New Jersey Administrative Code

(a) Behavioral assistance shall be delivered in accordance with a plan of care approved by the Department of Human Services, Children and Families, or a designated agent of either Department, which has been prepared by the responsible case management function, including, but not …

(a) Each beneficiary receiving behavioral assistance services shall have a documented individual behavioral assistance service plan that is based on an evaluation of the identified behavior(s) which includes recommendations for specific interventions with definable outcomes and s…

(a) Behavioral assistance services shall be provided only in conjunction with other treatment, rehabilitative and social support services as part of a coordinated and authorized plan of care as described in N.J.A.C. 10:77-4.7. (b) Effective for dates of service on or after Januar…

(a) Behavioral assistance services shall be provided directly by, or under the supervision of, individuals who are licensed clinicians, who, at a minimum, are licensed in a behavioral health field including, but not limited to, social work, counseling, psychology or psychiatric n…

(a) This subchapter sets forth the manner in which intensive in-community mental health rehabilitation services (intensive in-community services) shall be provided, through community-based provider entities, to eligible Medicaid/NJ FamilyCare and Department of Children and Famili…

(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 oth…

(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 FamilyCa…

(a) Each provider entity shall maintain all beneficiary records in compliance with appropriate State law and rules (see N.J.A.C. 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 provi…

(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…

(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 providi…

(a) Any community agency under contract with the Department of Human Services shall not pay, or contract with, any employee or agency head for the provision of services unless it has first been determined that no criminal history record information exists on file in the State Bur…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Fingerprint-based criminal history background check" means determination of whether a person has a criminal record by cross-referencing…

(a) Providers of intensive in-community mental health rehabilitation services shall be providers that are licensed in New Jersey to provide medical/mental health services or a medical/mental health practice or other agency that includes the appropriate licensed practitioners who …

(a) Eligible children, youth, or young adults shall be:1. Enrolled in Medicaid/NJ FamilyCare; or 2. Children, youth, or young adults who are ineligible for Medicaid/NJ FamilyCare but who are receiving services from DCF's Children's System of Care. (b) Children, youth, and young a…

(a) Any provider entity providing intensive in-community mental health rehabilitation services shall demonstrate regard for the rights of the child, youth or young adult and their families/caregivers to exercise choice of provider. Service providers shall communicate with the chi…

(a) Intensive in-community mental health rehabilitation services are intensive community-based and family-centered mental health services delivered as a defined set of interventions, within the context of an approved plan of care and are restorative or preventative in nature. The…

(a) The level of intensive in-community services provided shall be determined as part of the planning process of the individual service plan and shall be based on an assessment of need, a clinical evaluation and medical necessity. Such assessment shall determine the amount, durat…

(a) Each child, youth, or young adult receiving intensive in-community mental health rehabilitation services shall have an approved, documented individual plan of care addressing the services. The plan shall be individually tailored to address identified behavior(s) that impact o…

(a) The individual(s) responsible for administrative oversight of the program shall have, at a minimum, a master's degree in social work or in a relevant discipline including, but not limited to, counseling, psychology or psychiatric nursing, and a minimum of three years of post-…

(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 S…

(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 re…

(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, N.J.A.C. 10:49-9.8, and any appl…

(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 stabilizat…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Authorization" means the authorization and the a uthorization number provided by the Contracted Systems Administrator or other agency a…

(a) In order to participate as a Medicaid/NJ FamilyCare/Children's System of Care provider of children's mobile response and stabilization management services, a provider must apply to, and be approved by, the New Jersey Medicaid/NJ FamilyCare fee-for-service program as a mobile …

(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, counseli…

(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 Departm…

(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 serv…

(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…

(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 b…

(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,…

(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, emplo…

(a) Environmental Lead Inspection Codes: HCPCS Code Description Maximum Fee Allowance Y 9733 Initial Inspection for Lead $ 260.00 Y 9734 Reinspection for Lead 100.00 Qualifier: Limit of two reinspections per primary residence per family (b) Mental Health Rehabilitation Services p…

(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 …

(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. (b) Circumstances which are neither specifically nor generall…

The NJ FamilyCare program is under the supervision of the Division of Medical Assistance and Health Services. Notes N.J. Admin. Code § 10:78-1.3

(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 Family…

(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 …

(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 FamilyCa…

(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 wi…

(a) Any person who applies for NJ FamilyCare, by virtue of the application for benefits, shall be deemed to have assigned to the Commissioner of the Department of Human Services any rights to support for the purpose of medical care as determined by a court or administrative order…

All of the relevant provisions pertaining to fraud and abuse, third party liability, and administrative and judicial remedies which are contained in the following sections of N.J.A.C.N.J.S.A. 30:4D-1 et seq. and N.J.A.C. 10:49 shall be fully applicable to NJ FamilyCare: N.J.A.C.N…

(a) Subject to the limitations contained in 42 U.S.C. § 1320a- 7b(a), "Criminal Penalties for Acts involving Federal Health Care Programs," any violation of (b) below shall result in the issuance of a Notice of Proposed Termination of the processing of the applicant's application…

(a) The terminated individual, or anyone with authority to act on his or her behalf, may apply to the Director for readmission to the NJ FamilyCare program no earlier than one year from the date of the final agency decision terminating the applicant's application process or the b…

N.J.A.C. 10:78-10.1(a) and 10.2 shall apply only to NJ FamilyCare applicants and beneficiaries whose eligibility has been terminated for the reasons set forth in N.J.A.C. 10:78-10.1(b) and shall not apply to termination due to ineligibility initiated under N.J.A.C. 10:78-2 throug…

(a) The purpose of this subchapter is to set forth the general provisions of the New Jersey FamilyCare program as it applies to those who were enrolled in the New Jersey Health Access program on October 31, 2001. (b) This subchapter applies to all individuals who:1. Were enrolled…

(a) Individuals who were enrolled in the New Jersey Health Access program on October 31, 2001, and who returned a plan selection form by November 13, 2001, shall be eligible to enroll in the NJ FamilyCare program. 1. An enrollee who is denied the opportunity to enroll in the New …

(a) The total subsidy the State shall submit on behalf of a former New Jersey Health Access program enrollee shall be based upon the contract in force between the State and the managed care organization in which the individual is enrolled. The subsidy shall be recalculated in acc…

(a) Any individual who does not submit timely payment for his or her share of the premium, as determined by the State, in accordance with N.J.A.C. 10:78-7.1, shall be disenrolled. (b) The Division may disenroll any former Access program enrollee from the NJ FamilyCare program for…

(a) Except as otherwise specified in this subchapter, all provisions of N.J.A.C. 10:78, NJ FamilyCare, shall apply to the administration of the NJ FamilyCare program services provided to former New Jersey Health Access program enrollees. (b) Notwithstanding the provisions of this…