N.J. Admin. Code § 10:60A-2.1

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

Section 10:60A-2.1 - Standards for provider participation in Medicaid/NJ FamilyCare

(a) A PMDC facility shall meet the following requirements for Medicaid/NJ FamilyCare provider participation:

1. Licensure and approval by the Department in accordance with the Standards for Licensure of Pediatric Medical Day Care Facilities, N.J.A.C. 8:43J.

i. Participation as a provider is contingent upon continued licensure of the PMDC facility pursuant to, and in compliance with, N.J.A.C. 8:43J and in compliance with any applicable Federal or State laws of the Medicaid/NJ FamilyCare program respecting provider participation in Medicaid/NJ FamilyCare;

2. Conformance with the requirements for provider participation as set forth in the Medicaid Administration Manual.

i. The Administrator or other corporate officer of the PMDC facility shall complete any documentation required pursuant to the foregoing.

ii. Additional information respecting provider enrollment may also be obtained at www.njmmis.com or by telephoning Gainwell Technologies, the Medicaid/NJ FamilyCare fiscal agent, at 1-800-776-6334;

3. Maintenance of an on-site average daily census of 27 or fewer children and an on-site daily census of no more than 30 children.

i. The average daily census shall be calculated each calendar quarter beginning on January 1 of the calendar year.

ii. The facility administrator shall calculate the average daily census and shall attest in writing to the accuracy thereof;

4. Maintenance of a daily attendance record that includes the printed name and the arrival and departure times of each child attending on that day, signed by the parent or recorded by PMDC staff designated by the Administrator.

i. The facility administrator shall submit the daily attendance record to the Department upon the Department's request.

ii. If a child's parent is unable to sign the daily attendance record, the facility administrator or his or her designee shall attest in writing to the accuracy of the indicated arrival and departure times of the child and shall include the signed attestation as part of the daily attendance record the PMDC facility maintains;

5. Preparation and submission of a cost report pursuant to N.J.A.C. 10:60A-6.1;

6. Submission of a financial statement pursuant to N.J.A.C. 10:60A-6.2;

7. Acceptance of the amounts paid by the Department in the form of per diem reimbursement for PMDC beneficiaries as payment in full plus any deductible, coinsurance or co-payment required to be paid by the PMDC beneficiary, pursuant to N.J.A.C. 10:49-9.8(b)6; and

8. Retention, as part of each PMDC beneficiary's permanent record, of the signed acknowledgement of the PMDC beneficiary's parent that a determination of a Medicaid/NJ FamilyCare beneficiary's clinical eligibility to receive services is not permanent and that redeterminations of clinical eligibility will be made on the basis of subsequent functional assessments pursuant to N.J.A.C. 10:60A-3.1 and prior authorization of service pursuant to N.J.A.C. 10:60A-3.4.

N.J. Admin. Code § 10:60A-2.1

Amended and Recodified from 10:166-2.1 by 56 N.J.R. 262(a), effective 2/20/2024