N.J. Admin. Code § 10:75-1.3

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

Section 10:75-1.3 - Program participation criteria

(a) A psychiatric residential treatment facility (PRTF) that is not licensed as a hospital, but meets the requirements in 42 CFR Part 441 Subpart D and 42 CFR Part 483 Subpart G, shall be eligible for participation in the New Jersey Medicaid/NJ FamilyCare program.

(b) All PRTF providers shall be enrolled in the New Jersey Medicaid/NJ FamilyCare program as a residential treatment center providing services to children under the age of 21. This includes the filing of a Medicaid/NJ FamilyCare Provider Application (FD-20), the signing of a Provider Agreement MCNH-38, and submittal of the CMS-1513, Ownership and Control Interest Disclosure. Provider applications and required forms can be obtained from and should be submitted to: Division of Medical Assistance and Health Services

Office of Provider Enrollment, Mail Code #9

PO Box 712

Trenton, New Jersey 08625-0712

(c) A PRTF located in New Jersey that provides services for New Jersey Medicaid/NJ FamilyCare or DCF/DCSOC beneficiaries under the age of 21 shall, in order to participate in the Medicaid/NJ FamilyCare program:

1. Be licensed by the New Jersey DCF Office of Licensing as a residential facility in accordance with N.J.A.C. 10:127 or 10:128 or other State agencies with the authority to license such facilities to provide care to children;

2. Be accredited as a PRTF by TJC or any other accrediting agency authorized by DHS and DCF; and

3. Provide a copy of their license and a copy of their accreditation to DCF/DCSOC.

(d) A PRTF located out of New Jersey that provides services for New Jersey Medicaid, NJ FamilyCare, or DCF/DCSOC beneficiaries under the age of 21 shall, in order to participate in the New Jersey Medicaid/NJ FamilyCare program:

1. Be licensed as a health care provider by the appropriate State agency or be enrolled as a provider of inpatient psychiatric services for children in the Medicaid program in the state in which they are located;

2. Be accredited by TJC or any other accrediting agency authorized by DCF and DHS as a provider of inpatient psychiatric services for children; and

3. Provide a copy of their license, or their Medicaid enrollment agreement, and a copy of their accreditation to DCF/DCSOC.

(e) As a condition of enrollment, all PRTF providers shall complete an Attestation of Compliance, indicating that all requirements related to the use of emergency safety interventions in PRTFs as described in 42 C.F.R 483, Subpart G, are met. The form will be included in the enrollment package provided by the Division. If additional copies of this form are needed, they can be obtained from the Office of Provider Enrollment by writing the Division at the address in (b) above.

1. Out-of-State providers who are enrolled in the New Jersey Medicaid/NJ FamilyCare program as a PRTF and are not enrolled within their own state Medicaid agency shall file their attestation with the NJ DMAHS at the address in (b) above.

2. Out-of-State providers who are enrolled in the New Jersey Medicaid/NJ FamilyCare program as a PRTF and are also enrolled as a PRTF with their own state Medicaid agency shall file a copy of their state agency's attestation form with the NJ DMAHS at the address in (b) above.

(f) Upon approval as a Medicaid/NJ FamilyCare PRTF provider, providers shall comply with the provisions of N.J.A.C. 10:49, in addition to this chapter.

(g) All providers, in-State or out-of-State, shall notify the DMAHS Office of Provider Enrollment (Provider Enrollment) at the address in (b) above, if their license or accreditation is terminated, suspended, or not renewed, within five business days of the action taken against their license or accreditation.

1. The provider will be disenrolled as a Medicaid/NJ FamilyCare provider until such time as the license or accreditation is restored.

2. Once the provider's license and/or accreditation is restored by the appropriate agency, the provider shall notify Provider Enrollment, who will reinstate the provider as a Medicaid/NJ FamilyCare provider as long as the requirements of N.J.A.C. 10:49 and this chapter are met and continue to be met. The notification to Provider Enrollment shall be in writing and shall include documentation from the licensing or accreditation agency that the provider's license or accreditation has been restored, as well as the specific facts and circumstances regarding the action against the license or accreditation, and the restoration.

3. A PRTF provider shall be held liable for recoupment of any monies paid for services during the time that the provider did not possess a valid license and accreditation.

N.J. Admin. Code § 10:75-1.3

Amended by 49 N.J.R. 101(a), effective 1/3/2017