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Guidance for Avoiding Fraud, Waste, and Abuse: A Presentation for New Jersey Personal Care Agencies - Questions and Answers
New Jerseysub_regulatoryNJ Office of the State Comptroller (Medicaid Fraud Division) with DMAHS, Board of Nursing, HHAeXchange
What this rule requires your agency to do
- 1Providers must check members' Medicaid eligibility monthly.(Guidance for Avoiding Fraud, Waste, and Abuse: A Presentation for New Jersey Personal Care Agencies - Questions and Answers)
- 2Providers must include the servicing caregiver's license and/or certification number in the EVV record, in addition to the provider licensing information.(Guidance for Avoiding Fraud, Waste, and Abuse: A Presentation for New Jersey Personal Care Agencies - Questions and Answers)
- 3PCA providers must be certified as homemaker-home health aides; Medicaid does not cover housekeeping as a stand-alone service, and PCA (T1019) covers ADL assistance, meal preparation, light household duties, and accompaniment to appointments only when in the member's plan of care.(Guidance for Avoiding Fraud, Waste, and Abuse: A Presentation for New Jersey Personal Care Agencies - Questions and Answers)
- 4For a new member in a plan, the plan of care must be created within 30 days (MCO responsibility).(Guidance for Avoiding Fraud, Waste, and Abuse: A Presentation for New Jersey Personal Care Agencies - Questions and Answers)
- 5The PCA reimbursement rate increased to $25.16 effective 7/1/2023.(Guidance for Avoiding Fraud, Waste, and Abuse: A Presentation for New Jersey Personal Care Agencies - Questions and Answers)
Applies to: personal care
State Comptroller/Medicaid Fraud Division Q&A for NJ personal care agencies covering authorizations, background checks, PCA certification/coding, EVV reconciliation, plan-of-care timing, and the PCA rate.
Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.