N.J. Admin. Code § 10:79-8.3 - Presumptive eligibility determination entities

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

(a) A qualified presumptive eligibility entity shall be a New Jersey Medicaid provider and:
1. An acute care hospital;
2. A local health department that provides primary care services; or
3. A Federally Qualified Health Center (FQHC).
(b) An eligible entity shall apply to the Division of Medical Assistance and Health Services and shall be approved as a presumptive eligibility determination agency upon training of the entity by the Division of Medical Assistance and Health Services.
(c) The Division of Medical Assistance and Health Services shall monitor the presumptive eligibility determinations made by approved presumptive eligibility determination entities. If the review discloses a pattern of incorrect presumptive eligibility determinations or failure to adhere to requirements, the Division shall initiate corrective action, including, but not limited to, consultation and training. Continued incorrect presumptive eligibility determinations or failure to adhere to procedural requirements shall result in the Division revoking approval for that entity to make presumptive eligibility determinations.

Notes

N.J. Admin. Code § 10:79-8.3
Amended by R.2004 d.42, effective 1/20/2004.
See: 35 New Jersey Register 3802(a), 36 New Jersey Register 572(b).
In (a), inserted "that provides primary care services" following "department" in 2.

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.