Division of Health Facilities Evaluation and Licensing

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PROVIDER ENROLLMENT PROCEDURES

ASSISTED LIVING NEW JERSEY MEDICAID PROVIDER APPLICATION
FOR
ASSISTED LIVING RESIDENCE (ALR)
ASSISTED LIVING PROGRAM (ALP)
COMPREHENSIVE PERSONAL CARE HOME (CPCH)


Regarding enrollment as an Assisted Living (AL) New Jersey Medicaid provider.

The Department of Health contracts Molina Medicaid Solutions as the fiscal agent for the processing of Medicaid applications. To access Medicaid applications and for inquiries regarding Medicaid and Medicaid Provider Enrollment, please click on the following link: http://www.njmmis.com or contact Molina Medicaid Solutions at (609) 588-6036.

To become a provider the following documents will be required by Molina Medicaid Solutions :

  • New Jersey Medicaid Provider Application
  • Ownership and Control Interest Disclosure Statement
  • Provider Agreement
  • New Jersey Department of Health license;
  • Current fee schedule.

 

 

 


Health Facilities Licensure Payments

Submit Payments for Health Facilities Licensure


Nursing Home Administrator Licensing Board Payments

Submit Payments for Nursing Home Administrator Licensing Board