New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 50 - TRANSPORTATION SERVICES MANUAL › Subchapter 1 - GENERAL PROVISIONS › Section 10:50-1.2 - 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.
"Advanced life support-Level 1" means transportation by a
				  ground ambulance vehicle licensed by the Department of Health (DOH) with the
				  provision of medically necessary supplies and services, including the provision
				  of an ALS assessment or at least one ALS intervention.
"Advanced life support-Level 2" means transportation by a
				  ground ambulance vehicle licensed by the Department of Health with the
				  provision of medically necessary supplies and services, including at least
				  three separate administrations of one or more medications by intravenous
				  push/bolus or by continuous infusion, excluding crystalloid fluids; or ground
				  ambulance transportation with the provision of medically necessary supplies and
				  services, as well as the provision of at least one of the following procedures:
				  manual defibrillation/cardioversion, endotracheal intubation, central venous
				  line, cardiac pacing, chest decompression, surgical airway, or intraosseous
				  line.
"Advanced life support assessment" means an assessment
				  performed by an ALS crew as part of an emergency response that was determined
				  necessary because the client's reported medical condition at the time of
				  dispatch was such that only an ALS crew was qualified to perform the
				  assessment.
"Advanced life support intervention" means a procedure
				  provided in accordance with New Jersey practice guidelines (see N.J.A.C. 8:41)
				  by an EMT-Paramedic, which includes, but is not limited to, basic life support
				  functions, cardiac monitoring, cardiac defibrillation, telemetered
				  electrocardiography, administration of anti-arrhythmic agents, intravenous
				  therapy, administration of specific medications, drugs and solutions,
				  utilization of adjunctive ventilation devices, or trauma care.
"Air ambulance service" means the provision of emergency or
				  non-emergency medical transportation in an aircraft (fixed wing or rotary wing)
				  certified by and operated in accord with Federal Aviation Administration
				  requirements.
"ALS" means advanced life support.
"Basic life support (BLS)-emergency" means transportation by
				  a ground ambulance vehicle licensed by DOH and the provision of medically
				  necessary supplies and services, including patient stabilization, airway
				  clearance and maintenance, cardiopulmonary resuscitation (CPR), hemorrhage
				  control, initial wound care, fracture stabilization, victim extrication, and
				  other techniques and procedures as defined in the United States Department of
				  Transportation (USDOT) EMT-Basic National Standards Curriculum (obtainable from
				  National Highway Traffic Safety Administration, Office of Emergency Medical
				  Services (NTI-140), 1200 New Jersey Avenue S.E., Washington DC 20590, by
				  accessing their website at
www.ems.gov
or by
				  calling (202) 3665440).
"Basic life support (BLS)-non-emergency" means transportation
				  by a ground ambulance licensed by DOH with the provision of medically necessary
				  supplies and services for a medically stable individual to and from a medical
				  appointment or discharge home from an inpatient medical facility.
"Beneficiary" means any person meeting the definition of that
				  term contained in
				  N.J.A.C.
				  10:49-1.3.
"Broker" means an entity under contract or agreement with the
				  Department of Human Services, pursuant to
				  N.J.A.C.
				  10:50-1.3(e), for the
				  delivery of non-emergency transportation services.
"Division" means the Division of Medical Assistance and
				  Health Services (DMAHS) in the New Jersey Department of Human Services.
"DOH" means the New Jersey Department of Health.
"Emergency condition" means an illness or injury of such
				  magnitude and gravity as to constitute an imminent threat to life or limb or
				  where there may be intractable pain.
"Ground ambulance service" means the provision of emergency
				  or non-emergency medical transportation in a vehicle that is licensed,
				  equipped, and staffed in accord with New Jersey State Department of Health
				  rules, as specified in N.J.A.C. 8:40.
"Independent transportation provider" or "provider" means an
				  air ambulance (rotary wing) service or ground ambulance service provider that
				  is enrolled and authorized in accordance with N.J.A.C. 10:49-3 and this
				  chapter. An independent transportation provider is enrolled independently from
				  any transportation broker and is reimbursed directly from the Medicaid/NJ
				  FamilyCare program on a fee-for-service basis.
"Loaded mile" means mileage accrued when a vehicle is
				  actually carrying a Medicaid/NJ FamilyCare fee-for-service beneficiary.
"Lower mode service" means non-emergency transportation,
				  reserved for sick, infirm or otherwise disabled persons who are under the care
				  and supervision of a physician and whose medical condition requires
				  transportation for medical care.
"Mobile intensive care unit (MICU)" means a specialized
				  emergency services vehicle that is licensed, equipped, and staffed in
				  accordance with DOH rules, as specified at N.J.A.C. 8:41.
"Mobility assistance vehicle (MAV)" means a specialized
				  transport vehicle that is validly licensed, equipped, staffed, and operated in
				  accordance with DOH rules regarding such vehicles at N.J.A.C. 8:40 and
				  8:41.
"Mobility assistance vehicle service" means the provision of
				  non-emergency health care transportation provided by a transportation broker
				  under contract with the Department of Human Services, in a vehicle that is
				  licensed, equipped, staffed, and operated in accordance with New Jersey State
				  Department of Health rules, as specified at N.J.A.C. 8:40, by certified trained
				  personnel, for sick, infirm or otherwise disabled individuals who are under the
				  care and supervision of a physician and whose medical condition is not of
				  sufficient magnitude or gravity to require transportation by ambulance, but
				  whose medical condition or functional ability, including, but not limited to,
				  any relevant mental/behavioral health issues or intellectual or cognitive
				  limitations, requires transportation from place to place for medical care, and
				  whose use of an alternate form of transportation, such as taxicab, bus, other
				  public conveyance or private vehicle might create a serious risk to life and
				  health.
"Modified livery transportation service" means livery service
				  or MAV service provided by a transportation broker under contract with the
				  Department of Human Services to beneficiaries under 21 years of age who require
				  supervision provided by a qualified broker-supplied attendant.
"Motor Vehicle Commission (MVC)" means the New Jersey Motor
				  Vehicle Commission.
"Multiple loading" means that more than one Medicaid/NJ
				  FamilyCare fee-for-service beneficiary is being transported in the same vehicle
				  at the same time.
"National Plan and Provider Enumerations System (NPPES)"
				  means the system that assigns NPIs, 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).
"Specialty care transport (SCT)" means ground transportation
				  of a critically injured or critically ill beneficiary between medical
				  facilities, in a ground ambulance that is licensed, equipped, staffed, and
				  operated in accordance with DOH rules, as specified at N.J.A.C. 8:41, including
				  the provision of medically necessary supplies and services, at a level of
				  service beyond the scope of the EMT-Paramedic, when such services require
				  ongoing care that must be furnished by one or more health professionals in an
				  appropriate specialty area, such as emergency or critical care nursing,
				  emergency medicine, respiratory care, cardiovascular care, or a paramedic with
				  additional training.
"Taxonomy code" means a code that describes the provider or
				  organization's type, classification, and the area of specialization.
"Transportation" means the use of an approved vehicle to move
				  a Medicaid/NJ FamilyCare fee-for-service beneficiary from place to place for
				  the purpose of obtaining a Medicaid/NJ FamilyCare-covered service.
"Transportation reimbursement allowance" means that claims
				  are paid on a fee-for-service basis, as indicated in N.J.A.C. 10:50-2,
				  Healthcare Common Procedure Coding System (HCPCS).
"Type 1 NPI" means a code that describes an individual
				  provider in the NPPES system.
"Type 2 NPI" means a code that describes an organizational
				  provider in the NPPES system.
"Waiting time" means that period of actual time, in
				  increments of 15 minutes, beginning 30 minutes following delivery of the
				  beneficiary to his or her destination, for ground ambulance and mobility
				  assistance vehicle service.