N.J. Admin. Code § 11:24C-2.4 - Application: procedure to become a designated health care provider of home treatment services

(a) A person seeking to become a designated health care provider shall submit to the Department an original and at least one copy of an application at the following address:

Mailing Address (U.S. Postal Service):

NJ Department of Banking and Insurance

Consumer Protection Services

Office of Managed Care

Attention: Hemophilia Treatment Designation Application

PO Box 329

Trenton, NJ 08625-0329

Overnight Services (UPS, FedEx, Airborne):

NJ Department of Banking and Insurance

Consumer Protection Services

Office of Managed Care

Attention: Hemophilia Treatment Designation Application

20 West State Street

9th Floor

Trenton, NJ 08625-0329

(b) The applicant shall comply with the "Instructions and Checklist" set forth in the Appendix to this subchapter, incorporated herein by reference, when submitting the application.

(c) Applicants may submit copies of the application in paper or electronic format, or both, subject to the requirement that at least one copy of the application be in paper format, and that the original and copy(ies) be set forth in the same order and contain the same content.

(d) The applicant shall submit a response to each of the requirements set forth in 11:24C-2.5.

Notes

N.J. Admin. Code § 11:24C-2.4

Amended by 48 N.J.R. 804(a), effective 4/15/2016