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N.J.A.C. 10:71-3.13 This file includes all Regulations adopted and published through the New Jersey Register, Vol. 57 No. 12, June 16, 2025 NJ - New Jersey Administrative Code > TITLE 10. HUMAN SERVICES > CHAPTER 71. MEDICAID ONLY > SUBCHAPTER 3. ELIGIBILITY FACTORS § 10:71-3.13 County social service agency responsibility and procedures (a) The CSSA shall furnish the Medical Review Team with current, pertinent social and medical information, and obtain any special or additional reports on request. (b) When it appears that an applicant meets the income and resources requirements for Medicaid Only, arrangements for obtaining medical evidence should be initiated immediately by whichever of the following procedures is applicable to the applicant's situation: 1. When the applicant is currently (within three months) under the care of a private physician, he or she shall be furnished with a copy of Form PA-5 (Examining Physician's Report) to take to the physician for completion; 2. If the applicant is currently receiving treatment in a hospital clinic, public health facility (that is, tuberculosis clinic, mental health clinic or other outpatient facility) on a regular basis for the medical condition related to his or her application for Medicaid Only, a copy or abstract of the clinic record may be submitted in lieu of the PA-5; 3. If the applicant has been hospitalized within three months for a condition related to the impairment for which he or she is applying for Medicaid Only, an abstract of the hospital record may be submitted for patients in long-term care facilities; 4. In the event none of the above are applicable, the CSSA should assist the applicant in choosing a physician to complete the PA-5, who is competent to determine the nature and extent or degree of disability; or 5. When the applicant states that he or she is blind or that visual impairment is his or her primary disability, the CSSA shall, prior to submission of the record to the Medical Review Team, obtain a Report of Eye Examination (Form PA-5A) from a qualified medical specialist in diseases of the eye (for example, ophthalmologist), or an optometrist, or from an eye clinic of a general hospital, whichever the individual may select. (The membership directory of the Medical Society of New Jersey is suggested as reference for identification of, in each municipality, physicians specializing in diseases of the eye.) Optometrists are listed in the yellow pages of local telephone directories under the heading "Optometrists--Doctors of Optometry." The Form PA-5A should be transmitted in duplicate to the Medical Review Team with any other pertinent medical evidence as outlined above. When appropriate, the Certification of Need for Patient Care in Facility Other Than Public or Private General Hospital (Form PA-4) will be submitted to the Medical Review Team. (c) Other evidence, such as education, training, work experience and daily living activities, shall be submitted to the Medical Review Team by completion of the PA-6 (Medical-Social Information Report). The PA-6 shall be carefully and completely filled out. (d) If the applicant refuses to furnish medical or other evidence concerning his or her disability, the application for Medicaid Only shall be referred to the Medical Review Team for recommendations. (e) As soon as medical reports and the Medical Social Information Report (PA-6) are completed, one copy of each shall be stapled together for transmittal to the Medical Review Team. It shall be clearly indicated on