N.J. Admin. Code § 10:49-3.5
Current through Register Vol. 56, No. 23, December 2, 2024
Section 10:49-3.5 - One-time provider enrollment(a) Any potential provider that is licensed or certified by the State of New Jersey as one of the provider types listed at 10:49-3.1(a), or that is licensed or certified as such by a comparable state agency in the state in which the potential provider is located, and that is not enrolled as a New Jersey Medicaid or NJ FamilyCare provider, may submit an application to enroll as a New Jersey Medicaid or NJ FamilyCare one-time provider for the purpose of providing services to a specified beneficiary for a specified, limited period of time. The Department may approve such applications from providers if: 1. The applicant will provide, or has provided, covered services to a beneficiary; or2. The applicant will provide a covered special or unique service to a beneficiary that is not accessible to the beneficiary from any other providers that are enrolled with the Division, as determined by the Division.(b) One-time provider applicants shall complete and submit a one-time provider enrollment application (see Appendix, N.J.A.C. 10:49, Form 8, FD-20A) along with copies of the provider's current licenses and certifications, to: Division of Medical Assistance and Health Services
Provider Enrollment Unit
PO Box 712
Mail Code #09
Trenton, New Jersey 08625-0712
(c) A one-time provider shall comply with all Federal and State laws, rules and regulations applicable to the provision of services to Medicaid and NJ FamilyCare beneficiaries including, but not limited to, N.J.A.C. 10:49 and all other rules applicable to the specific provider type. A one-time provider shall be reimbursed only for services provided in accordance with those laws, rules and regulations. Failure to comply with the requirements of those laws, rules or regulations shall result in denial of reimbursement.(d) A one-time provider shall indemnify and reimburse the State of New Jersey and the New Jersey Medicaid and NJ FamilyCare programs for the Federal share of State expenditures, as described at 42 CFR 433.10, of any payment on any claim paid in accordance with this rule in the event that the Federal share of the payment on the claim is disallowed by the Federal government.(e) Payment of a one-time provider claim by the New Jersey Medicaid or NJ FamilyCare program shall be considered payment in full for all services covered by the claim. A one-time provider shall not institute or cause the initiation of collection activities, including, but not limited to, billing, balance billing or litigation, against beneficiaries, their family members, their representatives, or others on their behalf for the payment of claims, except as permitted by 30:4D-6.c, or as otherwise specifically permitted or required by State or Federal statutes, rules and regulations.(f) An applicant that is excluded from the New Jersey Medicaid or NJ FamilyCare program, from the Medicare program, from any other state Medicaid program, or from any State or Federal health care program, shall not be eligible for enrollment under this section.N.J. Admin. Code § 10:49-3.5
New Rule, R.2006 d.186, effective 5/15/2006.
See: 37 N.J.R. 4503(a), 38 N.J.R. 2158(b).