MedicaidDocumentationHigh impact
Newsletter Vol. 3, No. 38
New Jersey Medicaid·NJ · Palliative Care·Provider Notice
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is streamlining hospice eligibility determination by accepting physician certification of terminal illness for the first 6 months without formal disability review. After 6 months, hospice agencies must submit comprehensive medical documentation (physician statement, lab results, imaging reports) to the Disability Review Section by the last month of certification to continue eligibility and ensure payment.
Action Required
Before the last month of each hospice patient's 6-month certification period: Hospice agencies must collect and submit medical recertification documentation to the NJ Division of Medical Assistance and Health Services, Disability Review Section, including (1) attending physician statement with diagnosis, prognosis, and illness stage; (2) copies of laboratory test results, biopsy/pathology reports; (3) MRI/CAT scan results and other objective medical documentation supporting diagnosis. Submit to: Division of Medical Assistance and Health Services, Office of Eligibility Policy and Operations, Disability Review Section, Mail Code CN, Trenton, NJ with copy of Physician Certification/Recertification for Hospice Benefit Form FD. Failure to submit documentation by the last month of certification will result in loss of Medicaid eligibility and claim denials for continued hospice services.