Chapter 49 - ADMINISTRATION MANUAL

  1. Subchapter 1 - GENERAL PROVISIONS (§ 10:49-1.1 to 10:49-1.8)
  2. Subchapter 2 - NEW JERSEY MEDICAID BENEFICIARIES (§ 10:49-2.1 to 10:49-2.19)
  3. Subchapter 3 - PROVIDER PARTICIPATION (§ 10:49-3.1 to 10:49-3.5)
  4. Subchapter 4 - PROVIDERS' ROLE IN A SHARED HEALTH CARE FACILITY (§ 10:49-4.1 to 10:49-4.5)
  5. Subchapter 5 - SERVICES COVERED BY MEDICAID AND THE NJ FAMILYCARE PROGRAMS (§ 10:49-5.1 to 10:49-5.10)
  6. Subchapter 6 - AUTHORIZATIONS REQUIRED BY MEDICAID AND THE NJ FAMILYCARE PROGRAMS (§ 10:49-6.1 to 10:49-6.2)
  7. Subchapter 7 - SUBMITTING CLAIMS FOR PAYMENT POLICIES AND REGULATIONS (§ 10:49-7.1 to 10:49-7.6)
  8. Subchapter 8 - PAYMENT FOR SERVICES PROVIDED (§ 10:49-8.1 to 10:49-8.5)
  9. Subchapter 9 - PROVIDER AND BENEFICIARY'S RIGHTS AND RESPONSIBILITIES; ADMINISTRATIVE PROCESS (§ 10:49-9.1 to 10:49-9.15)
  10. Subchapter 10 - NOTICES, APPEALS AND FAIR HEARINGS (§ 10:49-10.1 to 10:49-10.13)
  11. Subchapter 11 - EXCLUSION FROM PARTICIPATION IN THE NEW JERSEY MEDICAID AND NJ FAMILYCARE PROGRAMS SUSPENSION, DEBARMENT, AND DISQUALIFICATION (§ 10:49-11.1 to 10:49-11.110:69-5.12)
  12. Subchapter 12 - PROVIDER REINSTATEMENT (§ 10:49-12.1 to 10:49-12.7)
  13. Subchapter 13 - PROGRAM CONTROLS (§ 10:49-13.1 to 10:49-13.4)
  14. Subchapter 14 - RECOVERY OF PAYMENTS AND SANCTIONS (§ 10:49-14.1 to 10:49-14.6)
  15. Subchapter 15 - AVAILABILITY AND MAINTENANCE OF PROGRAM POLICY ISSUANCES (§ 10:49-15.1 to 10:49-15.3)
  16. Subchapter 16 - DEMONSTRATION PROJECTS (§ 10:49-16.1 to 10:49-16.5)
  17. Subchapter 17 - RESERVED
  18. Subchapter 18 - EARLY AND PERIODIC SCREENING, DIAGNOSIS AND TREATMENT EPSDT (§ 10:49-18.1)
  19. Subchapter 19 - HEALTHSTART (§ 10:49-19.1)
  20. Subchapter 20 - RESERVED
  21. Subchapter 21 - THE MEDICAID/NJ FAMILYCARE MANAGED CARE PROGRAM (§ 10:49-21.1 to 10:49-21.4)
  22. Subchapter 22 - HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS (§ 10:49-22.1 to 10:49-22.8)
  23. Subchapter 23 - LIFELINE PROGRAMS (§ 10:49-23.1 to 10:49-23.2)
  24. Subchapter 24 - WORK FIRST NEW JERSEY/GENERAL ASSISTANCE CLAIMS PROCESSING (§ 10:49-24.1 to 10:49-24.5)
  25. Appendix - APPENDIX, version 5

Notes

CHAPTER SOURCE AND EFFECTIVE DATE:
R.2016 d.010, effective January 7, 2016.
See: 47 N.J.R. 2039(a), 48 N.J.R. 207(a).
CHAPTER HISTORICAL NOTE:
Chapter 49, Administration, was adopted and became effective prior to September 1, 1969. Subchapters 1 through 6 were amended by R.1977 d.213, effective July 1, 1977. See: 9 N.J.R. 123(b), 9 N.J.R. 342(c).
Pursuant to Executive Order No. 66(1978), Chapter 49, Administration, was readopted as R.1990 d.390. See: 22 N.J.R. 1512(a), 22 N.J.R. 2313(a).
Chapter 49, Administration, was repealed and a new Chapter 49, Administration, was adopted as R.1992 d.317, effective August 17, 1992. See: 24 N.J.R. 1728(b), 24 N.J.R. 2837(a). Subchapter 19, Prepaid Health Care Services: Medicaid Eligibles, was repealed by R.1995 d.337, effective June 19, 1995. See: 27 N.J.R. 853(a); 27 N.J.R. 2446(b).
Pursuant to Executive Order No. 66(1978), Chapter 49, Administration, was readopted as R.1997 d.354, effective August 8, 1997. As a part of R.1997 d.354, effective September 2, 1997, Chapter 49, Administration, was renamed Chapter 49, Administration Manual; Subchapter 2, New Jersey Medicaid Recipients, was renamed Subchapter 2, New Jersey Medicaid Beneficiaries; Subchapter 9, Provider and Recipient's Rights and Responsibilities; Administrative Process, was renamed Subchapter 9, Provider and Beneficiary's Rights and Responsibilities; Administrative Process; Subchapter 17, Home and Community-Based Services Waivers, was recodified as N.J.A.C. 10:49-22, Home and Community Based Services Waiver Programs; Subchapter 18, Home Care Expansion Program, was recodified as N.J.A.C. 8:81-2, and Subchapter 18, Early and Periodic Screening, Diagnosis and Treatment (EPSDT), was adopted as new rules; Subchapter 19, HealthStart, was adopted as new rules; Subchapter 21, Pharmaceutical Assistance to the Aged and Disabled (PAAD), was recodified as N.J.A.C. 8:81-3, and Subchapter 21, The Medicaid Managed Care Program--NJ Care, was adopted as new rules; Subchapter 22, Lifeline Programs, was recodified as N.J.A.C. 8:81-4, and Subchapter 22, Home and Community-Based Services Waiver Programs, was adopted as new rules; and Subchapter 23, Hearing Aid Assistance to the Aged and Disabled, was recodified as N.J.A.C. 8:81-5, and a new Subchapter 23, Lifeline Programs, was adopted as new rules. See: 29 N.J.R. 2512(a), 29 N.J.R. 3856(a).
Subchapter 24, Work First New Jersey/General Assistance Claims Processing, was adopted as R.2000 d.309, effective August 7, 2000. See: 32 N.J.R. 1342(a), 32 N.J.R. 2900(a).
Chapter 49, Administration Manual, was readopted as R.2003 d.81, effective January 22, 2003. See: 34 N.J.R. 2647(a), 35 N.J.R. 1116(a).
Subchapter 20, The Garden State Health Plan (GSHP), was repealed by R.2003 d.82, effective February 18, 2003. See: 34 N.J.R. 2650(a), 35 N.J.R. 1118(a).
Chapter 49, Administration Manual, was readopted as R.2008 d.230, effective July 11, 2008. As a part of R.2008 d.230, Subchapter 21, The Medicaid Managed Care Program--NJ Care 2000, was renamed The Medicaid/NJ FamilyCare Managed Care Program, effective August 4, 2008. See: 40 N.J.R. 984(a), 40 N.J.R. 4531(a).
In accordance with N.J.S.A. 52:14B-5.1b, Chapter 49, Administration Manual, was scheduled to expire on July 11, 2015. See: 43 N.J.R. 1203(a).
Chapter 49, Administration Manual, was readopted as R.2016 d.010, effective January 7, 2016. See: Source and Effective Date.

CHAPTER AUTHORITY:

N.J.S.A. 30:4D-1 et seq. and 30:4J-8 et seq.

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.