N.J. Admin. Code § 10:52-1.4

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

Section 10:52-1.4 - Use of PA-1C when applying for benefits for a hospital patient

(a) A hospital shall adhere to the following procedure for completing the form, the "Public Assistance Inquiry (PA-1C)" to inform the appropriate agency that an individual intends to file a Medicaid/NJ FamilyCare application:

1. For those aged, blind or disabled persons with limited income and resources who appear to be eligible for Supplemental Security Income (SSI)/Medicaid, a hospital shall complete the form PA-1C and send it to the Social Security Administration (SSA) District Office serving their locale to initiate the eligibility process. The date of the inquiry shall protect the application date provided that the individual follows through with filing of an application.

2. For the aged, blind and/or disabled individuals, and/or pregnant women and/or children who do not qualify or who do not want an SSI money payment from the Social Security Administration and/or do want to be a Medicaid beneficiary through "Medicaid Only" or New Jersey Care . . . Special Medicaid Programs, a hospital shall complete the form PA-1C and send it to the appropriate county welfare agency (CWA).

3. A hospital shall submit the form PA-1C to the county welfare agency (CWA) immediately after the birth of a newborn of a mother who is or may become eligible for Medicaid/NJ FamilyCare. (Information on the newborn shall be included in item 1, 2, 3, 11a, and 15 only. The mother's signature shall be included in Item 22.)

i. There shall be no requirement for joint hospitalization of a mother and newborn as the sole condition for which claims for services to the newborn may be submitted using the mother's Person Number.

ii. With the exception of mothers receiving benefits through the Emergency Services for Aliens Program, a mother who is a Medicaid/NJ FamilyCare beneficiary and her newborn shall have the same Health Benefits Identification (HBID) Number when they are a part of the same household, but each shall be assigned his or her own Person Number. A mother receiving benefits through the Emergency Services for Aliens Program shall be assigned an HBID Number, and her newborn shall be assigned a separate HBID Number after being determined eligible in accordance with N.J.A.C. 10:69 or 10:72, as applicable.

iii. A hospital shall be permitted to submit a claim for services to a newborn of a mother not enrolled in managed care for 60 days from the date of the birth through the end of the month in which the 60th day occurs or until the newborn is assigned his or her own Person Number, whichever happens first.

iv. After the extended time frame of 60 days from the date of birth through the end of the month in which the 60th day occurs or upon the assignment of the newborn's Person Number, the newborn's personal data shall be used on the claim form as soon as it is available to the hospital. The mother's personal data shall not be used on the claim form after this time frame or after the newborn's Person Number is available to the hospital.

4. Previously submitted PA-1C forms shall be updated by the hospital if subsequent facts emerge that alter the original referral.

i. When it is determined that the original referral to the Social Security Administration was incorrect, the hospital shall forward a copy of the original PA-1C to the CWA with a note of explanation (see also N.J.A.C. 10:49-2 in Administration for further information on Medicaid eligibility).

N.J. Admin. Code § 10:52-1.4

Amended by 50 N.J.R. 1261(a), effective 5/21/2018