New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 8:85-1.3 - Program participation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An NF shall comply
				with the following requirements in order to be eligible to participate in the New
				Jersey Medicaid program. An in-State NF shall:
1.
				Be licensed by the Department in accordance with N.J.A.C. 8:39;
2. Be certified by the Department, and in the case
				of both Medicare and Medicaid, by the Centers for Medicare & Medicaid Services
				(CMS), which assures that the NF meets the Federal requirements for participation in
				Medicaid and Medicare;
3. Be approved
				for participation as an NF provider by the New Jersey Medicaid program. This
				includes the filing of a New Jersey Medicaid Provider Application PE-1 that
				establishes eligibility to receive direct payment for services to recipients under
				the New Jersey Medicaid program (see N.J.A.C. 8:85 Appendix A, incorporated herein
				by reference, as posted at
www.state.nj.us/health/ltc/formspub.htm
),
				the signing of a Participation Agreement PE-3, which is the participation agreement
				between the nursing facility and DHSS, which stipulates that an NF shall provide all
				NF services required by this chapter (see N.J.A.C. 8:85 Appendix B, incorporated
				herein by reference, as posted at
www.state.nj.us/health/ltc/formspub.htm
)
				and submittal of the CMS-1513 that is required to be completed before the State
				agency or Federal agency will enter into a contract for reimbursement of medical
				services, Ownership and Control Interest Disclosure Statement (see N.J.A.C. 8:85
				Appendix C, incorporated herein by reference, as posted at
www.state.nj.us/health/ltc/formspub.htm
).
				The agreement for participation in the New Jersey Medicaid program stipulates that
				an NF shall provide all NF services required by this chapter. Continued
				participation as a New Jersey Medicaid provider will be subject to recertification
				by the Department and compliance with all Federal and State laws, rules and
				regulations. If recertification by the Department is denied, the Department's Office
				of Provider Enrollment shall notify the nursing facility that its provider agreement
				is not being continued.
4. File with the
				Department a completed cost report for the nursing facility as required pursuant to
				8:85-3.2.
5. In accordance with
				42 C.F.R.
				483.12(d)(1)(i)(ii), not require
				residents or potential residents to waive their rights to Medicare or Medicaid; and
				not require oral or written assurance that residents or potential residents are not
				eligible for, or will not apply for Medicare or Medicaid benefits;
6. Accept as payment in full the Medicaid
				program's reimbursement for all covered services delivered during that period when,
				by mutual agreement between Medicaid and the facility, the beneficiary is under the
				provider's care, in accordance with
				42 CFR §
											447.15 and
				30:4D-6(c);
				and
7. Except as provided in (a)7i
				below, by December 1, 1997, be certified by Medicare as a provider of skilled
				nursing services for no less than seven percent of the facility's total licensed
				long-term care beds.
i. This requirement shall not
				apply if a nursing facility cannot be certified as a Medicare skilled nursing
				facility due to its inability to meet structural requirements for a physical plant
				as required by the Medicare certification process.
ii. Upon receipt of the application, the
				Department shall determine whether the facility shall be recommended for Medicare
				certification in accordance with 42 CFR Part 483. If the facility cannot be
				certified for Medicare participation, the Department shall provide the facility with
				the reasons for the certification denial in writing.