N.J. Admin. Code § 10:54-6.3

Current through Register Vol. 56, No. 19, October 7, 2024

Section 10:54-6.3 - HealthStart provider participation criteria

(a) Providers that are eligible to participate as HealthStart providers shall be: independent clinics (including local health departments meeting the New Jersey Department of Health and Senior Services Improved Pregnancy Outcome criteria); hospital outpatient departments; Federally Qualified Health Centers; physicians; certified nurse midwives; advanced practice nurses (APNs); and physician and/or practitioner groups, approved as providers in the New Jersey Medicaid/NJ FamilyCare program in accordance with N.J.A.C. 10:49 and 10:54-6.3.

(b) In addition to New Jersey Medicaid program rules applicable to provider participation, HealthStart providers shall:

1. Sign an Addendum to the New Jersey Medicaid Program Provider Agreement;

2. Have a valid "HealthStart Maternity Care Certificate" or a "HealthStart Maternity Medical Care Certificate" and/or a Pediatric Care Certificate; and

3. Provide maternity medical care and/or health support services, if applicable, or pediatric care services, in accordance with the requirements for issuance of "HealthStart Comprehensive Maternity Care Certificate" or "HealthStart Maternity Medical Care Certificate," and/or a "HealthStart Pediatric Care Certificate," and in accordance with the New Jersey State Department of Health and Senior Services Guideline for HealthStart Maternity Care Providers and HealthStart Pediatric Care Providers at N.J.A.C. 10:66-3.

4. Shall participate in program evaluation and training activities, including, but not limited to, site monitoring, agency and patient record review, and submission of required summary information on each patient according to the "New Jersey State Department of Health and Senior Services Guidelines for HealthStart Providers," as delineated in N.J.A.C. 10:66-3; and

5. Determine presumptive eligibility for the New Jersey Medicaid program, if approved to perform such determinations by the Division of Medical Assistance and Health Services.

(c) In addition to (a) and (b) above, HealthStart Comprehensive Maternity Care providers with more than one care site or more than one maternity clinic at the same site that uses different staff, shall apply for a separate HealthStart Comprehensive Maternity Care Certificate for each separate site. Within an agency, only those sites which hold a certificate shall be reimbursed for HealthStart services.

(d) In addition to (a) and (b) above, HealthStart Pediatric Care Providers shall:

1. Participate in program evaluation and training activities, including but not limited to, submission of Pediatric Preventive Child Health forms and documentation of outreach and follow-up activities in the patient's record; and

2. Enroll eligible children in Early and Periodic Screening, Diagnosis and Treatment (EPSDT). Hospital outpatient departments shall be excluded from this requirement.

3. Provide all components of the Child Health screening services within one clinic when the HealthStart Pediatric Care Provider is the outpatient department of a hospital. Referral to other clinics for screening shall be prohibited.

(e) An applicant's ability to meet the standards for HealthStart certificates in appropriate areas and to provide services in accordance with the "New Jersey State Department of Health and Senior Services Guidelines for HealthStart Providers" (N.J.A.C. 10:66-3) in appropriate areas will be assessed via a site review.

(f) HealthStart Provider Certificates will be reviewed by the New Jersey State Department of Health and Senior Services at least every 18 months from the date of issuance.

(g) Applications for HealthStart Provider Certificates are available from:

HealthStart Program

New Jersey State Department of Health and Senior Services

PO Box 360

Trenton, NJ 08625-0360

(h) Applications for New Jersey Medicaid HealthStart Provider agreements are available from:

Unisys Corporation

Provider Enrollment Unit

PO Box 4804

Trenton, New Jersey 08650-4804

N.J. Admin. Code § 10:54-6.3

Amended by R.2001 d.51, effective 2/5/2001.
See: 32 New Jersey Register 3929(a), 33 New Jersey Register 555(a).
Amended by R.2004 d.334, effective 9/7/2004.
See: 36 New Jersey Register 312(a), 36 New Jersey Register 4136(a).