reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 70 - CHIEF STATE MEDICAL EXAMINER RULES › Subchapter 3 - REPORTS AND RECORDS › Section 8:70-3.1 - Release of records

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The records that are
				required by law to be made, maintained or kept by the County or State Medical
				Examiner are the Report of Investigation by Medical Examiner, the inventory of
				property of value, the autopsy report, including its findings and conclusions, and
				the results of external examinations upon the bodies of deceased persons. Not
				included within this definition are any records or portions thereof which contain
				opinions, subjective evaluations or critical analyses.
(b) The medical examiner shall, upon request, make
				available for inspection during regular business hours the records required to be
				made, maintained or kept as defined by (a) above and shall produce copies of the
				requested records upon payment of such reasonable fee as may be provided by this
				chapter, except as otherwise provided by:
1. The
				Right to Know Law,
				N.J.S.A.
				47:1A-1 et seq.;
2. Laws covering confidentiality of records such
				as the AIDS Assistance Law, N.J.S.A. 5C-1 et seq.;
3. Any other law requiring confidentiality of
				records;
4. The status of an ongoing
				investigation as defined by Executive Order No. 123(1985); or
5. Whenever medical examiner's records are not yet
				complete.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 70 - CHIEF STATE MEDICAL EXAMINER RULES › Subchapter 3 - REPORTS AND RECORDS › Section 8:70-3.2 - Fees for copies of records

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The fee
				to be charged for copies of records supplied by the offices of the State Medical
				Examiner or county medical examiners, shall be $ 2.00 per page for each report or
				proof of death.
(b) The minimum fee for
				an autopsy report, regardless of the number of pages, shall be $ 10.00.
(c) All fees collected by the medical examiner
				shall be paid into the county or State treasury on or before the 10th day of each
				month.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 70 - CHIEF STATE MEDICAL EXAMINER RULES › Subchapter 3 - REPORTS AND RECORDS › Section 8:70-3.3 - Filing of Reports

Current through Register Vol. 56, No. 14, July 15, 2024
(a) It shall be the
				responsibility of the county medical examiner and the State Medical Examiner to
				maintain on permanent file, full and complete records of every death investigation
				conducted by their respective offices, indexed by date of report of death, name of
				decedent, and sequential case number.
(b) The standard "Report of Investigation by
				Medical Examiner" shall be filed in the office within one working day on every death
				reported to the county medical examiner's office.
1. These reports shall be forwarded to the State
				Medical Examiner and the county prosecutor twice monthly on the first and 15th day
				of the month.
2. The medical examiner on
				duty shall personally sign the Report of Investigation by Medical Examiner and shall
				be responsible for the information therein contained.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 70 - CHIEF STATE MEDICAL EXAMINER RULES › Subchapter 4 - MORGUES AND LABORATORIES › Section 8:70-4.1 - Morgue storage; facilities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The county
				medical examiners shall be responsible to establish and maintain refrigerated
				storage space for dead bodies sufficient to the needs of the population and area of
				the jurisdiction served. In every such morgue, there shall be kept a bound register
				of all bodies, their origin, and disposition.
(b) The county medical examiner shall be
				responsible for maintaining a regular and continuous access to facilities for the
				examination, dissection, and storage of dead bodies under investigation, and for
				such histologic, radiographic, toxicologic, microbiologic, dental, photographic, and
				anthropologic examinations, and other studies as may be required to establish and
				document the cause and manner of death, to establish the identity of the deceased,
				or to further the investigation of events contributing to the death.
(c) If the county medical examiner shall be unable
				to provide the essential facilities and services described above, it shall be the
				responsibility of said medical examiner to call upon the State Medical Examiner for
				assistance at county expense.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 70 - CHIEF STATE MEDICAL EXAMINER RULES › Subchapter 5 - INVESTIGATIONS › Section 8:70-5.1 - Death investigations; conduct

Current through Register Vol. 56, No. 14, July 15, 2024
(a) It
				shall be the responsibility of the county medical examiners to have a legally
				authorized physician medical examiner on duty and available at all times to
				investigate deaths occurring within the jurisdiction of such county or
				counties.
(b) The duty medical examiner
				shall require a proper determination of death prior to assuming responsibility for
				the death investigation.
(c) The duty
				medical examiner shall take complete charge of every body whose death is reported to
				the office, and shall not release it to the next of kin or authorized representative
				for burial or cremation until sufficient information has been accumulated, proper
				specimens and evidence have been collected as needed, and appropriate examinations
				have been conducted to establish the cause and manner of death and the identity of
				the decedent.
1. In cases of suspected criminal
				homicide, the medical examiner shall coordinate with the county prosecutor or
				Attorney General the removal of the body from the scene of death and shall not order
				the removal of the body from said scene until such coordination has been
				accomplished.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 70 - CHIEF STATE MEDICAL EXAMINER RULES › Subchapter 6 - DEATH CERTIFICATION › Section 8:70-6.1 - Medical examiner certification and amendments

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				It shall be the responsibility of the medical examiner to require the proper
				identification of the decedent for the death certificate. This may be accomplished
				by visual recognition of the decedent's body by next of kin or friend when the
				decedent's body is in recognizable condition. "Friend" means any person who, prior
				to the decedent's death, maintained close contact with the decedent sufficient to
				render that person knowledgeable with the decedent's activities, and who presents a
				sworn statement or affidavit stating the facts and circumstances upon which the
				claim that the person is a friend is based. Identification may also be made by a
				combination of scientific means, circumstances, and personal effects if the deceased
				is not in recognizable condition.
(b) It
				shall be the responsibility of the medical examiner who issues a death certificate
				to conduct personally a complete physical examination of at least the external
				surfaces of the unclothed dead body and to make a full and complete description of
				this examination and to file it with the Office of the State Medical Examiner. The
				clothing and personal effects shall be viewed and an inventory prepared, and a
				receipt shall be obtained upon release from the medical examiner's
				custody.
(c) The medical examiner shall
				personally sign the death certificate after examining the body, as required by law,
				and shall be responsible for the truthfulness and accuracy of the medical
				information herein contained.
(d) It
				shall be the responsibility of the medical examiner to supply all additional
				information required by the State Registrar for the completion of pending death
				certificates within a reasonable period not to exceed 120 days, on the forms
				provided by the Registrar, except for extenuating circumstances.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 70 - CHIEF STATE MEDICAL EXAMINER RULES › Subchapter 6 - DEATH CERTIFICATION › Section 8:70-6.2 - Notification of death from contagious, infectious, or communicable diseases

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When a medical
				examiner who makes the actual determination and pronouncement of death determines or
				has actual knowledge that the deceased person was infected with human
				immunodeficiency virus (HIV) or hepatitis B virus or that the deceased person
				suffered from acquired immune deficiency syndrome (AIDS), AIDS related complex (ARC)
				or any contagious, infectious, or communicable disease as may be determined by the
				Commissioner of the Department of Health, he or she shall immediately place with the
				remains written notification of the condition and shall provide written notification
				to the funeral director who is responsible for the handling and disposition of the
				body.
(b) Notification provided funeral
				directors pursuant to this section shall be made on a form prescribed or designated
				by the State Medical Examiner and shall contain a portion which provides for
				acknowledgment of such notification by the funeral director or his or her authorized
				representative.
(c) Whenever the medical
				examiner establishes a new diagnosis or confirms a suspected diagnosis of human
				immunodeficiency virus (HIV) infection by autopsy, he or she shall complete the HIV
				Confidential Case Report of the New Jersey Department of Health, and forward it to:
New Jersey Department of Health
PO Box 363
Trenton, New Jersey 08625-0363
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 70 - CHIEF STATE MEDICAL EXAMINER RULES › Subchapter 7 - ELIGIBILITY STANDARDS › Section 8:70-7.1 - Eligibility standards of county medical examiner, deputy or assistant county medical examiner, and forensic pathologist

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any
				person appointed or reappointed to the position of county medical examiner pursuant
				to N.J.S.A. 52:17B-83, deputy or assistant county medical examiner pursuant to
				N.J.S.A. 52:17B-84, or forensic pathologist authorized by the State Medical Examiner
				pursuant to N.J.S.A. 52:17B-88, on or after the effective date of this subchapter
				shall be a physician fully licensed in the State of New Jersey of recognized ability
				and good standing in his or her community, and shall have met the following
				standards relating to prior training and experience:
1. Successful completion of a minimum of 30 hours
				of basic education in death investigation conducted or sponsored by the Armed Forces
				Institute of Pathology, the American Society of Clinical Pathologists, the College
				of American Pathologists, the National Association of Medical Examiners, or an
				institution of higher education or other agency approved by the State Medical
				Examiner.
i. In addition, all persons appointed or
				reappointed to the position of county medical examiner pursuant to N.J.S.A.
				52:17B-83on or after the effective date of this subchapter who are to serve in the
				capacity of "County Medical Examiner", in addition to the above educational
				requirement, shall have completed a minimum of 20 hours of advanced education in
				death investigation conducted or sponsored by the Armed Forces Institute of
				Pathology, the American Society of Clinical Pathologists, the College of American
				Pathologists, the National Association of Medical Examiners, or an institution of
				higher education or other agency approved by the State Medical
				Examiner.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 70 - CHIEF STATE MEDICAL EXAMINER RULES › Subchapter 8 - ENFORCEMENT › Section 8:70-8.1 - Enforcement of eligibility standards

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If any
				person appointed to or holding the position of, or being a candidate for appointment
				to, the position of county medical examiner, deputy or assistant county medical
				examiner or forensic pathologist, authorized by the State Medical Examiner to
				perform autopsies, pursuant to N.J.S.A. 52:17B-88, does not meet any of the
				eligibility standards set forth in N.J.A.C. 8:70-7, the State Medical Examiner shall
				declare him or her ineligible to perform the duties prescribed in N.J.A.C. 8:70-7
				and the person shall cease to perform those duties pending a hearing and final
				resolution. If any such person fails to comply with any other provisions of the
				State Medical Examiner Act or administrative rules pertaining thereto, the State
				Medical Examiner shall declare him or her ineligible to perform the duties
				prescribed in N.J.A.C. 8:70-7 and the person shall cease to perform those duties
				pending a hearing and final resolution.
(b) If any county medical examiner, deputy or
				assistant county medical examiner or forensic pathologist authorized by the State
				Medical Examiner to perform autopsies, pursuant to N.J.S.A. 52:17B-88, having met
				the eligibility standards set forth in N.J.A.C. 8:70-7, has been demonstrated
				professionally incompetent to perform the duties of his or her office, the State
				Medical Examiner shall declare him ineligible to perform the professional duties of
				his or her office, or shall restrict the level of professional duties in accordance
				with the demonstrated level of professional competence of the examiner.
(c) As soon as practicable but no later than seven
				days from the date of the declaration of ineligibility or restriction of the duties,
				the State Medical Examiner shall give written notice of the declaration of
				ineligibility or restriction to the governing body of the county which appointed or
				is considering appointment of the officer.
(d) Any proceeding brought under this subchapter
				shall provide the county medical examiner, deputy or assistant county medical
				examiner or designated forensic pathologist with notice of the charges against him
				or her and afford him or her an opportunity to be heard, which shall conform with
				the provisions applicable to contested cases set forth in the Administrative
				Procedure Act, P.L. 1968, c.410 (N.J.S.A.
				52:14B-1 et seq.); P.L. 1978, c.67 (N.J.S.A.
				52:14-1 et seq.), and N.J.A.C. 1:1.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 8:85-1.1 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
This chapter addresses the provision of quality, cost-prudent
				  health care services available to New Jersey Medicaid eligible children and adults
				  in a nursing facility (NF) and addresses the provision of and reimbursement for
				  services required to meet the individual's medical, nursing, rehabilitative and
				  psychosocial needs to attain and maintain the highest practicable mental and
				  physical functional status. The following subchapters specifically address nursing
				  facility services. However, the Fiscal Agent Billing Supplement continues to apply
				  to all government psychiatric hospitals, inpatient psychiatric services and programs
				  in long term care facilities. These other types of facilities are addressed for
				  regulatory and administrative matters in the appropriate chapters elsewhere in Title
				  10 of the New Jersey Administrative Code.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 8:85-1.4 - Private pay

Current through Register Vol. 56, No. 14, July 15, 2024
(a) NFs which are
				approved for participation as providers of service under the New Jersey Medicaid
				program shall be prohibited under Section 6(a) of P.L. 1985, c. 303 from soliciting
				or accepting payment, any type of gift, money, contribution, donation or other
				consideration as a condition of admission or continued stay from a Medicaid
				recipient or his or her family.
(b) NFs
				which are providers of service under the New Jersey Medicaid program shall be
				prohibited under Section 6(b)(c) of P.L. 1985, c. 303 from requiring private pay
				contracts from Medicaid qualified applicants as a condition for admission or
				continued stay.
1. The prohibitions in (a) and (b)
				above are applicable regardless of the Medicaid occupancy level in a facility. A
				violation may be a criminal act punishable as a crime of the third degree.
2. The exception to the above is private pay
				contracts entered into with life-care communities that are explicitly referenced as
				such within their Medicaid participation agreement.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 8:85-1.6 - Termination of a Medicaid NF provider agreement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department shall
				terminate a NF's Medicaid provider agreement if:
1. The Long-Term Care Licensing and Certification
				Program of the Department or the Centers for Medicare & Medicaid Services (CMS)
				determines that the NF is no longer certified to provide NF services. In that case:
i. The Medicaid provider agreement shall be
				terminated 23 days from the survey date if the Long Term Care Licensing and
				Certification Program of the Department or the CMS finds that deficiencies pose
				immediate jeopardy to residents' health and safety.
ii. If the deficiencies do not pose immediate
				jeopardy to the resident's health and safety, the Medicaid provider agreement shall
				be terminated 180 days from the survey date.
iii. The termination of provider agreement shall
				be rescinded if, prior to the effective date of termination, the Long Term Care
				Licensing and Certification Program of the Department or the CMS determines that the
				deficiencies have been satisfactorily corrected and the NF is certified to provide
				NF services; and
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 8:85-1.7 - Administrative appeal of denial, termination or non-renewal of NF certification or Medicaid Provider Agreement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any NF whose
				certification or Medicaid Provider Agreement is denied, terminated or not renewed
				shall have the opportunity to request a full evidentiary hearing before an
				administrative law judge, in accordance with the New Jersey Administrative Procedure
				Act, 52:14B-1 et seq., and the Uniform
				Administrative Procedure Rules, N.J.A.C. 1:1.
1.
				In order to obtain a hearing, the NF shall submit, within 20 days from the date of
				the letter proposing termination, a written request to the Division of Long Term
				Care Systems, Office of Program Compliance, PO Box 367, Trenton, New Jersey
				08625-0367.
2. All hearings requested
				pursuant to this section shall be completed either before the effective date of the
				denial, termination or non-renewal, or within 120 days thereafter.
3. If the Division elects to provide a hearing
				after the effective date of denial, termination or non-renewal, the NF will be
				entitled to an informal reconsideration to be completed prior to the effective date
				of the denial, termination or non-renewal.
4. The informal reconsideration, if requested by
				the NF, will include the following:
i. Written
				notice by the Division to the NF outlining the findings upon which the denial,
				termination or non-renewal is based;
ii.
				Notice that the NF is allowed a reasonable opportunity to refute the findings in
				writing; and
iii. A written affirmation
				or reversal of the denial, termination or non-renewal.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 8:85-1.8 - Pre-Admission Screening (PAS), admission and authorization

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to
				30:4D-17.1 0, a Medicaid-participating
				NF shall not admit an individual who is financially eligible for Medicaid or who may
				become financially eligible for Medicaid within 180 days of admission to the NF, or,
				regardless of payment source, an individual with MI or MR/Related Condition (RC),
				unless professional staff designated by the Department have completed a Level I
				PASRR for the individual and the individual is determined clinically eligible for NF
				placement.
1. An individual who is financially and
				clinically eligible for Medicaid residing in a Medicaid-participating NF who is
				transferred to an acute care hospital shall not be subject to PAS prior to returning
				to the same or another NF.
2. If an
				individual who is financially and clinically eligible for Medicaid identified as
				having MI residing in a Medicaid-participating NF is admitted to a psychiatric unit
				for treatment for less than one year, the individual shall not be subject to PASRR
				prior to returning to the NF.
3. When an
				NF resident with MI or MR/RC is transferred to another NF, the admitting NF shall be
				responsible for ensuring that a copy of the resident's current PASRR determination,
				MDS (see 8:39-11.2(e)  ) and
				HSDP (N.J.A.C. 8:85 Appendix L, incorporated herein by reference) accompany the
				transferring resident.
4. If the Level I
				PASRR required by this subsection is positive, professional staff designated by the
				Department shall refer the individual to either DDD or DMHS for completion of a
				Level II evaluation and determination.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 8:85-1.9 - Waiting list

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The NF shall
				establish a single waiting list in chronological order. The order of names shall be
				predicated upon the order in which a completed written application is received.
				Hospitalized individuals ready for readmission to the NF are to be added to the top
				of the list as soon as the hospital notifies the NF of the contemplated discharge.
				As soon as a bed becomes available, it shall be filled from this waiting list.
				Provisions can be made for emergency, life-threatening situations or life-care
				community admissions or transfers from another nursing facility.
1. The NF shall meet the following requirements:
i. Maintain only one waiting list; this list shall
				reflect a roster updated on a regular basis, of all individuals who have applied for
				admission to the facility;
ii. Reflect
				in chronological order the full name and address of the individual applying by the
				date the written application for admission is made;
iii. Utilize the waiting list to admit individuals
				on a first-come, first-serve basis in the order in which they apply until the
				provider's Medicaid occupancy level equals the Statewide occupancy level, or the
				Medicaid occupancy level set forth in the provider's Certificate of Need, whichever
				is higher.
iv. A file shall be
				maintained containing full documentation to support any valid reason why the
				individual whose name appears first on the waiting list is not admitted to the
				NF.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 8:85-1.10 - Involuntary transfer

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department
				recognizes that there may be problems in relocating infirm aged persons from a NF.
				The purpose of this rule is to specify the circumstances in which the involuntary
				transfer of a Medicaid beneficiary in a NF is authorized and to establish conditions
				and procedures designed to minimize the risks, trauma and discomfort which may
				accompany the involuntary transfer of a Medicaid beneficiary from a NF.
(b) This rule shall be interpreted consistent with
				the Federal requirement that care and service under the Medicaid program be provided
				in a manner consistent with the best interests of the resident.
(c) This rule shall apply to the involuntary
				transfer of a Medicaid beneficiary at the request of a NF. This rule shall not apply
				to the Department's utilization review process, nor to the movement of a Medicaid
				beneficiary to another bed within the same facility.
(d) A transfer of a Medicaid beneficiary which was
				not consented to or requested by the beneficiary or by the beneficiary's family or
				authorized representative shall be considered an involuntary transfer. A Medicaid
				beneficiary is a Medicaid eligible individual residing in a NF which has a Medicaid
				provider agreement. This includes Medicaid beneficiaries over the minimum number
				stipulated in the agreement or an individual who had entered the facility as
				non-Medicaid and is awaiting resolution of Medicaid eligibility.
(e) A Medicaid beneficiary shall only be
				involuntarily transferred when adequate alternative placement, acceptable to the
				Department, is available. A Medicaid beneficiary may be transferred involuntarily
				only for the following reasons:
1. The transfer is
				required by medical necessity;
2. The
				transfer is necessary to protect the physical welfare or safety of the beneficiary
				or other residents;
3. The transfer is
				required because the resident has failed, after reasonable and appropriate notice,
				to reimburse the NF for a stay in the facility from his/her available income as
				reported on the PA-3L; or
4. The
				transfer is required by the New Jersey State Department of Health and Senior
				Services pursuant to licensure action or to the facility's suspension or termination
				as a Medicaid provider.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 8:85-1.12 - Clinical audit and MDS verification

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Clinical audit is a
				method of utilization control under the enforcement authority of Section
				1902(a)(30)(A) of the Social Security Act, to monitor the continued utilization of
				and payment for NF care and services reimbursable under the Medicaid program.
				Clinical audit has as its major component verification of NF services
				provision.
(b) In order to validate that
				the direct care component of the rate is supported by medical record documentation
				and accurately coded and submitted, the Department shall conduct a periodic MDS
				verification review, which shall:
1. Compare the
				MDS assessment coding with the corresponding medical record documentation to
				determine unsupported MDS assessments;
2. Determine the completeness and accuracy of the
				residents and MDS assessments identified on the resident roster; and
3. Determine the accuracy of the resident payment
				source listed on the resident roster.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 8:85-1.13 - Clinical and related records

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An individual
				clinical record shall be maintained for each Medicaid beneficiary covering his or
				her medical, nursing, social and related care in accordance with accepted
				professional standards and licensing standards as set forth by the Standards for
				Licensure of Long-Term Care Facilities, N.J.A.C. 8:39. All entries on the clinical
				record shall be current, dated and signed by the appropriate staff member. The
				clinical record, HSDP approval letter and if appropriate, PASRR determination shall
				be readily available at the appropriate nurses' station for review by DHSS
				staff.
(b) The clinical record of a
				deceased resident shall be properly completed. It shall include:
1. Written reports of visits made by the physician
				during the critical stage of illness;
2.
				Written documentation of death pronouncement completed by the qualified health
				professional as specified by the NF's policies and procedures;
3. Complete nurse's notes containing all necessary
				and pertinent information documenting the resident's condition during the illness
				and apparent demise, notification of physician and next of kin;
4. Autopsy records where appropriate;
				and
5. A written record of the
				disposition of the body of the deceased individual.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 8:85-1.14 - Absence from facility due to hospital admission or therapeutic leave; bed reserve

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The bed reserve
				policy for hospital admissions is as follows:
1.
				The NF shall reserve and hold the same room and the same bed of the Medicaid
				beneficiary transferred to a general or psychiatric hospital for a period not to
				exceed 10 days. The NF shall determine the individual's status or whereabouts during
				or after the 10-day bed reserve period.
i. If the
				resident is not readmitted to the same room or the same bed or the same NF during a
				bed reserve period, the NF requesting bed reserve reimbursement shall record on the
				resident's chart and make available for Department review, a justification for the
				action taken. Pending outcome of the Department's review, the facility may be
				subject to forfeiture of bed reserve reimbursement.
ii. Said reserved bed shall remain empty and shall
				not be occupied by another individual during the bed reserve period, unless
				authorized by the Department.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 8:85-1.15 - Complaints

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department will
				receive, document and investigate complaints from multiple sources and take
				appropriate corrective action as required. It is the Department's policy that the
				source of the complaint be held confidential, unless disclosure permission is
				obtained from the complainant.
(b) In
				addition to investigation by the Department, when complaints against a facility
				indicate the facility's failure to correct previously reported survey deficiencies
				or to comply with established licensure and Medicare/Medicaid certification
				standards, such complaint reports will be forwarded to the Office of the Ombudsman
				for the Institutionalized Elderly for review and action. Any complaints or reports
				received by the Department indicating legal violations will be referred to the
				office of the Attorney General for review and action, as required.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 8:85-1.16 - Utilization of resident's income for cost of care in the NF and for PNA

Current through Register Vol. 56, No. 14, July 15, 2024
(a) After provision for
				the resident's Personal Needs Allowance (PNA) is met, and then after provision for
				other allocations such as maintenance of spouse and/or dependent's home are
				satisfied, the remainder of the Medicaid beneficiary's income shall be applied to
				the cost of care in the NF, which includes per diem, bed reserve and other allowable
				expenses.
1. The amount of income which shall be
				collected by the NF from the beneficiary, beneficiary's family or Representative
				Payee (if any) will be established in the process of determining eligibility and
				identified by form PA-3L, Statement of Income Available for Medicaid Payment, issued
				by the CWA. The NF shall collect all of the recipient's income to offset the
				Medicaid payment.
2. The NF shall notify
				the CWA immediately whenever there is a change/difference in any income source, as
				well as when any additional assets or resources come to the attention of the
				NF.
3. The New Jersey Medicaid program
				encourages families or any other concerned individual(s) to make voluntary monetary
				contributions to the State of New Jersey on behalf of Medicaid beneficiaries
				residing in nursing facilities. Inquiries should be directed to the Division of
				Senior Benefits and Utilization Management, Office of Administration and Finance, PO
				Box 722, Trenton, New Jersey 08625-0722.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 8:85-1.17 - Residents rights

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The NF shall ensure
				that each resident and his or her representative are informed of their rights upon
				admission and provided with a written statement of all resident rights, in
				accordance with
				42
				CFR 483.10 through
				483.15,
				the Nursing Home Resident Rights Act,
				30:13-1 et seq. and
				8:39-4.1.
(b) The NF shall ensure that every resident who is
				entitled to Medicaid benefits shall receive a written statement of the services
				covered in the Medicaid per diem rate, those services required to be offered by the
				NF on an as-needed basis, and any charges not covered under the Medicaid program
				while in the facility.
(c) The NF shall
				notify each resident of his or her right under State law to make decisions
				concerning his or her medical care and his or her right to formulate an advance
				directive in compliance with the New Jersey Advance Directives for Health Care Act,
				26:2H-53 et seq., and the advance
				directive provisions of the Omnibus Reconciliation Act of 1990, effective December
				1, 1991 and Department of Health and Senior Services licensing requirements at
				8:39-9.5.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 8:85-1.18 - Medicaid/Medicare

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The New Jersey
				Medicaid Program will reimburse for NF services provided to combination
				Medicare/Medicaid beneficiaries only after Medicare covered benefits have been fully
				utilized or when medically necessary services are not covered by the Medicare
				Program. (Exceptions--see (f)1i below.)
1. A
				facility shall begin to bill Medicare for eligible residents immediately upon
				receipt of Medicare certification.
2.
				Failure by a facility to bill Medicare for Medicare/Medicaid eligible residents who
				meet the criteria for Medicare reimbursement for long-term care services, and who
				occupy Medicare certified beds may result in the termination of a facility's
				Medicaid provider agreement.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.1 - Nursing facility services; eligibility

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Eligibility for
				nursing facility (NF) services will be determined by the professional staff
				designated by the Department, based on a comprehensive needs assessment that
				demonstrates that the beneficiary requires, at a minimum, the basic NF services
				described in 8:85-2.2.
1. Individuals requiring NF services may have
				unstable medical, emotional/behavioral and psychosocial conditions that require
				ongoing nursing assessment, intervention and/or referrals to other disciplines for
				evaluation and appropriate treatment. Typically, adult NF residents have severely
				impaired cognitive and related problems with memory deficits and problem solving.
				These deficits severely compromise personal safety and, therefore, require a
				structured therapeutic environment. NF residents are dependent in several activities
				of daily living (bathing, dressing, toilet use, transfer, locomotion, bed mobility,
				and eating).
i. Children requiring NF services
				exhibit functional limitations identified either in terms of developmental delay
				requiring nursing care over and above routine parenting or are limited in terms of
				specific age-appropriate physical and cognitive activities, functional abilities
				(ADL) or abnormal behavior, as demonstrated by performance at home, school or
				recreational activities.
(1) Children who have
				achieved developmental milestones within appropriate time frames and who require
				only well child care and/or treatment of acute, time limited illnesses or injuries
				shall not be eligible for NF services.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.3 - Physician services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) General requirements
				for physician services shall be as follows:
1.
				Each Medicaid beneficiary's care shall be under the supervision of a New Jersey
				licensed attending physician chosen by, or agreed to by, the Medicaid beneficiary,
				or if the beneficiary is incompetent, by the family or legal guardian.
2. In a NF providing care to children, the
				attending physician shall be board certified/eligible by the American Board of
				Pediatrics or the American Board of Family Practice.
3. The NF shall maintain arrangements that assure
				that the services of a New Jersey licensed physician who can act in case of
				emergency, are continuously available.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.4 - Rehabilitative services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Rehabilitative
				services include physical therapy, occupational therapy and speech-language
				pathology services provided by a qualified therapist for the purpose of attaining
				maximum reduction of physical or mental disability and restoration of the resident
				to his or her best functional level. Rehabilitative services shall be made available
				to Medicaid beneficiaries as an integral part of an interdisciplinary program.
				Rehabilitative services shall not include physical medicine procedures administered
				directly by a physician, or physical therapy, which is purely palliative, such as
				the application of heat per se, in any form; massage; routine calisthenics or group
				exercises; assistance in any activity; use of a simple mechanical device; or other
				services not requiring the special skill of a qualified therapist.
1. If the attending physician orders an evaluation
				for physical, speech-language pathology services or occupational therapy, an
				appropriately qualified therapist shall perform an assessment to determine the need
				for services. The therapist shall complete a written report of therapy
				recommendations within 14 days of the physician's order and shall include the report
				in the clinical record, for review by the attending physician.
2. Rehabilitative treatment shall be provided
				under the direct supervision and in the presence of a qualified therapist or
				physiatrist, only upon the written signed order of the physician who shall indicate
				modality and frequency and duration of treatments. The attending physician shall
				evaluate each resident's response to therapeutic services on a monthly basis.
				Continuance of said services shall be based on documentation of a potential for
				significant functional improvement within a reasonable time frame.
i. Rehabilitation therapy services shall be
				integrated with medical, nursing, recreational and social services to promote
				development or restoration of the resident to his/her maximum potential and reviewed
				in conjunction with other periodic reviews of the interdisciplinary care
				plan.
3. Rehabilitative
				services shall be provided by qualified therapists employed by or under contract to:
i. An approved home health agency;
ii. A licensed or accredited general or special
				hospital;
iii. An approved independent
				outpatient health facility; or
iv. An
				NF.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.5 - Resident activities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An ongoing resident
				activities program shall be established as an adjunct to the treatment program and
				an integral component of the interdisciplinary plan of care. The program shall be a
				planned schedule of appropriate social, physical, spiritual, psychological, leisure,
				cognitive, vocational and educational activities designed to meet the needs,
				interests, and behaviors of all residents, whether ambulatory, chair bound, or
				bedfast. In a facility providing care to children, activities programming shall be
				geared to the child's developmental and behavioral needs.
(b) Activities shall enable the residents to
				maintain a sense of usefulness and self-respect, and when possible, help to prevent
				regression. Activities shall encourage development or restoration to self-care and
				resumption of normal activities, stimulate and maximize the total functional ability
				of the resident and assist the resident to integrate into the social life of the
				facility. Families and friends of the resident shall be encouraged to accompany the
				resident to activities.
(c) Outside
				community resources, such as the Commission for the Blind, Office of Education,
				Divisions of Developmental Disabilities and Vocational Rehabilitation shall be
				accessed to develop needs-specific activities. Community outreach shall be done to
				encourage community groups to participate in programs in the facility. Residents
				also shall be encouraged to participate in programs in the community.
(d) Resident activities staffing requirements are
				as follows:
1. The resident activities director
				shall meet the qualifications required by N.J.A.C. 8:39-7, Mandatory Patient
				Activities. In a facility providing care exclusively to children, the resident
				activities director who does not possess a baccalaureate degree shall have one year
				of the required three years of experience in a recreational program for
				children;
2. The facility shall appoint
				a resident activities director who shall provide resident activity services in the
				facility on an average of 45 minutes per week per resident. Additional resident
				activity staff time shall be provided at a ratio of no less than 1:53 residents;
				and
3. The use of volunteers should be
				encouraged as adjuncts to staff. Volunteers should be trained and supervised in the
				performance of their duties by qualified staff.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.6 - Social services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Social work services
				shall have as their fundamental purpose the enhancement of a resident's sense of
				well-being and control over his life to the fullest extent possible. Social work
				interventions shall be geared to the resident's strengths, regardless of the extent
				of disability and shall be designed to enhance coping skills. Social work services
				shall help residents make the fullest use of nursing facility life, and shall assist
				residents in discharge to community living.
(b) Social workers shall assist residents with the
				emotional reactions to pain and functional loss, interpersonal conflicts, fear of
				death, and other issues impacting on the quality of life. Supportive intervention
				and encouragement shall be provided. The social worker collaborates with other staff
				to maximize opportunities for choice and individual expression. Social workers shall
				monitor a resident's concrete and personal needs and shall serve as primary
				advocates for the resident in the NF.
(c) Social work services shall not include:
1. Clerical or billing activity;
2. Public relations activity that does not relate
				to social work services; or
3. Medical
				records monitoring responsibilities.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.7 - Pharmaceutical services; general

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Prescribed legend
				drugs shall be supplied to each individual resident by a licensed pharmacy. Legend
				drugs may be supplied to individual residents by other than a licensed pharmacy when
				dispensed by NF medical professional staff from an emergency drug box, or the like,
				supplied by the NF's contracted pharmacy provider. Non-legend drugs, such as
				aspirin, milk of magnesia, etc., may be separately stocked in the drugroom or
				medication cart of the NF. This will permit the NF to maintain a supply of
				non-legend drugs to be administered as directed by the prescribing physician under
				the supervision of a NF professional staff in keeping with established stop order
				policies (see (b) below). Reimbursement for non-legend drugs (that is, drugs which
				by Federal law do not require a prescription) shall be included in the NF per diem
				rate.
1. The New Jersey Medicaid program shall not
				reimburse for Methadone when used for drug detoxification or addiction.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.8 - Consultations and referrals for examination and treatment

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Certain services,
				such as medical and surgical specialties, chiropractic, dental, mental health,
				podiatric, and vision care, shall be initiated by the attending physician as either
				a request for a "consultation" or as a "referral for examination and
				treatment".
(b) A consultation shall be
				ordered when the attending physician wishes an appropriate practitioner to evaluate,
				through history and appropriate physical findings and other ancillary means:
1. The nature and progress of a disease, illness,
				or condition, and/or
2. To establish or
				confirm a diagnosis, and/or
3. To
				determine the prognosis, and/or
4. To
				suggest appropriate therapy.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.9 - Mental health services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All facilities shall
				assist Medicaid beneficiaries to obtain mental health care through a licensed
				psychiatrist or psychologist, who shall provide, or make provision for, routine and
				emergency services.
(b) An initial
				consultation for mental health services shall be performed only upon a written order
				signed by the attending physician (on the order sheet) citing the reason(s) for the
				consultation in the progress notes.
(c)
				If the mental health services are recommended following initial consultation, the
				psychiatrist or psychologist may provide the mental health service upon the written
				order signed by the attending physician. If the individual who provides the mental
				health services is a psychiatrist, he or she shall comply with the Medicaid policies
				cited in N.J.A.C. 10:54 regarding the request for authorization requirements for
				mental health services. If the individual who provides the mental health services is
				a psychologist, he or she shall comply with N.J.A.C. 10:67 regarding the request for
				authorization requirements for mental health services.
(d) Therapeutic goals and outcomes shall be
				documented by the psychiatrist and/or psychologist in the clinical record and
				treatment provided only where there is potential for significant functional
				improvement within a reasonable time frame.