New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 49 - ADMINISTRATION MANUAL › Subchapter 11 - EXCLUSION FROM PARTICIPATION IN THE NEW JERSEY MEDICAID AND NJ FAMILYCARE PROGRAMS SUSPENSION, DEBARMENT, AND DISQUALIFICATION › Section 10:49-11.1 - Program participation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The provisions
				of this section were adopted and issued pursuant to Executive Order No. 34,
				dated March 29, 1976, and the authority vested in the Division of Medical
				Assistance and Health Services to implement the New Jersey Medicaid and NJ
				FamilyCare programs by rules and regulations set forth in
				30:4D-5,
				30:4D-17.1 a and c, Reorganization
				Plan No. 001-1996 and
				P.L.
				1997, c. 272.
(b) Suspension, debarment, and
				disqualification are measures which shall be invoked by the Division of Medical
				Assistance and Health Services to exclude or render ineligible certain persons
				from participation in contracts and subcontracts with the New Jersey Medicaid
				or NJ FamilyCare program, or in projects or contracts performed with the
				assistance of and subject to the approval of the Medicaid Agent or DMAHS, on
				the basis of a lack of responsibility. These measures shall be used for the
				purpose of protecting the interests of the New Jersey Medicaid and/or NJ
				FamilyCare programs and not for punishment. To assure the New Jersey Medicaid
				and/or NJ FamilyCare programs, the benefits to be derived from the full and
				free competition between and among such persons and to maximize the opportunity
				for honest competition and performance, these measures shall not be invoked for
				any time longer than deemed necessary to protect the interests of the New
				Jersey Medicaid and/or NJ FamilyCare programs.
1. Any individuals, including but not limited
				to, owners, officers, administrators, assistant administrators, employees,
				accountants, attorneys, and management services, who have been suspended,
				debarred or disqualified from participation in the Medicaid and/or NJ
				FamilyCare programs for any reason shall not be involved in any activity
				relating to the New Jersey Medicaid and/or NJ FamilyCare programs.
2. Providers reimbursed on a cost-related
				basis may not claim as allowable costs any amounts paid or credited to such
				individuals, and such amounts shall not be reimbursed by the New Jersey
				Medicaid and/or NJ FamilyCare programs.
3. Providers may not submit claims and shall
				not be reimbursed for any goods supplied or services rendered by such
				individuals.
4. The requirement in
				(b)3 above shall apply only for the period during which such individuals are
				suspended, debarred or disqualified from Medicaid and/or NJ FamilyCare
				participation.
5. Claims shall not
				be submitted and claims shall not be reimbursable for any item or service
				(other than an emergency item or service, not including items or services
				furnished in an emergency room of a hospital) furnished at the direction or on
				the prescription of a physician, an individual or entity, during the period
				when such individual, entity or physician is excluded from participation in the
				Medicaid and NJ FamilyCare programs, and when the individual or entity
				furnishing such item or service has received written notice from the Division
				that the entity, individual or physician has been excluded from participation
				in the Medicaid and NJ FamilyCare programs.