reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 75 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES FOR INDIVIDUALS UNDER AGE 21 › Subchapter 3 - EMERGENCY SAFETY INTERVENTIONS › Section 10:75-3.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, as used in this subchapter,
				  shall have the following meanings, unless the context clearly indicates
				  otherwise:
"Drug used as a restraint" means any drug that is
				  administered to manage a resident's behavior in a way that reduces the safety
				  risk to the resident or others; has the temporary effect of restricting the
				  resident's freedom of movement; and is not a standard treatment for the
				  resident's medical or psychiatric condition.
"Emergency safety intervention" means the use of any form of
				  restraint or seclusion as an immediate response to stabilize an emergency
				  safety situation.
"Emergency safety situation" means unanticipated resident
				  behavior that places either the resident or other beneficiaries and/or staff,
				  at serious threat of violence or injury if no intervention occurs and calls for
				  an emergency safety intervention because non-restraining interventions have not
				  worked to deescalate the situation.
"Mechanical restraint" means any device attached or adjacent
				  to the resident's body, that he or she cannot easily remove, that restricts
				  freedom of movement or normal access to his or her body.
"Personal restraint" means the application of physical force
				  without the use of any device, for the purpose of restricting the free movement
				  of a resident's body. Personal restraint does not include briefly holding a
				  resident in order to calm or comfort the resident, or holding a resident's hand
				  or arm to safely escort a resident from one area to another.
"Restraint" means a personal hold of any duration, a
				  mechanical restraint, or a drug used as a restraint.
"Seclusion" means involuntary confinement of a resident alone
				  in a room or an area from which the resident is physically prevented from
				  leaving. A "time out" intervention is not considered seclusion.
"Time out" means the restriction of a resident for a period
				  of time in a designated area from which the resident is not physically
				  prevented from leaving, for the purpose of providing the resident an
				  opportunity to regain self-control.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 75 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES FOR INDIVIDUALS UNDER AGE 21 › Subchapter 3 - EMERGENCY SAFETY INTERVENTIONS › Section 10:75-3.3 - General principles

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Restraint and
				seclusion shall be considered emergency safety interventions and shall be used
				in emergency situations solely to minimize or avoid the likelihood of harm to
				the residents or staff of the PRTF.
(b) Restraint and seclusion shall never be
				ordered or used as a means of coercion, discipline, retaliation, or for the
				convenience of staff members.
(c)
				Choice of restraint and seclusion shall be limited to the least restrictive
				intervention that can be performed safely and is appropriate to the severity if
				the behavior, and the resident's age, developmental status, size, gender,
				physical, medical and psychiatric condition and personal history (including any
				history of physical or sexual abuse).
(d) The restraint or seclusion shall
				terminate once the emergency situation has ended, even if the order for
				restraint or seclusion has not expired.
(e) Restraint and seclusion shall never be
				ordered or used simultaneously.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 75 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES FOR INDIVIDUALS UNDER AGE 21 › Subchapter 3 - EMERGENCY SAFETY INTERVENTIONS › Section 10:75-3.4 - Communication regarding the use of emergency safety interventions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All residents
				shall be informed of all facility policies related to the use of restraint or
				seclusion upon admission to the facility. In the case of a resident who is
				under the age of 18, the resident's parent or legal guardian shall be informed
				of the policies.
(b) The policies
				shall be explained orally and provided in writing in a language that the
				resident and/or the resident's parent or legal guardian understands.
(c) The written policies shall include the
				contact information for the State's Protection and Advocacy agency.
Disability Rights New Jersey
210 South Broad Street, 3rd floor
Trenton, NJ 08608
(d) The resident, or the resident's parent or
				legal guardian, shall sign an acknowledgement that this policy was provided to
				them and that they understand the policy. This written and signed
				acknowledgement shall be placed in the resident's file.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 75 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES FOR INDIVIDUALS UNDER AGE 21 › Subchapter 3 - EMERGENCY SAFETY INTERVENTIONS › Section 10:75-3.5 - Staff training and certification

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All full and
				part-time clinical and direct care staff shall be trained in the following
				areas:
1. The use of non-physical and
				non-restraining intervention skills, such as de-escalation, mediation, conflict
				resolution, active listening, and verbal and observational methods to prevent
				emergency safety situations; and
2.
				Safe and appropriate restraint and seclusion techniques, including the ability
				to respond to signs of physical distress in beneficiaries who are being
				restrained or in seclusion, including adult and child cardiopulmonary
				resuscitation (CPR). Competency or certification in CPR shall be demonstrated
				and documented annually.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 75 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES FOR INDIVIDUALS UNDER AGE 21 › Subchapter 3 - EMERGENCY SAFETY INTERVENTIONS › Section 10:75-3.6 - Appropriate timelines for use of restraint of seclusion techniques

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Restraint and
				seclusion shall only be used in emergency situations. These techniques are
				intended to be used for a limited time period, and only to ensure the safety of
				the resident and other residents and staff in the immediate area.
Example: A resident in a PRTF facility has become agitated
				  beyond the point of being calmed by non-restraining interventions. The
				  individual is actively trying to physically harm either himself or other people
				  in the area. In this situation, the use of restraint may be ordered to ensure
				  that the agitated individual does not physically harm either himself or another
				  resident or staff person in the area.
(b) As soon as the resident and the situation
				are stabilized, the use of the restraint or seclusion shall cease
				immediately.
(c) The following time
				limits for the use of either restraint or seclusion shall be the maximum time
				limits allowed:
1. Not to exceed a total of
				four hours for residents ages 18 through 21;
2. Not to exceed a total of two hours for
				residents ages nine through 17; and
3. Not to exceed a total of one hour for
				residents under the age of nine.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 75 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES FOR INDIVIDUALS UNDER AGE 21 › Subchapter 3 - EMERGENCY SAFETY INTERVENTIONS › Section 10:75-3.7 - Mechanical restraint, drug restraint, or seclusion

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The resident's
				treatment team physician shall order the use of mechanical restraint, drug
				restraint or seclusion, as follows:
1. If
				someone other than the treatment team physician orders the mechanical or drug
				restraint or seclusion, the treatment team physician shall be contacted as soon
				as reasonably possible, but no later than the next regular business day, and
				shall be informed that the order was placed.
2. For in-State facilities, if the treatment
				team physician is unavailable, a physician, advance practice nurse, or
				physician's assistant shall order the use of a restraint or seclusion.
				Facilities may use on-call staff, per diem staff, consultants or other methods
				of pooling coverage in order to meet this requirement.
3. Out-of-State facilities providing services
				to New Jersey Medicaid/NJ FamilyCare beneficiaries shall follow the state
				Medicaid program requirements of the state in which they are located.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 75 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES FOR INDIVIDUALS UNDER AGE 21 › Subchapter 3 - EMERGENCY SAFETY INTERVENTIONS › Section 10:75-3.8 - Personal restraint

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The resident's
				treatment team physician shall order the use of personal restraint, as follows:
1. If someone other than the treatment team
				physician orders the personal restraint, the treatment team physician shall be
				contacted as soon as reasonably possible and shall be informed that the order
				was placed.
2. If the treatment
				team physician is unavailable, a licensed member of the child's treatment team
				or other member of the treatment team authorized by the facility to order a
				personal restraint, shall order the use of a personal restraint. In-State
				facilities may use on-call or per diem staff; however, the treatment team
				physician shall be notified as soon as reasonably possible, but no later than
				the next regular business day.
3.
				Out-of-State facilities providing services to New Jersey Medicaid/NJ FamilyCare
				beneficiaries shall follow the state Medicaid program requirements of the state
				in which they are located.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 75 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES FOR INDIVIDUALS UNDER AGE 21 › Subchapter 3 - EMERGENCY SAFETY INTERVENTIONS › Section 10:75-3.9 - Resident monitoring

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Clinical staff
				who have been trained in the appropriate use of restraints shall be physically
				present in order to continually evaluate and monitor the physical and
				psychological well-being of the resident being restrained throughout the
				duration of the intervention.
(b)
				Clinical staff who have been trained in the appropriate use of seclusion shall
				be continually monitoring the resident who has been placed in seclusion. The
				staff persons shall be physically present in the room or immediately outside
				the seclusion room to ensure the safety of the resident. Video monitoring shall
				not meet this requirement.
(c) If
				the emergency safety intervention continues beyond the time limit specified in
				the order given by the physician/practitioner, staff who have been authorized
				to receive the order as indicated at
				10:75-3.5 and 3.6 shall contact
				the physician/practitioner who initiated the order for further
				instructions.
(d) A physician,
				advance practice nurse, registered nurse, physician's assistant or other
				licensed practitioner trained in the use of emergency safety interventions, who
				are not precluded by regulation to conduct an evaluation, shall conduct a
				face-to-face evaluation of the physical and psychological well-being of the
				individual involved in the emergency safety intervention within one hour of the
				initiation of the intervention.
1. The
				one-hour assessment shall include, but shall not be limited to:
i. The resident's physical and psychological
				status, including the resident's behavior;
ii. The appropriateness of the intervention;
				and
iii. Any complications
				resulting from the use of the intervention.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 75 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES FOR INDIVIDUALS UNDER AGE 21 › Subchapter 3 - EMERGENCY SAFETY INTERVENTIONS › Section 10:75-3.10 - Notification of the parent(s) or legal guardian(s)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The facility
				shall notify the parent(s) or legal guardian(s) of the resident as soon as
				possible after the initiation of the intervention.
(b) Documentation shall be included in the
				resident's file, and shall include, but shall not be limited to:
1. The name of the individual
				notified;
2. The date and time of
				the notification; and
3. The
				printed name, signature and title of the staff member(s) providing the
				notification.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 75 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES FOR INDIVIDUALS UNDER AGE 21 › Subchapter 3 - EMERGENCY SAFETY INTERVENTIONS › Section 10:75-3.11 - Evaluation after the emergency safety intervention

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Immediately
				after the drug or mechanical restraint or seclusion is over, for in-State
				facilities, a physician, an advance nurse practitioner, a registered nurse or a
				physician's assistant who is trained in the use of emergency safety
				interventions shall evaluate the physical and mental condition of the resident.
				Staff may use on-call staff to perform either or both parts of the evaluation
				as long as they assure the evaluation is completed timely. Out-of-State
				facilities shall follow their state Medicaid program requirements for who shall
				perform this evaluation.
(b)
				Immediately after the personal restraint is over, for in-State facilities,
				licensed staff who are not precluded from making an evaluation of the
				well-being of the child, and who are trained in the use of emergency safety
				interventions, shall evaluate the well-being of the resident. Staff may use
				more than one staff member to perform both parts of the evaluation as long as
				they assure the evaluation is completed timely. Out-of-State facilities shall
				follow their state Medicaid program requirements for who shall perform this
				evaluation.
(c) For all emergency
				safety interventions, staff shall document the intervention no later than the
				end of the shift in which the emergency safety intervention ended.
				Documentation shall include, at a minimum:
1.
				The name of the physician/practitioner who gave the order;
2. The date and time that the order was
				given, including the name and title of who received the order;
3. The type of intervention order, including
				the length of time authorized for the use of the intervention;
4. The actual time of the initiation and
				termination of the intervention;
5.
				The actual time and results of all evaluations performed during or after the
				intervention;
6. The emergency
				safety situation that required the use of the intervention; and
7. The name, title and credentials of all
				staff involved in the intervention.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 75 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES FOR INDIVIDUALS UNDER AGE 21 › Subchapter 3 - EMERGENCY SAFETY INTERVENTIONS › Section 10:75-3.12 - Medical treatment for injuries resulting from the use of emergency safety interventions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Staff shall immediately obtain medical
				treatment from qualified medical personnel for treatment of any injury
				sustained by any individual as a result of an emergency safety
				intervention.
(b) The facility
				shall have affiliations or written transfer agreements in effect with the
				closest hospitals in the area that can provide needed treatment for the
				resident. If possible, the facility should use Medicaid/NJ
				FamilyCare-participating hospitals.
(c) The agreements or affiliations shall
				ensure that:
1. A resident will be admitted
				to the hospital when necessary for medical or acute psychiatric care;
2. Medical and other information needed for
				the care of the resident that is allowed to be exchanged in accordance with a
				State's medical privacy law will be exchanged between the two facilities;
				and
3. Services are available 24
				hours a day, seven days a week.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 75 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES FOR INDIVIDUALS UNDER AGE 21 › Subchapter 3 - EMERGENCY SAFETY INTERVENTIONS › Section 10:75-3.13 - Debriefings

Current through Register Vol. 56, No. 14, July 15, 2024
(a) As soon as
				reasonably possible, but no later than 24 hours after the incident, the staff
				members and beneficiaries involved in the incident shall have a face-to-face
				discussion. This discussion may include other staff members and/or the
				resident's legal guardians, as deemed appropriate by the facility. If the
				presence of a particular staff member would jeopardize the well-being of the
				resident, then that staff person may be excused from this discussion by
				administrative staff.
1. The discussion shall
				provide both the resident and staff an opportunity to discuss the circumstances
				resulting in the intervention, and strategies to be used by the staff, resident
				or others to prevent the future use of an intervention.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 75 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES FOR INDIVIDUALS UNDER AGE 21 › Subchapter 4 - REIMBURSEMENT › Section 10:75-4.1 - Basis of reimbursement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Reimbursement
				for PRTF services provided in accredited facilities shall be on a per diem
				rate. These rates shall be based on reasonable costs, as defined in the
				Department of Human Services' Contract Reimbursement Manual and the Contract
				Policy and Information Manual. Providers have access to these manuals as
				indicated at 10:3-3.3(e)12.
				1.
PRTFs shall submit claims only for those procedure codes
				  that correspond to the allowable services included in their Medicaid/NJ
				  FamilyCare provider application approval letter. Claims for reimbursement shall
				  be submitted on the CMS-1500 claim form to:
Molina Medicaid Solutions
PO Box 4808
Trenton, New Jersey 08650-4808
(b) The reimbursement rate shall include
				medically necessary PRTC services. These services shall include, but shall not
				be limited to:
1. Room and board
				costs;
2. Clothing that is required
				as part of a treatment regimen;
3.
				Temporary absence from the facility due to authorized therapeutic or hospital
				leave days (see
				10:75-1.6 ); and
4. Transportation necessary for treatment
				purposes.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 75 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES FOR INDIVIDUALS UNDER AGE 21 › Subchapter 4 - REIMBURSEMENT › Section 10:75-4.2 - Billing procedures

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Beginning on
				the date of admission, and for each subsequent whole day that a resident is
				under the care of the PRTF, the provider shall seek reimbursement using the
				appropriate HCPCS procedure code as defined in
				10:75-5.2.
(b) Providers shall request reimbursement for
				services provided on the date that the resident adult is admitted to the
				facility, but shall not request reimbursement for services provided on the day
				that the resident is discharged from the facility. Discharged means that the
				resident has been discharged from the facility and is not reasonably expected
				to return to the facility.
(c)
				Providers may bill for consecutive dates of service on the same claim line, but
				shall not span dates from more than one month on any given claim lime.
				Therapeutic and hospital leave days shall be indicated on separate lines and
				reimbursement shall be requested using the appropriate HCPCS code, as defined
				in 10:75-5.2.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 75 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES FOR INDIVIDUALS UNDER AGE 21 › Subchapter 5 - HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) › Section 10:75-5.1 - Introduction

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The New Jersey Medicaid/NJ FamilyCare
				program utilizes the Centers for Medicare and Medicaid Services' Healthcare
				Common Procedure Coding System (HCPCS). HCPCS follows the American Medical
				Association's Physicians' Current Procedural Terminology (CPT) architecture,
				employing a five-position code and as many as two 2-position modifiers. Unlike
				the CPT numeric design, the CMS assigned codes and modifiers contain alphabetic
				characters. HCPCS is a two-level coding system.
1. Level I Codes (Narratives found in CPT):
				These codes are adapted from the CPT for utilization primarily by Physicians,
				Certified Nurse Practitioners and Independent Laboratories. CPT is a listing of
				descriptive terms and numeric identifying codes and modifiers for reporting
				medical services and procedures performed by physicians.
i. Copyright restrictions make it impossible
				to print excerpts from the CPT procedure narratives for Level I codes. Thus, in
				order to determine those narratives, it is necessary to refer to the CPT, which
				is incorporated herein by reference, as amended and supplemented. The CPT is
				available in medical bookstores or may be obtained by contacting the American
				Medical Association at 515 North State Street, Chicago, IL 60610, telephone:
				312-464-5000, website:
www.ama-assn.org
.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 75 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES FOR INDIVIDUALS UNDER AGE 21 › Subchapter 5 - HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) › Section 10:75-5.2 - PRTF procedure codes

Current through Register Vol. 56, No. 14, July 15, 2024
IND
HCPCS Code
Mod
Description
Maximum Fee Allowance
Y9947
Mental health rehabilitation services provided in TJC or
						  DHS/DCF authorized agency accredited RTCs licensed by DCF.
Contract pricing
Y9948
Mental health rehabilitation services provided in TJC or
						  DHS/DCF authorized agency accredited PRTFs licensed by DCF.
Contract pricing
Y9949
Therapeutic Leave--TJC or DHS/DCF authorized agency
						  accredited PRTFs licensed by DCF or enrolled by the Division of Medical
						  Assistance and Health Services.
Contract pricing
Y9950
Hospital Leave--TJC or DHS/DCF authorized agency
						  accredited PRTFs licensed by the DCF or under contract with the Division of or
						  enrolled by the Division of Medical Assistance and Health Services.
Contract pricing
Y9951
Therapeutic Leave for beneficiaries residing in TJC or
						  DHS/DCF authorized agency accredited RTCs licensed by DCF.
Contract pricing
Y9952
Hospital Leave for beneficiaries residing in TJC or
						  DHS/DCF authorized agency accredited RTCs licensed by DCF.
Contract pricing
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 76 - PROGRAMS OF ASSERTIVE COMMUNITY TREATMENT (PACT) SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 10:76-1.1 - Purpose, scope, and eligibility

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of
				this chapter is to set forth the rules governing the provision of Programs of
				Assertive Community Treatment (PACT) services to New Jersey Medicaid and
				certain NJ FamilyCare-Plan A beneficiaries and NJ FamilyCare Alternative
				Benefit Plan beneficiaries.
1. Beneficiaries
				enrolled under the Medically Needy program (N.J.A.C. 10:70) are not eligible to
				receive PACT services.
2. NJ
				FamilyCare-Plans B, C, and D beneficiaries are not eligible for PACT
				services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 76 - PROGRAMS OF ASSERTIVE COMMUNITY TREATMENT (PACT) SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 10:76-1.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, as used in this chapter, shall
				  have the following meanings, unless the context clearly indicates
				  otherwise:
"Adult" means an individual age 18 and older.
"Centers for Medicare and Medicaid Services (CMS)" means the
				  agency of the Federal Department of Health and Human Services that is
				  responsible for the administration of the Medicaid program and the State
				  Children's Health Insurance Program (SCHIP) in the United States. In New
				  Jersey, the SCHIP is known as NJ FamilyCare.
"Department (DHS)" means the New Jersey Department of Human
				  Services.
"Division of Mental Health and Addiction Services (DMHAS)"
				  means the organizational component of the New Jersey Department of Human
				  Services that is responsible for the administration of the State's mental
				  health and addiction programs.
"Division of Mental Health Services (DMHS)" means the
				  organizational component of the New Jersey Department of Human Services that is
				  responsible for the administration of the State's mental health
				  programs.
"Division of Medical Assistance and Health Services (DMAHS)"
				  means the organizational component of the New Jersey Department of Human
				  Services that is responsible for the administration of the State's medical
				  assistance programs.
"National Plan and Provider Enumerations System (NPPES)"
				  means the system that assigns a provider a National Provider Identifier (NPI)
				  number, maintains and updates information about health care providers with
				  NPIs, and disseminates the NPI Registry and NPPES downloadable file. The NPI
				  Registry is an online query system that allows users to search for a health
				  care provider's information.
"National Provider Identifier (NPI)" means a unique 10-digit
				  identification number issued to health care providers by the Centers for
				  Medicare and Medicaid Services (CMS).
"Prior authorization" means approval by DMHAS before
				  services are rendered.
"Programs of Assertive Community Treatment (PACT)" means
				  mental health rehabilitative services which are delivered in a self-contained
				  treatment program, provided by a service delivery team and managed by a
				  qualified program director, that merge clinical and rehabilitative expertise to
				  provide mental health treatment, rehabilitation, and support services which are
				  individualized and tailored to the unique needs and choices of the individual
				  receiving the services.
"Provider" means an organization that has a contract with,
				  and is licensed by, the DHS to provide PACT services.
"Taxonomy code" means a code that describes the provider or
				  organization's type, classification, and the area of
				  specialization.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 76 - PROGRAMS OF ASSERTIVE COMMUNITY TREATMENT (PACT) SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 10:76-1.3 - Provider participation criteria

Current through Register Vol. 56, No. 14, July 15, 2024
(a) To participate
				in the Medicaid/NJ FamilyCare program, all providers shall be under contract
				with the Division of Mental Health and Addiction Services (DMHAS) as a provider
				of PACT services and shall meet the requirements set forth by the DMHAS related
				to PACT services in accordance with N.J.A.C. 10:37J.
(b) In order to participate in the
				Medicaid/NJ FamilyCare program, all applicants shall complete and submit the
				"Medicaid Provider Application" (FD-20) and the "Medicaid Provider Agreement"
				(FD-62), as well as a copy of their license provided by DHS, in accordance with
				N.J.A.C. 10:190, to:
Division of Medical Assistance and Health Services
Office of Provider Enrollment, Mail Code #9
PO Box 712
Trenton, New Jersey 08625-0712
(c) The applicant will receive written
				notification of approval or disapproval of Medicaid/NJ FamilyCare provider
				status from DMAHS. If approved, the applicant will be assigned a Medicaid/NJ
				FamilyCare Provider Number, and will receive a copy of this chapter as part of
				the provider manual.
(d) Prior to
				billing for PACT services, those who have previously enrolled, and are
				currently approved, as Medicaid/NJ FamilyCare providers in other categories of
				service, shall be required to enroll as a PACT provider by completing and
				submitted a new provider application and shall receive an additional, unique,
				provider identification number for submitting claims for the provision of PACT
				services.
(e) Upon approval as a
				Medicaid/NJ FamilyCare provider of PACT services, the provider shall conform to
				the provisions of this chapter and the provisions of N.J.A.C. 10:49, the
				Administration Manual for DMAHS programs.
(f) If a PACT provider loses its license from
				DHS, and is unable to provide services, the provider shall notify the Provider
				Enrollment Unit, at the address in (b) above, within five business days of
				losing the license.
1. The PACT provider will
				be disenrolled as a Medicaid/NJ FamilyCare PACT provider until such time as the
				license is restored. Once the provider's PACT license is restored by the
				Department of Human Services, the provider will be reinstated as a Medicaid/NJ
				FamilyCare PACT provider as long as the requirements of N.J.A.C. 10:37J and
				this chapter are met and continue to be met.
2. A PACT provider shall be held liable for
				recoupment of any monies paid for services during the time that they did not
				possess a valid license.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 76 - PROGRAMS OF ASSERTIVE COMMUNITY TREATMENT (PACT) SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 10:76-1.4 - Recordkeeping

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All agencies
				providing PACT services shall keep, and require individual PACT Teams to keep,
				such legible records as are necessary to fully disclose the kind and extent of
				services provided, as well as the medical necessity for such
				services.
(b) The PACT provider
				shall, at a minimum, maintain the following data in support of all payment
				claims:
1. The name of the
				beneficiary;
2. The name of the
				provider agency and the name and title of the staff person providing
				service;
3. The date(s) of
				service;
4. The length of time
				face-to-face contact was provided;
5. The name of individual(s) with whom
				face-to-face contact was maintained on behalf of the beneficiary;
i. If the person contacted refuses to give
				his or her name to the PACT team member, the team member shall document that
				refusal in the record of the contact. For example: "Spoke to the neighbor at
				(give time and date of contact) who spoke on the condition that the neighbor's
				name would not be revealed, and who said (include statement here)";
				and
6. A summary of the
				services provided.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 76 - PROGRAMS OF ASSERTIVE COMMUNITY TREATMENT (PACT) SERVICES › Subchapter 2 - PROGRAM OPERATIONS › Section 10:76-2.1 - PACT services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All PACT services shall meet the
				requirements of N.J.A.C. 10:37J, Programs of Assertive Community
				Treatment.
(b) PACT services shall
				include mental health services and related supportive services, and shall be
				provided directly by one or more of the PACT team members. Such services *may*
				include, but are not limited to, the following:
1. Emotional and/or behavioral
				treatment;
2. Individual and/or
				group interventions for substance abuse when the need exists (see
				N.J.A.C.
				10:37J-2.5(h));
3. Psychiatric treatment, including
				medication monitoring;
4.
				Psychotherapy or counseling as permitted by the provider's individual
				certification; and
5. Psychiatric
				rehabilitative services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 76 - PROGRAMS OF ASSERTIVE COMMUNITY TREATMENT (PACT) SERVICES › Subchapter 2 - PROGRAM OPERATIONS › Section 10:76-2.2 - Clinical supervision of PACT teams

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each PACT team
				shall consist of a minimum of five separate clinical disciplines, including
				psychiatry, nursing, supportive counseling, substance abuse, and rehabilitation
				or occupation/vocational services, in accordance with
				10:37J-2.8.
(b) The PACT Director shall provide
				administrative supervision and shall assure clinical oversight, as necessary,
				for the overall operation of the team, including, but not limited to,
				individual case reviews and quality assurance reviews of the clinical
				record.
(c) The PACT team
				psychiatrist, or other appropriately licensed clinical professional as
				permitted by DMHAS, shall provide supervision to the team regarding medication
				administration and monitoring for all beneficiaries served by the
				team.
(d) The clinical status of
				each beneficiary shall be reviewed by the team as a whole a minimum of 95
				percent of the regular workdays in any given calendar month. Clinical
				supervision shall be provided as needed during these daily meetings by the
				Masters-level clinician or the team psychiatrist.
1. Notes for each meeting shall be maintained
				by each PACT team and shall include, at a minimum, a list of team members who
				attended the meeting and a list of cases that were discussed. This information
				need not be included in each beneficiary's individual record except as stated
				in (f) below.
2. A record of all
				team members present at the meeting shall also be documented on an attendance
				log. The participation of any team member from an off-site location via
				conference call shall be documented and that staff person shall sign the
				documentation within 30 days of the meeting.
3. If the daily meeting does not occur on any
				given day, the reason shall be clearly documented.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 76 - PROGRAMS OF ASSERTIVE COMMUNITY TREATMENT (PACT) SERVICES › Subchapter 2 - PROGRAM OPERATIONS › Section 10:76-2.3 - Beneficiary eligibility

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Medicaid and NJ
				Family Care Plan A and NJ FamilyCare Alternative Benefit Plan beneficiaries age
				18 and older shall be eligible to receive PACT services, except for
				beneficiaries enrolled under the Medically Needy program (N.J.A.C. 10:70).
1. NJ FamilyCare-Plan A adults without
				children shall not be eligible to receive PACT. These beneficiaries are
				identified by the Program Code "70" in positions 3 and 4 of their NJ FamilyCare
				Identification Number.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 76 - PROGRAMS OF ASSERTIVE COMMUNITY TREATMENT (PACT) SERVICES › Subchapter 2 - PROGRAM OPERATIONS › Section 10:76-2.4 - PACT beneficiaries receiving other mental health services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Partial
				care/partial hospitalization (PC/PH) services shall not be available, except if
				clinically indicated and recommended by the PACT team, for up to the last 30
				days before a beneficiary terminates from PACT services. The PACT agency shall
				obtain prior authorization for services before enrolling a beneficiary in a
				PC/PH program. See
				10:76-2.5.
(b) A PACT provider shall not request
				reimbursement for PACT services delivered during the same month the beneficiary
				is also receiving integrated case management services (ICMS).
(c) A PACT provider shall not request
				reimbursement for PACT services when the beneficiary is also receiving mental
				health rehabilitation services provided in/by community residence programs
				during the same month of service. (See N.J.A.C. 10:77 and 10:77A).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 76 - PROGRAMS OF ASSERTIVE COMMUNITY TREATMENT (PACT) SERVICES › Subchapter 2 - PROGRAM OPERATIONS › Section 10:76-2.5 - Prior authorization

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No PACT services shall be provided to an
				eligible beneficiary without prior authorization. The eligible beneficiaries
				for PACT are described at
				10:76-2.3(a).
(b) For the provision of PACT services, the
				provider shall obtain prior authorization as follows:
1. The provider shall complete the "DMHAS
				PACT Referral and Intake Outcome" form to request authorization to provide PACT
				services and shall submit the form to the DMHAS Regional Office in the county
				in which the provider is located.
2. The Regional DMHAS Program Analyst will
				evaluate the eligibility of the beneficiary for PACT services in accordance
				with 10:37J-2.3(b),
				and will advise the provider of results of the evaluation.
3. Upon receipt of this approval, the
				provider shall meet with the beneficiary, enroll the beneficiary into the PACT
				program, and return the signed and dated "DMHAS PACT Referral and Intake
				Outcome" form to the DMHAS Regional Office, confirming the enrollment of the
				beneficiary into the PACT program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 76 - PROGRAMS OF ASSERTIVE COMMUNITY TREATMENT (PACT) SERVICES › Subchapter 2 - PROGRAM OPERATIONS › Section 10:76-2.6 - Reimbursement methodology

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Providers will
				be reimbursed on a fee-for-service basis for PACT services provided to an
				eligible beneficiary, as described at
				10:76-2.3(a),
				based on the lower of the provider's usual and customary charge or the
				established DMAHS contracted reimbursement rate for the service.
1. Reimbursement amounts for PACT services
				shall be determined by the Commissioner of the Department of Human
				Services.
2. The DMAHS contracted
				reimbursement rate shall be based on an average of PACT provider costs for
				billable beneficiaries, that is, those beneficiaries who meet the minimum
				service standards in PACT programs that are under contract with, and licensed
				by, the Department of Human Services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 76 - PROGRAMS OF ASSERTIVE COMMUNITY TREATMENT (PACT) SERVICES › Subchapter 3 - PROCEDURE CODES FOR REIMBURSEMENT › Section 10:76-3.1 - Introduction

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The New Jersey Medicaid/NJ FamilyCare
				programs utilize the Centers for Medicare & Medicaid Services (CMS)
				Healthcare Common Procedure Coding System (HCPCS). HCPCS follows the American
				Medical Association's Physicians' Current Procedural Terminology (CPT)
				architecture, employing a five-position code and as many as two 2-position
				modifiers. The CPT is a listing of descriptive terms and numeric identifying
				codes and modifiers for reporting medical procedures and services performed by
				physicians. Unlike the CPT numeric design, the CMS assigned codes and modifiers
				contain alphabetic characters. The New Jersey Medicaid/NJ FamilyCare program
				adopted the Centers for Medicare and Medicaid Services Healthcare Common
				Procedure Coding System codes for 2006, established and maintained by CMS in
				accordance with the Health Insurance Portability and Accountability Act of
				1996, P.L.
				104-191, and incorporated herein by reference, as
				amended and supplemented, and published by PMIC, 4727 Wilshire Blvd, Suite 300,
				Los Angeles, CA 90010. Revisions to the Healthcare Common Procedure Coding
				System made by CMS (code additions, code deletions and replacement codes) will
				be reflected in this chapter through publication of a notice of administrative
				change in the New Jersey Register. Revisions to existing reimbursement amounts
				specified by the Department and specification of new reimbursement amounts for
				new codes will be made by rulemaking in accordance with the Administrative
				Procedure Act,
				52:14B-1 et seq.
(b) HCPCS is a two-level coding system:
1. LEVEL I CODES (narratives found in CPT):
				These codes are adapted from the Current Procedural Terminology (CPT),
				incorporated herein by reference, and are utilized primarily by physicians,
				podiatrists, optometrists, certified nurse-midwives, certified nurse
				practitioners/clinical nurse specialists, independent clinics and independent
				laboratories. Copies of the CPT may be obtained from the American Medical
				Association, 515 North State Street, Chicago, IL 60610.
2. LEVEL II CODES: The narratives for Level
				II codes are found in this subchapter. These codes are not found in the CPT and
				are assigned by CMS for use by physicians and other practitioners.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 76 - PROGRAMS OF ASSERTIVE COMMUNITY TREATMENT (PACT) SERVICES › Subchapter 3 - PROCEDURE CODES FOR REIMBURSEMENT › Section 10:76-3.2 - Procedure codes and maximum fee allowance

Current through Register Vol. 56, No. 14, July 15, 2024
HCPCS
Maximum Fee
IND
Code
MOD
Description
Allowance
P
H0040
22
Comprehensive PACT
Contract
services, monthly (adults)
Pricing
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 76 - PROGRAMS OF ASSERTIVE COMMUNITY TREATMENT (PACT) SERVICES › Subchapter 3 - PROCEDURE CODES FOR REIMBURSEMENT › Appendix - FISCAL AGENT BILLING SUPPLEMENT

Current through Register Vol. 56, No. 14, July 15, 2024
AGENCY NOTE: The Fiscal Agent Billing Supplement is appended
				  as a part of this chapter but is not reproduced in the New Jersey
				  Administrative Code. The Fiscal Agent Billing Supplement can be downloaded free
				  of charge from:
www.njmmis.com
. When
				  revisions are made to the Fiscal Agent Billing Supplement, a revised version
				  will be posted on the njmmis website and copies will be filed with the Office
				  of Administrative Law.
If you do not have access to the Internet and require a copy
				  of the Fiscal Agent Billing Supplement, write to:
Gainwell Technologies
PO Box 4801
Trenton, New Jersey 08650-4801
or contact:
Office of Administrative Law
Quakerbridge Plaza, Bldg. 9
PO Box 049
Trenton, New Jersey 08625-0049
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 2 - ENVIRONMENTAL LEAD INTERVENTION SERVICES › Section 10:77-2.1 - Scope of services

Current through Register Vol. 56, No. 14, July 15, 2024
This subchapter describes the New Jersey Medicaid/NJ
				  FamilyCare program's provisions specifically pertaining to environmental lead
				  inspection/hazard assessment services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 2 - ENVIRONMENTAL LEAD INTERVENTION SERVICES › Section 10:77-2.2 - Environmental lead intervention service definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, as used in this subchapter,
				  shall have the following meanings, unless the context clearly indicates
				  otherwise.
"Certified lead inspector/risk assessor" means one who is
				  hired or contracted by the local board of health and who has completed a lead
				  inspector/risk assessor training course approved by the New Jersey Department
				  of Health and holds a valid inspector/risk assessor permit to perform
				  inspections and conduct risk assessments as defined at N.J.A.C.
				  8.62-2.1.
"Elevated blood lead level" (EBLL) means an excess of lead in
				  the bloodstream as defined in N.J.A.C. 8:51A.
"Environmental intervention" means the same as that term is
				  defined at N.J.A.C. 8:51-1.4.
"Environmental lead inspection service or hazard assessment"
				  means conducting a comprehensive assessment of "hazard assessment," pursuant to
				  N.J.A.C.
				  8:51-1.4 by a certified lead inspector/risk
				  assessor in order to identify lead hazards in the primary residence of a child
				  who is a Medicaid/NJ FamilyCare beneficiary and who is determined to have an
				  EBLL.
"High risk" means a child whose history is positive for one
				  or more of the following criteria in assessing his or her risk of high-dose
				  exposure to lead:
1. Lives in a house
				built before 1978 with leaded paint that is peeling, chipped or otherwise in a
				deteriorated condition;
2. Lives in
				a house built before 1978 with lead contaminated dust created during removal or
				disturbance of leaded paint in the process of home renovations or
				repairs;
3. Lives with a child
				being followed or treated for EBLL; and/or
4. Lives with an adult whose occupation or
				hobby involves contact with or exposure to lead or materials containing lead.
"Lead hazard" means any condition that allows access or
				  exposure to lead, in any form, to the extent that adverse human health effects
				  are possible (N.J.A.C. 8:51-1.4)
"Local board or local board of health" means any local board
				  of health, as established pursuant to
				  N.J.S.A.
				  26:1A-1, and as defined at
				  N.J.A.C.
				  8:51-1.4 and
				  8:62-2.1.
"Screening" means the taking of a blood sample from an
				  asymptomatic child, and its analysis by a medical laboratory licensed in
				  accordance with N.J.A.C 8:44, to determine if the child has elevated blood lead
				  level, as defined at
				  N.J.A.C.
				  8:51A-1.4.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 2 - ENVIRONMENTAL LEAD INTERVENTION SERVICES › Section 10:77-2.3 - Provider participation requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Requirements
				for a provider to participate in environmental lead inspection or hazard
				assessment services shall be as follows:
1.
				An applicant shall be a local board of health;
2. Each local board of health shall enroll
				and be approved by the New Jersey Medicaid/NJ FamilyCare programs specifically
				for reimbursement for this service, including local boards of health previously
				approved as Medicaid/NJ FamilyCare independent clinic providers;
3. A local board of health not previously
				approved as a Medicaid/NJ FamilyCare independent clinic provider but wishing to
				enroll as a Medicaid/NJ FamilyCare-participating provider for environmental
				lead intervention services shall complete and submit a provider application
				packet pursuant to
				N.J.A.C.
				10:49-3.2.
i. The completed application packet shall be
				submitted to:
Gainwell Technologies
Provider Enrollment
PO Box 4804
Trenton, New Jersey 08650;
ii. A provider application can be requested
				by calling 1-800-776-6334 or downloaded at
www.njmmis.com
; and
iii. The applicant shall receive written
				notification of approval or disapproval of its provider status. If approved,
				the applicant shall be assigned a Medicaid/NJ FamilyCare Provider Number and
				shall receive a packet which contains a Medicaid/NJ FamilyCare Provider Manual
				(N.J.A.C. 10:77) and the Fiscal Agent Billing Supplement
				(FABS);
4. A local board
				of health previously approved as a Medicaid/NJ FamilyCare independent clinic
				provider or a local board of health previously issued a provider number but
				requiring reactivation of its provider number, wishing to perform environmental
				lead inspection or hazard assessment services needs only to submit a request on
				local board of health letterhead to:
Division of Medical Assistance and Health Services
Office of Provider Enrollment
Mail Code #9
PO Box 712
Trenton, New Jersey 08625-0712;
5. Upon approval as a Medicaid/NJ FamilyCare
				provider, the local board of health shall conform to applicable State and
				Federal laws, rules and regulations, including, but not limited to, N.J.A.C.
				10:49 and this chapter; and
6. In
				order to participate in the New Jersey Medicaid/NJ FamilyCare Program, a local
				board of health provider shall:
i. Have a
				valid National Provider Identifier (NPI) number obtained from the National Plan
				and Provider Enumeration System (NPPES);
ii. Have a valid taxonomy code obtained from
				the NPPES; and
iii. Remain a
				provider in good standing by successfully completing provider revalidation,
				when requested by DMAHS.