New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 1 - GENERAL PROVISIONS › Section 10:52-1.11 - Preadmission screening for nursing facility (NF) placement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department of Health and Senior Services is the agency responsible for administering the Preadmission Screening Program. The following is provided to hospitals so that they understand the process and the rules a hospital shall follow to ensure Medicaid or NJ FamilyCare-Plan A reimbursement for the care of individuals whose discharge planning includes placement into a nursing facility.
(b) The following words and terms, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise.
"Health Services Delivery Plan (HSDP)" means an initial plan of care prepared during the Preadmission Screening (PAS) process. The HSDP reflects the individual's current or potential problems, required care needs, the need for Preadmission Screening and Resident Review (PASRR) and the Track of Care.
"Level I PASRR screen" means the process of identification of an individual meeting the criteria for serious mental illness (MI) or mental retardation (MR) or both, as described throughout this section, and determining whether the individual also meets the NF level of care requirements.
"Level II PASRR evaluation" means the process of evaluating and determining whether an individual meets NF level of care, and determining whether an individual needs specialized services for MI or MR or both. An individual who requires specialized services cannot receive those services in a NF.
"Preadmission screening (PAS)" means that process by which all Medicaid eligible beneficiaries seeking admission to a Medicaid certified NF and individuals who may become Medicaid eligible within six months following admission to a Medicaid certified NF, receive a comprehensive needs assessment by professional staff designated by the Department of Health and Senior Services to determine their long-term care needs and the most appropriate setting for those needs to be met, pursuant to 30:4D-17.1 0. ( P.L. 1988, c.97.)
"Preadmission Screening and Resident Review (PASRR)" means that process by which all individuals meeting the clinical criteria for mental illness (MI) or mental retardation (MR), regardless of payment source, are screened prior to admission to an NF in order to determine the individual's appropriateness for NF services, and whether the individual requires specialized services for his or her condition. PASRR includes two levels, Level I PASRR screen and Level II PASRR evaluation, as defined above and described in this section.
"Professional staff designated by the Department of Health and Senior Services (DHSS professional staff)" means a nurse licensed or certified in accordance with N.J.A.C. 13:37 or a social worker who performs health needs assessments and care management counseling in accordance with this section.
"Specialized Services for Mental Illness (MI)" means those services that are determined to be medically indicated when an individual is experiencing an acute episode of serious mental illness and psychiatric hospitalization is recommended, based upon a Psychiatric Evaluation. Specialized Services entail implementation of a continuous, aggressive and individualized treatment plan by an interdisciplinary team of qualified and trained mental health personnel. During a period of 24-hour supervision of the individual, specific therapies and activities are prescribed, with the following objectives: to diagnose and reduce behavioral symptoms; to improve independent functioning; and as early as possible, to permit functioning at a level where less than Specialized Services are appropriate. Specialized Services go beyond the range of services that an NF is authorized to provide and can only be provided in a 24-hour inpatient psychiatric setting.
"Specialized Services for Mental Retardation (MR)" means those services required when an individual is determined to have skill deficits or other specialized training needs that necessitate the availability of trained MR personnel, 24-hours per day, to teach the individual functional skills. Specialized Services are those services needed to address such skill deficits or specialized training needs. Specialized services may be provided in an Intermediate Care Facility for the Mentally Retarded (ICF/MR) or in a community-based setting which meets ICF/MR standards. Specialized services go beyond the range of services which a NF is authorized to provide.
"Track of care" means designation of the setting and scope of Medicaid/NJ FamilyCare-Plan A services as determined by the PAS process. The PAS is conducted by the professional staff designated by the Department of Health and Senior Services (DHSS) following an assessment of the Medicaid or NJ FamilyCare-Plan A beneficiary or potential Medicaid or NJ FamilyCare-Plan A beneficiary, as follows:
1. "Track I" means long-term NF care;
2. "Track II" means short-term NF care; and
3. "Track III" means long-term care services in a community setting.