reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 5 - INTENSIVE IN-COMMUNITY MENTAL HEALTH REHABILITATION SERVICES › Section 10:77-5.10 - Authorization for services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Intensive
				in-community mental health rehabilitation services shall be provided only in
				conjunction with other mental health treatment, rehabilitative and social
				support services as part of an individualized service plan authorized by the
				contracted system administrator or other authorized agent of the Department of
				Human Services or Children and Families.
(b) Effective for dates of service on or
				after January 1, 2004, intensive in-community mental health rehabilitation
				services included in the individual service plan of a Medicaid/NJ
				FamilyCare-Plan A child, youth, or young adult or any other NJ FamilyCare-Plan
				child, youth, or young adult who is receiving services under Children's System
				of Care programs shall be subject to prior authorization by the CSA.
(c) Authorization for service utilization and
				continuing care shall be determined by the CSA and shall be based upon the
				individual needs of the child, youth or young adult receiving
				services.
(d) Requests for
				authorization for service utilization and continuing care shall include
				justification of the need for the level of service intervention, the frequency
				of the intervention, and the period of time the intervention is needed. Such
				justification shall be provided for the initial request as well as for each
				request for continued services beyond the initial authorization.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 5 - INTENSIVE IN-COMMUNITY MENTAL HEALTH REHABILITATION SERVICES › Section 10:77-5.11 - Reimbursement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Reimbursement for intensive in-community
				mental health rehabilitation services shall be fee-for-service, based on the
				level of service required.
(b) All
				reimbursements shall be restricted to approved Medicaid/NJ FamilyCare providers
				and are subject to all Medicaid/NJ FamilyCare regulations.
(c) Providers shall seek reimbursement for
				each separate unit of service using the appropriate Healthcare Common Procedure
				Coding System (HCPCS) for the service provided. See 10:77-7.2(e).
(d) A unit of service shall be defined as 15
				minutes of face-to-face therapeutic services provided to an individual.
				Non-consecutive shorter time periods may not be added together to total 15
				minutes.
1. Time spent providing intensive
				in-community services to a beneficiary while being transported shall be
				included in the units of service if a staff member is not the driver but
				provides the therapeutic service while in the vehicle. Travel time to and from
				the location of beneficiary contact shall not be included in the units of
				service.
2. Non-therapeutic
				services, including, but not limited to, simple transportation, mentoring,
				respite care, educational tutoring, and non-therapeutic recreational activities
				shall not be reimbursed as intensive in-community services by the Medicaid/NJ
				FamilyCare program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 5 - INTENSIVE IN-COMMUNITY MENTAL HEALTH REHABILITATION SERVICES › Section 10:77-5.12 - Recordkeeping; beneficiary information

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each
				provider entity shall maintain all beneficiary records in compliance with
				appropriate State law and rules (see 10:49-9.8 ).
(b) Providers shall keep such individual and
				legible records as are necessary to fully disclose the nature and extent of the
				services provided in accordance with all applicable Federal and State
				requirements.
(c) Providers shall
				make the records described at (a) and (b) above available to the Department of
				Human Services, the Division of Medical Assistance and Health Services, the
				Division of Mental Health and Addiction Services, the Department of Children
				and Families, the Children's System of Care, the contracted system
				administrator, or other authorized State agents, as requested.
(d) Providers shall maintain the following
				data in support of all intensive in-community mental health rehabilitation
				services claims:
1. The name and address of
				the beneficiary;
2. The name and
				credentials of the person(s) providing the service;
3. The exact date(s), location(s) and time(s)
				of service;
4. The type of the
				service(s) provided; and
5. The
				length of face-to-face contact, excluding travel time to or from the location
				of the beneficiary contact.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 5 - INTENSIVE IN-COMMUNITY MENTAL HEALTH REHABILITATION SERVICES › Section 10:77-5.13 - Outcomes

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A provider
				entity providing intensive in-community mental health rehabilitation services
				shall deliver those services in accordance with the child/youth or young
				adult's plan of care and shall participate in studies related to consumer
				satisfaction developed by the Department of Human Services, Children and
				Families or the contracted system administrator.
(b) This information shall be made available
				on a regular basis to the Department of Human Services, Children and Families
				and/or the contracted system administrator.
(c) At a minimum, the provider entity shall
				maintain a record of the following information for each beneficiary for whom
				services are provided in a manner prescribed by the Department of Human
				Services, Children and Families or the designated contract agent of either
				Department:
1. A complete service record as
				described in
				10:77-5.12(e);
2. A record of services other than intensive
				in-community mental health rehabilitation services required;
3. The frequency of staff changes for each
				beneficiary;
4. The level of
				beneficiary satisfaction for each service; and
5. The degree of improvement in the
				beneficiary's ability to function at home, in school, in the community and/or
				on the job, as applicable.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 5 - INTENSIVE IN-COMMUNITY MENTAL HEALTH REHABILITATION SERVICES › Section 10:77-5.14 - General provider recordkeeping requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Approved Medicaid/NJ FamilyCare enrolled intensive in-community mental health
				rehabilitation providers shall retain, in a secure location, and in compliance
				with all applicable Federal and State laws and regulations, confidential
				information related to the individuals providing or supervising the provision
				of services and shall produce the information for the Department of Human
				Services, Children and Families, or any authorized agents of either Department,
				in an orderly fashion on demand.
(b) For licensed clinical staff members of
				the agency, the following information shall be maintained:
1. Verifiable written documentation of the
				supervising licensed behavioral health care practitioner's credentials and any
				other adjunct staff involved with the direct administration and/or delivery of
				this service as appropriate, including, at a minimum:
i. His or her current and valid license
				number authorizing him or her to practice in New Jersey and the state where
				services are delivered; and
ii.
				Verifiable written documentation of his or her experience working with the
				target population; and
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 6 - MOBILE RESPONSE AND STABILIZATION MANAGEMENT SERVICES › Section 10:77-6.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter sets forth the manner in
				which mobile response and stabilization management services shall be provided
				to eligible children and youth up to 18 years of age and young adults 18 to 21
				receiving services under the Department of Children and Families' Children's
				System of Care, who are experiencing emotional or behavioral health challenges,
				placing them at risk of losing their current living arrangement.
(b) Mobile response services provide
				face-to-face response by a local response team 24 hours a day, 365 days a year,
				by trained professional team member(s) who is/are qualified to assess,
				stabilize the presenting crisis situation and respond to the child/youth or
				young adult's needs.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 6 - MOBILE RESPONSE AND STABILIZATION MANAGEMENT SERVICES › Section 10:77-6.4 - Staff requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Mobile response
				and stabilization management services shall be delivered directly by, or under
				the supervision of, a licensed behavioral clinician, who, at a minimum:
1. Is licensed in a behavioral health field,
				including, but not limited to: psychiatry, social work, counseling, psychology
				or psychiatric nursing;
2. Has
				three and one-half years applicable clinical and supervisory experience;
				and
3. Has the authority to
				directly provide, or supervise the provision of, these services within the
				scope of their practice, as defined by applicable New Jersey State statute and
				regulation.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 6 - MOBILE RESPONSE AND STABILIZATION MANAGEMENT SERVICES › Section 10:77-6.5 - Eligibility for services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Children, youth
				and young adults are eligible for mobile response and stabilization management
				services under this subchapter if the services have been determined necessary
				by the Department of Human Services or Children and Families, any authorized
				Division of either Department or any contracted agent of either Department
				authorized to assess the need for these services.
(b) Children, youth, or young adults are
				eligible to receive mobile response and stabilization management services as
				described in this subchapter if they are:
1.
				Covered under Medicaid/NJ FamilyCare; or
2. Are ineligible for Medicaid or any NJ
				FamilyCare program and receiving services from the Children's System of Care
				only.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 6 - MOBILE RESPONSE AND STABILIZATION MANAGEMENT SERVICES › Section 10:77-6.6 - Processing Medicaid/NJ FamilyCare eligibility applications

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All mobile
				response agencies shall designate a Medicaid presumptive eligibility (PE)
				coordinator and assure that this individual and all appropriate staff complete
				DMAHS PE training prior to completing any PE applications.
(b) Mobile response and stabilization
				management services include eligibility processing activities.
1. Mobile crisis response services shall
				include:
i. Completing a Medicaid/NJ
				FamilyCare Presumptive Eligibility (PE) application for each child, youth and
				young adult who are not Medicaid/NJ FamilyCare beneficiaries at the time of
				referral if this process has not already been initiated by another entity;
				and
ii. Submitting the completed PE
				application to DMAHS.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 6 - MOBILE RESPONSE AND STABILIZATION MANAGEMENT SERVICES › Section 10:77-6.7 - Mobile crisis response services; program description and agency responsibilities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Mobile crisis response services shall be
				provided in the first 72 hours, spanning up to four days after the initial
				referral/dispatch, and shall include, but shall not be limited to:
1. Mobile outreach services;
2. Assessment and evaluation of the
				presenting crisis that shall include an assessment of child and community
				safety, caregiver capability, and clinical risk;
3. Clinical interventions to stabilize the
				presenting crisis;
4. Temporary
				placement (not to exceed seven days) in a community residence for youth, group
				home or residential childcare facility;
5. The development of an individualized
				crisis plan (ICP); and
6. Providing
				information to the family support organization (FSO), as
				appropriate.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 6 - MOBILE RESPONSE AND STABILIZATION MANAGEMENT SERVICES › Section 10:77-6.8 - Stabilization management services; program description and agency responsibilities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Upon transition from mobile crisis
				response services, stabilization management services for children, youth, or
				young adults who are receiving services from the Children's System of Care but
				who are not receiving CMO or youth case management (YCM) services shall be
				provided by the mobile response agency in order to monitor and coordinate
				ongoing care and services.
(b)
				During the period of stabilization management services, the CSA and a
				designated representative from the mobile response agency shall review the
				individualized crisis plan (ICP), to ensure that the services included are
				effectively addressing the presenting issues. Amendments to the ICP shall be
				registered with the CSA within 24 hours.
1.
				For a child, youth or young adult who is temporarily placed in a crisis bed in
				a community residential mental health rehabilitation facility, the need for
				continued stay in the crisis bed shall be reviewed and documented by the mobile
				response agency during placement, which shall not exceed seven days, with
				appropriate amendments to the ICP as indicated.
2. For a child, youth or young adult
				receiving on-going stabilization management services, the ICP shall be reviewed
				by the mobile response agency a minimum of once per week. Stabilization
				management services shall be authorized by the CSA up to eight weeks. (See
				10:77-6.9.)
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 6 - MOBILE RESPONSE AND STABILIZATION MANAGEMENT SERVICES › Section 10:77-6.9 - Authorization for services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Initial
				response services shall be limited to 72 hours per episode, beginning at the
				start of the initial referral/dispatch and spanning up to four days, and shall
				be registered with the CSA. The CSA shall provide an authorization number upon
				registration of the initial plan, which shall be used by the mobile response
				agency when requesting reimbursement. Crisis response services may be provided
				immediately after receiving the referral from the CSA prior to receiving the
				authorization number.
(b) The
				stabilization management services provided by the mobile response agency,
				subsequent to the initial 72 hours, shall require authorization by the CSA. The
				CSA will authorize stabilization management services up to a maximum of eight
				weeks.
(c) For children, youth or
				young adults receiving care management organization (CMO) or youth case
				management (YCM) services, mobile crisis response services shall be authorized
				for the initial 72-hour period only. Stabilization management services for
				those receiving CMO or YCM services shall be included in the CMO's
				individualized service plan in accordance with
				10:73-3.12 or the individual YCM
				service plan in accordance with
				N.J.A.C.
				10:73-4.8.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 6 - MOBILE RESPONSE AND STABILIZATION MANAGEMENT SERVICES › Section 10:77-6.10 - Reimbursement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Reimbursement
				for mobile response services shall be fee-for-service. For the first 72 hours
				of service, a flat fee-for-service rate per episode shall be provided and shall
				cover all the services provided during this time period except for temporary
				placement in a community residence for youth, group home or residential
				childcare facility. Reimbursement for temporary placement shall be provided
				directly to the facility in which the child, youth or young adult is placed.
				Providers shall bill one unit of service per episode.
1. Mobile response services provided to
				children, youth or young adults who were discharged into the community from
				receiving mobile response services within three days of the last billable
				episode shall be provided by the mobile response agency without additional
				reimbursement.
2. Mobile response
				services provided to a child, youth or young adult who had been discharged from
				receiving stabilization management services shall initiate a new course of
				treatment, beginning with mobile response services, and shall be reimbursed
				accordingly.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 6 - MOBILE RESPONSE AND STABILIZATION MANAGEMENT SERVICES › Section 10:77-6.11 - Required records for each beneficiary

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each provider
				entity shall maintain all records in accordance with Department of Human
				Services contract rules (see N.J.A.C. 10:3) and in compliance with appropriate
				Federal and State laws, regulations and rules, including, but not limited to,
				10:49-9.8, and any applicable
				rules of the Department of Children and Families.
(b) Providers shall maintain any and all
				information required by the Department of Human Services, the Department of
				Children and Families, or authorized designee of either Department, or the
				contracted system administrator for services rendered to a child, youth, or
				young adult receiving services from the Children's System of Care.
(c) Providers shall maintain the following
				data in support of all mobile response services claims:
1. The name and address of the
				beneficiary;
2. The name and title
				of the individual providing the service;
3. The exact date(s), location(s) and time(s)
				of service; and
4. The length of
				face-to-face contact, excluding travel time to or from the location of the
				beneficiary contact.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 6 - MOBILE RESPONSE AND STABILIZATION MANAGEMENT SERVICES › Section 10:77-6.12 - General provider recordkeeping requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Medicaid/NJ FamilyCare enrolled mobile response agencies shall retain, in a
				secure location, and in compliance with all applicable Federal and State laws,
				rules and regulations, confidential information related to the employees
				providing mobile response services or stabilization management services as
				described in this subchapter and shall produce the information for the
				Department of Human Services, Children and Families or any State-authorized
				agents, in an orderly fashion on demand.
(b) For licensed clinical staff members of
				the agency, the following information shall be maintained:
1. Verifiable written documentation of the
				supervising licensed behavioral healthcare practitioner's credentials and any
				other adjunct staff involved with the direct administration and/or delivery of
				this service as appropriate, including, at a minimum:
i. His or her current and valid license
				number authorizing him or her to practice in New Jersey and the state where
				services are delivered; and
ii.
				Verifiable written documentation of his or her experience working with
				children; and
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 7 - CENTERS FOR MEDICARE & MEDICAID SERVICES' HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) › Section 10:77-7.1 - Introduction

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The New Jersey Medicaid NJ FamilyCare
				programs utilize the Centers for Medicare and 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. 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,
				42
				U.S.C. §§
										1320d et seq., 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. The HCPCS codes
				as listed in this subchapter are relevant to Medicaid and NJ FamilyCare
				fee-for-services rehabilitation services for children and must be used when
				filing a claim. An updated copy of the HCPCS codes may be obtained by accessing
www.njmmis.com
.
(b) HCPCS is a two-level coding system:
1. LEVEL I CODES (narratives found in CPT):
				These codes are adapted from CPT for utilization primarily by physicians,
				podiatrists, optometrists, certified nurse-midwives, certified nurse
				practitioners/clinical nurse specialists, independent clinics and independent
				laboratories. Copyright restrictions make it impossible to print excerpts from
				CPT procedure narratives for Level I codes. Thus, in order to determine those
				narratives, it is necessary to refer to CPT, which is incorporated herein by
				reference.
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 HCFA for use by physicians and other
				practitioners.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 7 - CENTERS FOR MEDICARE & MEDICAID SERVICES' HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) › Appendix - APPENDIX

Current through Register Vol. 56, No. 14, July 15, 2024
FISCAL AGENT BILLING SUPPLEMENT
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 08625-004
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77A - ADULT MENTAL HEALTH REHABILITATION SERVICES PROVIDED IN/BY COMMUNITY RESIDENCE PROGRAMS › Subchapter 1 - GENERAL PROVISIONS › Section 10:77A-1.1 - Scope and purpose

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The subchapter
				sets forth the program standards pertaining to the provision of adult mental
				health rehabilitation services provided to New Jersey Medicaid/NJ FamilyCare
				beneficiaries in/by community residence programs licensed under N.J.A.C.
				10:37A.
(b) Adult mental health
				rehabilitation services support and encourage the development and maintenance
				of appropriate skills needed by the beneficiary to ensure successful living
				within the community, reducing or eliminating the need for inpatient
				psychiatric hospitalization.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77A - ADULT MENTAL HEALTH REHABILITATION SERVICES PROVIDED IN/BY COMMUNITY RESIDENCE PROGRAMS › Subchapter 1 - GENERAL PROVISIONS › Section 10:77A-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.
"Adult" means any individual who meets the Division of
				  Mental Health and Addiction Services' criteria for adult services, as defined
				  in N.J.A.C. 10:37A.
"Advanced practice nurse (APN)" means a person currently
				  licensed to practice as a registered professional nurse who is certified by the
				  New Jersey State Board of Nursing in accordance with N.J.A.C. 13:37 and with
				  45:11-45 through 52, or similarly
				  licensed and certified by a comparable agency of the state in which he or she
				  practices.
"Community residences for mentally ill adults" as used in
				  this chapter means any community residential program licensed by, and under
				  contract with, the Division of Mental Health and Addiction Services (DMHAS) to
				  provide services in accordance with N.J.A.C. 10:37A to mentally ill adults who
				  require assistance to live independently in the community. "Community
				  residences for mentally ill adults" does not include " supportive housing
				  residences."
"Mental health rehabilitation services" means services
				  provided in/by a community residence program licensed by DMHAS, which include,
				  but are not limited to, assessment and development of a comprehensive service
				  plan and implementation of the service plan through individual services
				  coordination, training in daily living skills and supportive counseling.
"Registered professional nurse (RN)" means a person who is
				  licensed by the New Jersey Board of Nursing as a professional nurse pursuant to
				  45:11-26 and in accordance with
				  N.J.A.C. 13:37 or similarly licensed and certified by a comparable agency of
				  the state in which he or she practices.
"Supportive housing residence" means any unit of dwelling
				  space as defined at
				  10:37A-1.2.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77A - ADULT MENTAL HEALTH REHABILITATION SERVICES PROVIDED IN/BY COMMUNITY RESIDENCE PROGRAMS › Subchapter 1 - GENERAL PROVISIONS › Section 10:77A-1.3 - Provider participation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In order to
				participate in the Medicaid/NJ FamilyCare programs, all applicants shall be
				licensed by and under contract with the Division of Mental Health and Addiction
				Services (DMHAS) as a community residence for mentally ill adults in accordance
				with N.J.A.C. 10:37A.
(b) All
				providers shall complete and submit the following documents, and shall update
				the documents when the information contained therein changes, for example, when
				a new license is issued and/or when any information on the FD-20 changes:
1. "Medicaid Provider Application"
				(FD-20);
2. "Medicaid Provider
				Agreement" (FD-62);
3. A copy of a
				current and valid license from the Division of Mental Health and Addiction
				Services; and
4. "Disclosure of
				Ownership and Control Interest Statement" (CMS 1513).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77A - ADULT MENTAL HEALTH REHABILITATION SERVICES PROVIDED IN/BY COMMUNITY RESIDENCE PROGRAMS › Subchapter 1 - GENERAL PROVISIONS › Section 10:77A-1.4 - Beneficiary eligibility

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Medicaid/NJ
				FamilyCare beneficiaries shall be eligible for adult mental health
				rehabilitation (AMHR) services provided in/by community residence programs, if
				such services have been determined clinically necessary using the criteria
				established by the Division of Mental Health and Addiction Services (see
				N.J.A.C. 10:37), or as authorized by any contracted agent of the Department of
				Human Services, which authorizes clinical need for mental health services for
				adults.
(b) NJ FamilyCare-Plan G
				beneficiaries are not eligible for AMHR services provided in/by community
				residence programs. (See
				10:49-24.3 )
(c) Beneficiaries eligible as "medically
				needy" in accordance with N.J.A.C. 10:71 shall not be eligible for AMHR
				services provided in/by community residence programs.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77A - ADULT MENTAL HEALTH REHABILITATION SERVICES PROVIDED IN/BY COMMUNITY RESIDENCE PROGRAMS › Subchapter 2 - PROGRAM OPERATIONS › Section 10:77A-2.1 - Program requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Adult mental
				health rehabilitation (AMHR) services provided in/by community residence
				programs to Medicaid/NJ FamilyCare beneficiaries shall meet all program and
				licensure requirements contained in N.J.A.C. 10:37A, Community Residences for
				Mentally Ill Adults.
(b) AMHR
				services shall include, at a minimum, but are not limited to:
1. Assessment and evaluation;
2. Individual services
				coordination;
3. Training in daily
				living skills;
4. Residential
				counseling;
5. Support services;
				and
6. Crisis intervention
				counseling services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77A - ADULT MENTAL HEALTH REHABILITATION SERVICES PROVIDED IN/BY COMMUNITY RESIDENCE PROGRAMS › Subchapter 2 - PROGRAM OPERATIONS › Section 10:77A-2.2 - Levels of care

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Level A+ means community mental health
				rehabilitation services available in the community residence, or in a community
				setting, 24 hours per day, delivered by the provider.
(b) Level A means community mental health
				rehabilitation services available in the community residence or in a community
				setting at least 12 hours per day, but less than 24 hours per day, delivered by
				the provider.
(c) Level B means
				community mental health rehabilitation services available in the community
				residence, or in a community setting, at least four hours per day, but less
				than 12 hours per day, delivered by the provider.
(d) Level C means community mental health
				rehabilitation services provided in the community residence or in a community
				setting a minimum of one hour per week, but less than four hours per day,
				delivered by the provider.
(e)
				Level D means community mental health rehabilitation services available in the
				community residence, in residences not to exceed five residents, or in a
				community setting, 24 hours per day, delivered by the provider.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77A - ADULT MENTAL HEALTH REHABILITATION SERVICES PROVIDED IN/BY COMMUNITY RESIDENCE PROGRAMS › Subchapter 2 - PROGRAM OPERATIONS › Section 10:77A-2.3 - Nursing assessments

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Upon admission to an adult mental health
				rehabilitation community residence program, all beneficiaries shall receive a
				comprehensive nursing assessment, completed by a registered nurse, or higher
				level nursing professional, in addition to any and all assessments required by
				N.J.A.C. 10:37A.
(b) The initial
				nursing assessment shall be completed within 14 calendar days of admission, as
				follows:
1. The initial nursing assessment
				shall justify the need for continued mental health rehabilitation services and
				shall include a recommendation for an appropriate level of service;
				and
2. The initial nursing
				assessment shall be used in conjunction with the comprehensive intake
				assessment to develop the comprehensive service plan as required in N.J.A.C.
				10:37A.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77A - ADULT MENTAL HEALTH REHABILITATION SERVICES PROVIDED IN/BY COMMUNITY RESIDENCE PROGRAMS › Subchapter 2 - PROGRAM OPERATIONS › Section 10:77A-2.4 - Staff training

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All providers shall comply with the
				general training requirements prescribed by the Division of Mental Health and
				Addiction Services (DMHAS) at
				N.J.A.C.
				10:37D-2.14.
(b) In addition to the general training
				requirements at
				N.J.A.C.
				10:37D-2.14, each provider shall develop,
				update, and administer a comprehensive, competency-based training program for
				individuals providing adult mental health residential services.
				Competency-based training programs involve measurable skill development and
				demonstrated, documented evidence of employee skill attainment. Training in CPR
				and First Aid shall be provided by an American Heart Association (AHA) or Red
				Cross certified trainer, which, upon successful completion of the training,
				issues a certificate to the employee confirming that competency was achieved.
				The DMHAS will be responsible for monitoring the provider's training programs.
				The following topics, at a minimum, shall be included in the training
				curriculum:
1. Overview to adult mental
				health rehabilitation services, including, but not limited to:
i. Psychiatric rehabilitation;
ii. Resident populations;
iii. Working with persons with mental
				illness;
iv. Continuum of care and
				discharge orientation;
v.
				Professional ethics and boundaries; and
vi. Confidentiality;
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77A - ADULT MENTAL HEALTH REHABILITATION SERVICES PROVIDED IN/BY COMMUNITY RESIDENCE PROGRAMS › Subchapter 2 - PROGRAM OPERATIONS › Section 10:77A-2.5 - Basis of reimbursement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Reimbursement
				for AMHR services provided in or by community residence programs to eligible
				Medicaid and NJ FamilyCare beneficiaries shall be based on the site-specific
				levels of care delivered by each provider, in accordance with this
				chapter.
(b) Reimbursement will be
				on a fee-for-service basis for each level of care, billable in either per-diem
				or quarter-hour units of service as applicable and as enumerated in this
				chapter and the billing supplement to this chapter. The rates shall be
				all-inclusive and shall be based on the range of services included in the
				service definition. The fee shall not include non-treatment and/or
				non-rehabilitation-related services, including, but not limited to, room and
				board, recreational and vocational services.
(c) Providers will be reimbursed on a per
				diem basis for services provided by all Level A+, A and D programs and those
				Level B programs that are group homes.
1.
				Providers shall seek reimbursement only for the dates that the beneficiary:
i. Received services;
ii. Was documented as being under the care of
				the facility; and
iii. Was
				physically present in the facility during at least part of the 24-hour period
				starting and ending at midnight.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77A - ADULT MENTAL HEALTH REHABILITATION SERVICES PROVIDED IN/BY COMMUNITY RESIDENCE PROGRAMS › Subchapter 2 - PROGRAM OPERATIONS › Section 10:77A-2.6 - Recordkeeping

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All community
				residences for mentally ill adults shall 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, and the place, date and the total
				units of service that were provided.
(b) Recordkeeping for AMHR services shall
				include clinical records and reports for each individual beneficiary. These
				reports shall cover the medical, nursing, social and health-related care
				rendered to the beneficiary, in accordance with accepted professional
				standards.
(c) The provider shall
				maintain, at a minimum, the following documentation in support of all claims
				for payment:
1. The name of the
				beneficiary;
2. The date(s) of
				service(s);
3. The type(s) of
				service(s) provided;
4. The name of
				the residential program providing the service and the specific location that
				the service was provided; and
5.
				Appropriate service documentation:
i. For
				services reimbursed on a per diem basis, documentation shall include a daily
				census of the residence and proof of staffing levels consistent with the level
				of care.
ii. For services
				reimbursed on a per quarter-hour basis documentation shall include the time of
				arrival and departure of the staff member, the total amount of time the
				Medicaid-reimbursable service(s) were provided, the name(s) of the staff
				rendering the service(s) and the name of the resident(s) receiving the
				service(s).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77A - ADULT MENTAL HEALTH REHABILITATION SERVICES PROVIDED IN/BY COMMUNITY RESIDENCE PROGRAMS › Subchapter 3 - HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) › Section 10:77A-3.1 - Introduction

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The New Jersey Medicaid/NJ FamilyCare
				programs use the Centers for Medicare and 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 may contain
				alphabetic characters.
(b) HCPCS is
				a two-level coding system, as follows:
1.
				LEVEL I CODES (narratives found in the CPT): These codes are adapted from the
				Physicians Current Procedural Terminology, as amended and supplemented,
				published by the American Medical Association, 515 N. State Street, Chicago, IL
				60610, incorporated herein by reference. The CPT codes are used primarily by
				physicians, podiatrists, optometrists, certified nurse-midwives, advanced
				practice nurses, independent clinics and independent laboratories. Copyright
				restrictions make it impossible to print substantial excerpts from CPT
				procedure narratives for Level I codes. Thus, in order to determine those
				narratives, it is necessary to refer to the CPT.
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 77A - ADULT MENTAL HEALTH REHABILITATION SERVICES PROVIDED IN/BY COMMUNITY RESIDENCE PROGRAMS › Subchapter 3 - HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) › Section 10:77A-3.2 - HCPCS codes and maximum fee allowance schedule for adult mental health rehabilitation services provided in/by community residence programs

Current through Register Vol. 56, No. 14, July 15, 2024
Maximum
HCPCS
Fee
Code
MOD
Definition
Allowance
Z7333
Adult MH Rehab. Svcs.
$
						  164.00
Level A+ Group Home
(per diem)
Z7333
52
Adult MH Rehab.
						  Svcs.
$ 164.00
Level A+ Supervised
Apartment (per diem)
Z7334
Adult MH Rehab. Svcs.
$
						  131.00
Level A Group Home
(per diem)
Z7334
52
Adult MH Rehab.
						  Svcs.
$ 66.00
Level A Supervised
Apartment (per diem)
Z7335
Adult MH Rehab. Svcs.
$
						  102.00
Level B Group Home
(per diem)
Z7335
52
Adult MH Rehab.
						  Svcs.
$ 3.75
Level B Supervised
($ 15.00/hour)
Apartment
(per 15 minutes)
Z7336
Adult MH Rehab. Svcs.
$ 3.75
Level C Group Home
($ 15.00/hour)
(per 15 minutes)
Z7336
52
Adult MH Rehab.
						  Svcs.
$ 3.75
Level C Supervised
($ 15.00/hour)
Apartment
(per 15 minutes)
Z7337
Adult MH Rehab. Svcs.
$
						  40.00
Level D
(per diem)
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 78 - NJ FAMILYCARE › Subchapter 1 - INTRODUCTION › Section 10:78-1.1 - Program outline

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This chapter
				contains the criteria for NJ FamilyCare eligibility for certain uninsured
				parents, caretakers and caretaker relatives and children not eligible under the
				provisions of N.J.A.C. 10:69, AFDC-Related Medicaid, and 10:79, NJ FamilyCare
				Children's Program, as well as certain uninsured single individuals and couples
				without dependent children not eligible under the provisions of N.J.A.C. 10:90,
				Work First New Jersey Program. Prior to June 15, 2002, NJ FamilyCare also
				provided subsidized health insurance to those legal immigrants who were
				lawfully admitted for permanent residence and who met all other qualifications
				under the provisions of N.J.A.C. 10:69, 10:72 and 10:79, but for the Federal
				immigrant residency restrictions. After June 14, 2002, no applications were
				accepted from individuals who were parents, caretakers and caretaker relatives.
				As of September 1, 2005, the program was reopened to new applicants who were
				parents, or caretakers, of dependent children under the age of 19 and who meet
				the eligibility criteria contained in
				10:78-3.4(a)6 
				and this chapter. For all applications received after February 28, 2010, all
				programs under this chapter are closed to any enrollments of, or benefits for,
				parents and caretakers whose benefits are not funded or payable under Title XIX
				of the Social Security Act. Therefore, such applications for such persons will
				not be processed for enrollment. Additionally, on and after April 1, 2010,
				applicants or beneficiaries who are adult restricted aliens, as defined at
				10:78-3.2, are ineligible for
				enrollment in, or benefits from, the NJ FamilyCare Program and any other
				program under this chapter, except as allowed pursuant to
				10:78-3.2(e)2;
				this termination of enrollments and benefits does not apply to individuals who
				are pregnant women or children under the age of 19.
(b) Individuals financially ineligible for
				Medicaid under the provisions of N.J.A.C. 10:71, 10:72 or 10:69 and who are
				income ineligible for FamilyCare under the provisions of this chapter shall be
				evaluated for eligibility as Medically Needy under the provisions of N.J.A.C.
				10:70.
(c) Eligibility under the
				provisions of this chapter shall be limited to those individuals not otherwise
				eligible for Medicaid or NJ FamilyCare, including:
1. Parents and caretakers of children under
				the age of 19, as described and limited at
				10:78-3.4;
2. Pregnant women whose income is over 185
				percent, but does not exceed 200 percent, of the Federal poverty level
				(FPL);
3. Immigrant pregnant women
				lawfully admitted for permanent residence who would be eligible for Medicaid
				but for Federal immigrant residency restrictions;
4. Single individuals and couples without
				dependent children; and
5. Children
				under the age of 21.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 78 - NJ FAMILYCARE › Subchapter 1 - INTRODUCTION › Section 10:78-1.2 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of
				the rules contained within this chapter is to:
1. Set forth eligibility criteria for the NJ
				FamilyCare program; and
2. Specify
				the rights and responsibilities of program applicants and
				beneficiaries.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 78 - NJ FAMILYCARE › Subchapter 1 - INTRODUCTION › Section 10:78-1.4 - Principles of administration

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				principles of administration apply in the NJ FamilyCare program.
1. Opportunity to make application shall be
				as follows:
i. Any individual who believes he
				or she is eligible shall be afforded an opportunity to make application (or
				reapplication) for the NJ FamilyCare program without delay.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 78 - NJ FAMILYCARE › Subchapter 1 - INTRODUCTION › Section 10:78-1.5 - Confidentiality of information

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No member,
				officer, or employee of the eligibility determination agency shall produce or
				disclose any confidential information to any person except as authorized below.
1. Information considered confidential shall
				include, but shall not be limited to, the following:
i. Names and addresses;
ii. Medical services provided;
iii. Social and economic conditions and
				circumstances;
iv. Eligibility
				determination agency evaluation of personal information; and
v. Medical data, including diagnosis and past
				history of disease or disability.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 78 - NJ FAMILYCARE › Subchapter 1 - INTRODUCTION › Section 10:78-1.6 - Materials distributed to NJ FamilyCare applicants or beneficiaries

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All materials
				distributed to program applicants or beneficiaries shall:
1. Directly relate to the administration of
				the NJ FamilyCare program;
2. Have
				no political implications;
3.
				Contain names only of individuals directly connected with the administration of
				the NJ FamilyCare program; and
4.
				Identify those individuals only in their capacity with the State or the
				eligibility determination agency.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 78 - NJ FAMILYCARE › Subchapter 1 - INTRODUCTION › Section 10:78-1.7 - Nondiscrimination

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Discrimination
				on the basis of race, color, national origin, age, or disability shall be
				prohibited.
(b) All persons seeking
				or receiving FamilyCare benefits shall be afforded an opportunity to file a
				complaint alleging discrimination. Such complaints may be filed directly with
				the Director, Division of Medical Assistance and Health Services, PO Box 712,
				Trenton, New Jersey 08625-0712.
(c)
				In any instance in which a complaint of alleged discrimination is filed with a
				State or county agency, the complaint shall be forwarded immediately to the
				Director, Division of Medical Assistance and Health Services. The Director,
				upon receipt of any such complaint, shall take any such action he or she deems
				appropriate to the situation. This action may include, but shall not be limited
				to, the securing of reports from whatever sources have knowledge pertinent to
				the situation and referral to the Division on Civil Rights of the New Jersey
				Department of Law and Public Safety for investigation, evaluation, and
				recommendation by that agency.
(d)
				The eligibility determination agency shall afford full cooperation in the
				investigation of complaints of discrimination as may be requested by the State
				Division of Medical Assistance and Health Services, or the State Division on
				Civil Rights.