N.J. Admin. Code § 10:49-2.15
Current through Register Vol. 56, No. 21, November 4, 2024
Section 10:49-2.15 - Health Benefits Identification (HBID) Card and Emergency Services Letter(a) The HBID Card (see Appendix, N.J.A.C. 10:49) is issued to: 1. Persons (aged, blind and disabled) determined by the Social Security Administration to be eligible for Supplemental Security Income (SSI) and their spouses, if eligible as an essential person;2. Persons determined by the CWA to be eligible for the New Jersey Care . . . Special Medicaid Programs and the Medically Needy program;3. Beneficiaries in the Special Status program (see (e)2 below); and4. Children (Medicaid recipients) under the supervision of the Division of Youth and Family Services (DYFS).(b) The HBID Card identifies only one beneficiary. Each family member will receive his or her own plastic HBID Card. The HBID Card is a permanent, plastic card with a magnetic strip on the back. The card is for identification purposes only; providers must verify eligibility before they provide services.(c) The information on the HBID Card includes the beneficiary name and the beneficiary's unique, 16-digit card control number (CCN), which is linked to the beneficiary's Medicaid or NJ FamilyCare Identification Number as described at 10:49-2.12(b).(d) The HBID Card is valid only when signed by the Medicaid beneficiary or his or her representative payee/legal guardian.(e) A message on the eligibility verification systems (REVS/MEVS/eMEVS) will indicate the cardholder's enrollment in any waivered or special programs, such as Home and Community-Based Services Waiver Programs (see N.J.A.C. 10:49-22); or in another managed care program (see N.J.A.C. 10:49-21). 1. The "Special Status program" either restricts the Medicaid beneficiary listed on the HBID Card to a single provider, except in a medical emergency, or warns providers that the beneficiary's card has been used by an unauthorized person or persons, or for an unauthorized purpose. If a warning letter is issued, a message will be included in the eligibility information provided by the REVS/MEVS/eMEVS system alerting the provider to ask the Medicaid beneficiary for additional identification or to take other appropriate action. (See 10:49-14.2 --Sanctions--Special Status program).2. The HBID Card issued for the Medically Needy program will have the following message included in the eligibility information provided by the REVS/MEVS/eMEVS system: "Medically Needy Eligible, Check Provider Manual for Authorized Services." It is important for the provider to always review the eligibility dates and to be aware that eligibility is not always established for an entire month. Coverage may begin on any day during the month. Also, a provider shall always review the "service code" for each Medically Needy beneficiary. The service code will enable the provider to determine which services are available to each Medically Needy beneficiary (see 10:49-2.3 and 5.3 for service exceptions). The service codes for the three groups under Medically Needy are: (A) Group A--Pregnant women,(B) Group B--Needy children,(C) Group C--Aged, blind and disabled.(f) In instances in which a beneficiary requires emergency medical services prior to receiving a permanent HBID Card in the mail, the eligibility office issuing the card (CWA, MACC office or State agency, including DYFS, DFD and DDD) will issue an HBID Emergency Services Letter. This letter shall contain pertinent information, which the provider will need to confirm eligibility and submit claims for services rendered to that client. The letter will also include an expiration date indicating when the letter will no longer be acceptable as a substitute for the HBID Card.N.J. Admin. Code § 10:49-2.15
Recodified from N.J.A.C. 10:49-2.13 and amended by R.1997 d.354, effective 9/2/1997.
See: 29 N.J.R. 2512(a), 29 N.J.R. 3856(a).
Substituted references to beneficiary for references to recipient throughout; in (a), deleted reference to quarterly issuance of MEI card and made conforming amendments; in (e), amended Program references; and in (e)1, substituted "Enrolled in HMO, etc." for "HMO-Check-GSHP ID Card". Former section "Validation form (DYFS-16-36) 'Validation for Health Services program' (Medicaid)" was repealed.
Recodified from N.J.A.C 10:49-2.14 by R.1998 d.116, effective 1/30/1998 (operative February 1, 1998; to expire July 31, 1998).
See: 30 N.J.R. 713(a).
Former N.J.A.C. 10:49-2.15, Validation form (FD 34) Validation of Eligibility, recodified to N.J.A.C. 10:49-2.16.
Adopted concurrent proposal, R.1998 d.426, effective 7/24/1998.
See: 30 N.J.R. 713(a), 30 N.J.R. 3034(a).
Readopted provisions of R.1998 d.116 without change.
Amended by R.2003 d.82, effective 2/18/2003.
See: 34 N.J.R. 2650(a), 35 N.J.R. 1118(a).
Amended by R.2008 d.230, effective 8/4/2008.
See: 40 N.J.R. 984(a), 40 N.J.R. 4531(a).
Section was "Validation form (FD-73/178) Medicaid Eligibility Identification Card (MEI Card)". In the introductory paragraph of (a), substituted "HBID Card" for "MEI Card, Validation Form FD-73/178" and deleted "monthly" following "issued"; in (a)2, substituted "CWA" for "CBOSS"; rewrote (b) and (c); in (d), substituted "HBID" for "MEI" and "his or her" for "his/her"; in the introductory paragraph of (e), substituted "on the eligibility verification systems (REVS/MEVS/eMEVS)" for "printed on the MEI card", inserted a comma following "programs" and updated the second N.J.A.C. reference, in (e)1, deleted "MEI Card for the Medicaid" preceding " 'Special Status program' ", substituted "beneficiary" for "beneficiary(ies)" preceding "listed", "HBID" for "MEI", "letter" for "card" and "included in the eligibility information provided by the REVS/MEVS/eMEVS system" for "printed on the card"; in (e)2, substituted "HBID" for "MEI" and "included in the eligibility information provided by the REVS/MEVS/eMEVS system" for "printed on the top of the card"; and added (f).