New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 6 - PRESUMPTIVE ELIGIBILITY › Section 10:72-6.2 - Responsibilities of a qualified provider

Current through Register Vol. 56, No. 14, July 15, 2024
(a) From
				preliminary information provided by a woman whose pregnancy has been medically
				verified, the qualified provider shall determine if the pregnant woman meets
				the eligibility criteria of this chapter as it applies to pregnant women. The
				qualified provider must obtain sufficient information from the pregnant women
				to complete the Certification of Presumptive Eligibility (FD-334) by having the
				pregnant women complete, sign and date a referral for Medicaid benefits as
				designated and provided by the Division of Medical Assistance and Health
				Services. For purposes of the presumptive eligibility determination, the
				qualified provider shall request from the pregnant woman only that information
				necessary to determine her presumptive eligibility or ineligibility. The
				qualified provider shall make the determination of eligibility based solely on
				information obtained in the interview and shall not require any verification or
				documentation of the pregnant woman's statements.
1. For any pregnant woman determined
				presumptively eligible, the qualified provider shall complete and sign the
				FD-334. The completed FD-334 together with the pregnant woman's New Jersey Care
				Pregnant Women and Infants Application Referral (FD-335) for Medicaid shall be
				mailed or otherwise forwarded to the county welfare agency of the pregnant
				woman's county of residence within two working days of the presumptive
				eligibility determination. The qualified provider shall also forward a copy of
				the pregnant woman's Certification of Presumptive Eligibility (FD-334) to the
				Division of Medical Assistance and Health Services. The qualified provider
				shall inform the pregnant woman that her presumptive eligibility provides only
				limited services for a period of time not to exceed the length of the
				presumptive eligibility period, and that she must contact the county welfare
				agency in order to set up an appointment to complete the application process
				for Medicaid benefits. The qualified provider shall give the presumptively
				eligible pregnant woman a copy of both the Certification of Presumptive
				Eligibility (FD-334) and her New Jersey Care Pregnant Women and Infants
				Application Referral (FD-335) for Medicaid benefits. The qualified provider
				shall advise the presumptively eligible pregnant woman, in writing, of the
				address and telephone number of the appropriate county welfare agency
				office.
2. For any woman for whom
				the qualified provider is unable to determine presumptive eligibility or who is
				ineligible under the criteria and standards of this chapter as it applies to
				pregnant women, the qualified provider shall refer the woman to the county
				welfare agency for evaluation of potential eligibility for Medically Needy or
				other Medicaid entitlement. The address and telephone number of the appropriate
				county welfare agency office shall be provided, in writing, to the pregnant
				woman.