N.J. Admin. Code § 10:49-1.4

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:49-1.4 - Overview of provider manuals

(a) The Medicaid Fiscal Agent and the Division of Medical Assistance and Health Services maintain New Jersey Medicaid and NJ FamilyCare provider manuals. Each is designed for use by a specific type of provider that provides services to Medicaid and/or NJ FamilyCare beneficiaries. Each manual is written in accordance with Federal and State laws, rules, and regulations, with the intent to ensure that such laws, rules, and regulations are uniformly applied.

(b) Each provider manual consists of two chapters, broken down into subchapters. The first chapter is referred to as N.J.A.C. 10:49, Administration Manual, and outlines the general administrative policies of the New Jersey Medicaid program and other special programs including NJ FamilyCare. The second chapter of each manual specifies the rules and regulations relevant to the specific provider-type and the services provided. Following the second chapter of the manuals is the Fiscal Agent Billing Supplement.

(c) Codification of manual material follows that of the New Jersey Administrative Code (N.J.A.C.). The citation for a particular section of the provider manual reflects the same material under the same citation in the N.J.A.C. The following is an example of a citation in the N.J.A.C. or a provider manual:

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(d) There is an individual Program provider manual for each of the following services. These services are listed in the New Jersey Administrative Code (N.J.A.C.) under Title 10 (Department of Human Services) Chapters 10:50 through 10:79 as follows:

1.	10:50--Transportation Services Manual
2.	10:51--Pharmacy Services Manual
3.	10:52--Hospital Services Manual
4.	10:53--(Reserved)
5.	10:53A--Hospice Services Manual
6.	10:54--Physician Services Manual
7.	10:55--Prosthetic and Orthotic Services Manual
8.	10:56--Dental Services Manual
9.	10:57--Podiatry Services Manual
10.	10:58--Nurse-Midwifery Services Manual
11.	10:58A--Advanced Practice Nurse;
12.	10:59--Medical Supplier Services Manual
13.	10:60--Home Care Services Manual
14.	10:61--Independent Clinical Laboratory Services Manual
15.	10:62--Vision Care Services Manual
16.	10:63--Long Term Care Services Manual
17.	10:64--Hearing Aid Services Manual
18.	10:65--Medical Day Care Services Manual
19.	10:66--Independent Clinic Services Manual
20.	10:67--Psychological Services Manual
21.	10:68--Chiropractic Services Manual
22.	10:69 AFDC-Related Medicaid
23.	10:70 Medically Needy Manual
24.	10:71 Medicaid Only Manual
25.	10:72 New Jersey Care ... Special Medicaid Programs Manual
26.	10:73--Case Management Services Manual
27.	10:74--Managed Health Care Services for Medicaid and NJ
FamilyCare Beneficiaries
28.	10:75--Psychiatric Residential Treatment Facility Services
for Individuals Under Age 21
29.	10:76--Programs for Assertive Community Treatment (PACT)
Services
30.	10:77 Rehabilitation Services Manual
31.	10:78 NJ FamilyCare Manual
32.	10:79--NJ FamilyCare Children's Program

(e) Manual updates, revised pages or additions to the provider manual are issued, as required, for new policy, policy clarification, and/or revisions to the New Jersey Medicaid or NJ FamilyCare program. A newsletter system is utilized to distribute new or revised manual material and to provide any other pertinent information regarding manual updates. Newsletters should be filed at the back of the manual and replacement pages should be added to the manual in accordance with instructions provided. Substantive manual revisions shall be made through the rulemaking process, in accordance with the Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq.

(f) This manual and all subsequent updates are distributed as a guide to assist providers in their participation in the New Jersey Medicaid or NJ FamilyCare program. The provider is ultimately responsible for knowing and abiding by current Federal and State laws and regulations pertaining to this program.

N.J. Admin. Code § 10:49-1.4

Recodified from N.J.A.C. 10:49-1.8 and amended by R.1997 d.354, effective 9/2/1997.
See: 29 N.J.R. 2512(a), 29 N.J.R. 3856(a).
In (a), substituted "The New Jersey Medicaid Program maintains" for "There are 19" and "Medicaid beneficiaries" for "Medicaid recipients"; in (d), inserted additional N.J.A.C. references; inserted new (d)5, 11 and 23; recodified former (d)5 through 9 and 10 through 20 as (d)6 through 10 and 12 through 22; and in (e), substituted "Substantive manual revisions shall be made" for "Manual revisions shall be substantially made". Former section, "HealthStart", repealed.
Amended by R.1998 d.116, effective 1/30/1998 (operative February 1, 1998; to expire July 31, 1998).
See: 30 N.J.R. 713(a).
Inserted references to NJ KidCare and made corresponding language changes throughout; and in (a), substituted a reference to the Medicaid Agent and the Division of Medical Assistance and Health Services for a reference to the New Jersey Medicaid Program in the first sentence.
Adopted concurrent proposal, R.1998 d.426, effective 7/24/1998.
See: 30 N.J.R. 713(a), 30 N.J.R. 3034(a).
Readopted provisions of R.1998 d.116 without change.
Amended by R.2003 d.82, effective 2/18/2003.
See: 34 N.J.R. 2650(a), 35 N.J.R. 1118(a).
Rewrote (d).
Amended by R.2004 d.334, effective 9/7/2004.
See: 36 N.J.R. 312(a), 36 N.J.R. 4136(a).
In (d), rewrote 11.
Amended by R.2008 d.230, effective 8/4/2008.
See: 40 N.J.R. 984(a), 40 N.J.R. 4531(a).
In the introductory paragraph of (d), deleted "10:75, and 10:77 through" preceding "10:79"; in (d)27, substituted "and NJ FamilyCare Beneficiaries" for "Eligibles"; in (d)28, substituted "Psychiatric Residential Treatment Facility Services for Individuals Under Age 21" for "Programs of Assertive Community Treatment"; in (d)29, substituted "10:76--Programs for Assertive Community Treatment (PACT) Services" for "(Reserved)"; and in (d)32, substituted "--NJ FamilyCare Children's Program" for "NJ KidCare Manual".