MedicaidPrior AuthHigh impact
Newsletter Vol. 8, No. 62
New Jersey Medicaid·NJ·Provider Notice
Effective date
Sep 1, 1998
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid and NJ KidCare-Plan A now require expanded concurrent review and assessment for Personal Care Assistant (PCA) services in six counties (Bergen, Essex, Hudson, Middlesex, Passaic, Union). Effective immediately, providers must submit FD-365 forms with PCA Socio-Medical Evaluation scales to the Medicaid District Office regardless of service hours (1-40 hours per week), with reassessments due within five working days and MDO review completed within 15 working days. Services may continue during review unless formal prior authorization for over 25 hours is required.
Action Required
IMMEDIATE ACTION REQUIRED: All home health agencies and homemaker agencies in Bergen, Essex, Hudson, Middlesex, Passaic, and Union counties providing PCA services to Medicaid or NJ KidCare-Plan A beneficiaries must: (1) Implement mandatory submission of FD-365 (Rev. 9/91) forms paired with PCA Socio-Medical Evaluation scales to the appropriate Medicaid District Office for ALL PCA service authorizations (1-40 hours per calendar work week), effective immediately; (2) Initiate nursing reassessment at least 30 days before current authorization period ends; (3) Submit completed FD-365 and evaluation scale within FIVE WORKING DAYS of reassessment completion; (4) Allow 15 working days for MDO concurrent review and assessment; (5) Continue providing medically necessary PCA services during review process unless formal prior authorization for over 25 hours is required; (6) Maintain written notification to MDO when PCA services are initiated or terminated per N.J.A.C. 10:60-1.16(a)2. Contact the appropriate Medicaid District Office serving the beneficiary's county for prior authorization process details. Failure to comply may result in claim denials and service interruptions.