMHAS will certify to DMAHS, the level of care and the number of beds and separate sites for each agency.
(g) If an adult mental health rehabilitation services provider loses its license from DMHAS, the provider shall notify the DMAHS Provider Enrollment Unit, at the address in (c) above, within five business days of losing the license.
1. The adult mental health rehabilitation provider will be disenrolled as a Medicaid/NJ FamilyCare provider until such time as the license is restored. Once DMHAS restores the provider's license, the provider, upon providing proof of the restoration of the license to the provider enrollment office noted above, will be reinstated as a Medicaid/NJ FamilyCare provider, as long as the requirements of N.J.A.C. 10:37A and this chapter are met and continue to be met. The effective date shall be the date of reinstatement as determined by DMHAS licensing standards.
2. The adult mental health rehabilitation provider may be held liable for recoupment of any monies paid for services during the time that they did not possess a valid license or a valid license for the specific site at which the services were provided, for all services reimbursed.


N.J. Admin. Code § 10:77A-1.3
Amended by 49 N.J.R. 201(b), effective 1/17/2017

The following state regulations pages link to this page.

State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.