MedicaidDocumentationHigh impact
Medicaid Alert - MA2013-01
New Jersey Medicaid·NJ · Palliative Care·Provider Notice
Effective date
Jan 1, 2014
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid requires hospice providers to use specific state-mandated forms (FD-378 through FD-385) for all beneficiaries electing hospice benefits on or after January 1, 2014. Forms must be submitted to the Medicaid office of supervision and/or included in the beneficiary's medical record. Non-compliance will result in fund recovery and sanctions.
Action Required
By December 31, 2013: Hospice providers must obtain and implement all required New Jersey Medicaid forms (FD-378, FD-379, FD-380, FD-381, FD-382, FD-383, FD-384, FD-385) in their medical record and billing systems. Billing team must update workflows to ensure: (1) FD-378, FD-380, FD-383, and FD-385 are submitted to the beneficiary's Medicaid office of supervision; (2) All forms are included in the beneficiary's medical record with complete, legible, and accurate information; (3) FD-383 is completed with provider signature, date, phone, and fax number before submission; (4) Forms are updated for subsequent benefit periods or when services are revoked/terminated. Providers must verify all forms are signed by appropriate parties (beneficiary, legal representative, witness, attending physician, or hospice medical director as applicable). Failure to comply will result in claim denials, delayed eligibility approval, and potential recovery of funds paid for services.