N.J. Admin. Code § 10:51-1.2

Current through Register Vol. 56, No. 24, December 18, 2024

Section 10:51-1.2 - Participation of eligible providers

(a) A pharmacy with a retail or institutional permit may participate in the Medicaid or NJ FamilyCare program as a provider of pharmaceutical services and as a medical supplier providing medical supplies and durable medical equipment and as a provider of parenteral nutrition or intravenous therapy. The requirements for approval as a provider of these services are listed in (b) through (d) below.

(b) To be approved as a provider of pharmaceutical services, the pharmacy shall:

1. Operate under a valid retail and/or institutional permit issued by the Board of Pharmacy of the State of New Jersey or by the board of pharmacy of the state in which the pharmacy is located. A pharmacy operating under an out-of-State institutional permit and applying for approval as a retail pharmacy may not participate as an approved provider in the Medicaid or NJ FamilyCare program; and

2. File an application and sign an agreement with the Division of Medical Assistance and Health Services.

i. Upon sale or other change of ownership of an approved pharmacy, the agreement is automatically terminated. To execute a new agreement to participate in the Medicaid and NJ FamilyCare programs, the new owner(s) shall apply to the Division of Medical Assistance and Health Services, Department of Human Services, by contacting the Provider Enrollment Unit (see N.J.A.C. 10:49, Administration Chapter, Enroll ment Process) or the fiscal agent Provider Enrollment Unit (see Appendix D, Fiscal Agent Billing Supplement).

(c) To enroll as a Medicaid and NJ FamilyCare provider of pharmaceutical services, a pharmacy shall contact the fiscal agent Provider Enrollment Unit.

(d) A pharmacy may also apply to the Division to participate as a medical supplier. The Medical Supplier chapter, N.J.A.C. 10:59, available from the fiscal agent, provides information concerning the provision of and reimbursement for covered medical supplies and durable medical equipment provided by a medical supplier.

1. A pharmacy may apply to participate as a medical supplier by contacting the Provider Enrollment Unit or the fiscal agent Provider Enrollment Unit.

(e) Requirements for approval as a provider of parenteral nutrition and/or intravenous therapy are as follows:

1.In addition to the requirements for approval as a pharmacy provider listed in this section, a pharmacy that supplies parenteral nutrition and/or intravenous therapy shall:

i. Comply with all the requirements of N.J.A.C. 13:39; or

ii. Comply with similar applicable requirements of the state in which the applicant is located and submit a copy of the requirements of that state when applying for participation.

2. Parenteral nutrition and/or intravenous therapy may be provided by either a pharmacy/medical supplier or a medical supplier approved to provide these services by the Medicaid and NJ FamilyCare program; however, billing for the ancillary supplies associated with parenteral nutrition and/or intravenous therapy are subject to the requirements of the Medical Supplier Chapter (N.J.A.C. 10:59).

i. "Ancillary supplies" means medical supplies and/or durable medical equipment which are medically necessary to facilitate administration of parenteral or intravenous therapy.

N.J. Admin. Code § 10:51-1.2

Amended by 48 N.J.R. 2785(a), effective 12/19/2016