New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 1 - GENERAL PROVISIONS › Section 10:77-1.2 - General definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this chapter,
				  shall have the following meanings, unless the context clearly indicates
				  otherwise.
"Care management organization" (CMO) means an independent,
				  community-based organization that combines advocacy, service planning and
				  delivery, and care coordination into a single, integrated, cross-system
				  process, in order to assess, design, implement and manage child-centered and
				  family-focused individual service plans (ISPs) for children, youth and young
				  adults whose needs require intensive care management techniques that cross
				  multiple service systems. See N.J.A.C. 10:73.
"Centers for Medicare & Medicaid Services" (CMS) means
				  the agency of the Federal Department of Health and Human Services, which is
				  responsible for the administration of the Medicaid program and the State
				  Children's Health Insurance Program (SCHIP) in the United States.
"Child, youth, or young adult" means a Medicaid beneficiary
				  under 21 years of age or a NJ FamilyCare-Plan B or C beneficiary under 19 years
				  of age, or an individual receiving services under the Children's System of Care
				  who is not eligible for Medicaid/NJ FamilyCare who is under 21 years of
				  age.
"Children's System of Care" means the Division established
				  within the Department of Children and Families, which provides a comprehensive
				  approach to the provision of mental health/behavioral health services to
				  eligible children, youth, and young adults.
"Contracted system administrator" (CSA) means an
				  administrative organization contracted by, and serving as an agent of, the
				  Department of Children and Families to provide utilization management, care
				  coordination, quality management, and information management for the Children's
				  System of Care in its administration of the locally managed system of care that
				  provides mental and behavioral health services and supports to eligible
				  children, youth, and young adults.
"County Case Assessment Resource Team" (CART) means a team
				  which is part of a county-based interagency system of individual case planning
				  and service system development. This multi-disciplinary team reviews cases of
				  children with emotional or behavioral disturbances, who are placed
				  residentially, or at risk of psychiatric hospitalization, to determine if a
				  community-based placement is more appropriate. The CART also promotes
				  partnerships with parents, advocates across all child-serving systems and
				  coordinate services.
"Department" means the Department of Human Services
				  (DHS).
"Department of Children and Families" (DCF) means the
				  Department of New Jersey government, created by
				  P.L.
				  2006, c. 47, that has the goal of ensuring safety,
				  permanency, and well-being for all children and that has direct responsibility
				  for child welfare and other child and family services. DCF includes the
				  Division of Child Protection and Permanency, the Children's System of Care, the
				  Division of Prevention and Community Partnerships, the New Jersey Child Welfare
				  Training Academy, and the Office of Education.
"Division" means the Division of Medical Assistance and
				  Health Services (DMAHS) within the New Jersey Department of Human
				  Services.
"Division of Child Behavioral Health Services" (DCBHS) means
				  the Division established within the Department of Children and Families, which
				  provides a comprehensive approach to the provision of mental health/behavioral
				  health services to eligible children, youth and young adults.
"Family support organization" (FSO) means an independent
				  community-based organization providing services through a contract with the
				  Department of Children and Families. The FSOs are comprised of family members
				  who are involved or have been involved in the system of children's mental
				  health services and who provide direct peer support and advocacy to children
				  and families receiving services under CSOC.
"Healthcare Common Procedure Coding System" (HCPCS) means a
				  nationwide coding system, established and maintained by CMS in accordance with
				  the Health Insurance Portability and Accountability Act of 1996,
				  P.L.
				  104-191.
"Joint Commission" means the organization that evaluates and
				  accredits health care organizations and programs in the United States.
				  Information about the Joint Commission can be obtained from: Joint Committee on
				  Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook
				  Terrace, IL 60181; telephone (630) 792-5800; and on the web at
http://www.jointcommission.org/
.
"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).
"NJ FamilyCare" means the health insurance coverage program
				  administered by DMAHS under the provisions of Title XIX and Title XXI of the
				  Social Security Act, in accordance with N.J.A.C. 10:49, 10:78, and any other
				  applicable rules of the Division.
"Rehabilitative service" is an optional service that a state
				  may define to include (pursuant to
				  42 C.F.R.
				  440.130 ) medical or remedial services
				  recommended by a physician or other licensed practitioner within the scope of
				  practice under State law, for maximum reduction of physical or mental
				  disability and restoration of an individual to his or her best possible
				  functional level.
"Taxonomy code" means a code that describes the provider or
				  organization's type, classification, and the area of specialization.
"Young adult" means, for purpose of eligibility for DCF/CSOC
				  services, an individual, at least 18 years of age and under 21 years of age,
				  who had been receiving mental/behavioral health services under DCF/CSOC prior
				  to becoming 18 years of age, or who is currently receiving services in the
				  child-serving system and who demonstrates a clinical need for the continuation
				  of such services.
"Youth case management" means services provided in accordance
				  with N.J.A.C. 10:37H and 10:73 to facilitate a level of case management that
				  assists children, youth or young adults in accessing and receiving the
				  appropriate level of care, interventions and supports to maintain the optimal
				  functioning level in the community.