N.J. Admin. Code § 10:58-1.6

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:58-1.6 - Application for provider status; birth centers

(a) A birth center shall enroll as a CNM provider in order to receive reimbursement for the use of the facility for labor and delivery services provided at the center.

(b) The birth center shall be licensed by the Department of Health in accordance with the provisions at N.J.A.C. 8:43A-28.

(c) In order to receive reimbursement for professional services provided by a CNM employed by the birth center, the birth center shall enroll as a CNM provider and the CNM employed by the birth center shall meet the provider requirements in N.J.A.C. 10:58-1.4(a).

(d) When a CNM not employed by a birth center provides professional services at the birth center as an independent provider, the CNM shall bill Medicaid/NJ FamilyCare directly for those professional services.

(e) The birth center shall complete the Medicaid/NJ FamilyCare Provider Application (FD-20), the Provider Agreement (FD-62), and the Ownership and Control Interest and Disclosure Statement (CMS-1513).

1. The birth center shall include with the application a copy of its license, a list of all the CNMs employed by the center, together with their CNM Medicaid/NJ FamilyCare provider numbers, and copies of the CNMs' licenses. The application and all attachments shall be submitted to: Gainwell Technologies Provider Enrollment Mail Code #9 PO Box 4804 Trenton, NJ 08650-4804

2. Each CNM employed by the birth center shall have a provider servicing number. The birth center shall report this number when billing Medicaid/NJ FamilyCare for CNM services.

(f) For information regarding reimbursement for pre-natal and post natal care, see N.J.A.C. 10:58-2.16 and 3.6.

(g) Upon signing and returning the Medicaid/NJ FamilyCare Provider Application, the Provider Agreement and other enrollment documents to the New Jersey Medicaid/NJ FamilyCare programs, the birth center will receive written notification of approval or disapproval.

(h) Each approved birth center shall notify the New Jersey Medicaid/NJ FamilyCare programs a minimum of 30 days prior to the relocation or closing of its facilities.

N.J. Admin. Code § 10:58-1.6

Amended by R.1998 d.209, effective 5/4/1998.
See: 30 N.J.R. 57(a), 30 N.J.R. 1613(a).
Rewrote (a); inserted new (b) through (d) and recodified former (b) as (e) and added (e)1 and 2; added a new (f); and recodified former (c) through (d) as (g) through (h).
Amended by R.2001 d.204, effective 6/18/2001.
See: 33 N.J.R. 1160(a), 33 N.J.R. 2188(a).
Inserted "NJ Family Care" following "Medicaid" throughout.
Amended by R.2006 d.338, effective 9/18/2006.
See: 38 N.J.R. 2003(a), 38 N.J.R. 3900(a).
In the introductory paragraph of (e), substituted "CMS" for "HCFA".

Amended by 53 N.J.R. 1843(c), effective 11/1/2021