New Jersey Administrative Code

(a) The target population is limited to those individuals who are at risk of severe illness, fatigue or stress due to the demands of their basic, daily caregiving responsibilities for the eligible person. (b) The sponsor agency shall give priority in receiving services to those s…

The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise. "Adult day health services facility" means a facility or a distinct part of a facility, which is licensed by the Department of Health pursu…

The Department is the administrative unit of the State government, which has control over the administration of the Statewide Respite Care Program pursuant to N.J.S.A. 30:4F-7 et seq. Notes N.J. Admin. Code § 10:164B-2.1 Amended by R.2010 d.022, effective 1/19/2010. See: 41 N.J.R…

(a) The Advisory Council of the Area Agency on Aging in each county shall be responsible for choosing the sponsor agency in its respective county subject to confirmation by the Department. 1. The sponsor agency shall administer the Statewide Respite Care Program in that county an…

(a) The application process includes all activity related to a request for eligibility determination under the Statewide Respite Care Program. The process begins with the receipt of an application by a sponsor agency and continues in effect until there is an official disposition …

(a) Where the applicant is incapacitated or incapable of filing an application on his or her own behalf, the sponsor agency shall recognize any of the following persons, listed in order of priority, as an authorized agent for the purpose of initiating such application: 1. A legal…

(a) The sponsor agency has the responsibility in the application process to: 1. Explain the purposes and eligibility requirements of the program and indicate the applicant's rights and responsibilities under its provisions; 2. Accept and process applications; and 3. Maintain file…

(a) For the purpose of the Statewide Respite Care Program, an eligible person shall meet the following eligibility standards: 1. An eligible person shall be 18 years of age or older; functionally impaired; cared for at home by a caregiver who is not remunerated for his or her ser…

(a) All personally identifiable information regarding applicants, eligible persons or caregivers obtained or maintained under the Statewide Respite Care Program shall be confidential and shall not be released without the written consent of the applicant, eligible person, their au…

Notes N.J. Admin. Code § 10:164B-4.3 Recodified to N.J.A.C. 8:82-7.2 by R.2004 d.241, effective 7/6/2004. See: 35 N.J.R. 2633(a), 36 N.J.R. 3278(a).Former N.J.A.C. 8:82-4.3, "Primary and secondary payment", recodified to N.J.A.C. 8:82-7.2.

(a) The Commissioner, based upon the recommendations from the Advisory Council of the Area Agency on Aging, shall designate one sponsor agency for the Statewide Respite Care Program in each county in New Jersey, subject to the following qualifications: 1. A sponsor agency shall b…

(a) Provider agencies shall be accountable to the sponsor agency for the provision of respite services and shall enter into contracts with the designated sponsor agency. (b) Provider agencies shall have demonstrated prior experience in delivering services to families with elderly…

(a) Each eligible person shall receive up to $ 4,500 of respite services in a calendar year. 1. The Department shall adjust the service level based on the funding available to the Department. (b) A sponsor may request an exception to an eligible person's service level. 1. The spo…

(a) Co-payment fees shall apply to eligible persons rendered respite care services in accordance with the co-payment fee scale set forth in (b) below. 1. In all cases the point at which cost-sharing shall be initiated will be based upon the most current Supplemental Security Inco…

Notes N.J. Admin. Code § 10:164B-6.3 Recodified to N.J.A.C. 8:82-6.2 by R.2004 d.241, effective 7/6/2004. See: 35 N.J.R. 2633(a), 36 N.J.R. 3278(a).Former N.J.A.C. 8:82-6.3, Sliding fee scale for co-payments, recodified to N.J.A.C. 8:82-6.2.

Notes N.J. Admin. Code § 10:164B-6.4 Amended by R.1993 d.256, effective 6/7/1993. See: 25 N.J.R. 876(a), 25 N.J.R. 2557(b).Amended by R.1998 d.274, effective 6/1/1998.See: 30 N.J.R. 624(a), 30 N.J.R. 2001(a).Updated Department and Division names.Recodified to N.J.A.C. 8:82-5.1 by…

(a) The Department shall determine reimbursement and payment levels for the respite services to be provided under the program. (b) The rates for the various types of respite services are as follows: Service Reimbursement Amount Adult Day Health Services Medicaid Rate Alternate Fa…

If an eligible person's respite service costs are covered in whole or in part by another State or Federal government program or insurance contract, the government program or insurance carrier shall be the primary payer and the Statewide Respite Care Program shall be the secondary…

(a) An applicant who is denied participation in the program because he or she does not qualify as an eligible person has the right to request a hearing pursuant to the Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq., and the Uniform Administrative Procedure Rules, N.J.A.C…

(a) This chapter sets forth the procedures for establishing planning and service areas within the State, and designating Area Agencies on Aging, consistent with the Older Americans Act of 1965, and amendments thereto, 42 U.S.C. §§ 3001 et seq. (b) This chapter sets forth the proc…

"Area Agency on Aging" means a public or private nonprofit agency designated by the State Division in accordance with this chapter and 45 C.F.R. § 1321.17 to act as the central coordinating and planning body for older adult services within a PSA. "Area Plan" means the document co…

(a) The State Division shall provide no less than 60 days written notice of any intended action to define or redefine a PSA, or designate or revoke an Area Agency on Aging designation, except that this requirement shall not apply to PSAs and Area Agency on Aging designations esta…

(a) The State Division shall divide the State into distinct PSAs, based on the following factors: 1. The geographic distribution of older individuals in the State; 2. The incidence of the need for supportive services, nutrition services, multi-purpose senior centers, and legal as…

(a) A PSA designation shall be subject to the following minimum standards: 1. The PSA shall encompass a unit of general purpose local government with a population of 100,000 or more; or 2. The PSA shall encompass any region within the State recognized for purposes of area-wide he…

(a) The State Division shall designate one Area Agency on Aging for each PSA. (b) An Area Agency on Aging shall be one of the following: 1. An established office of aging operating within a PSA; 2. Any office or agency of a unit of general purpose local government or combination …

(a) The State Division shall not revoke a designation unless notice and a public hearing has been held in accordance with N.J.A.C. 10:165-1.3. (b) In addition to providing notice in accordance with (a) above, the State Division shall provide personal written notice to the designa…

(a) The State Division may revoke the status of an agency or organization as the Area Agency on Aging when the State Division determines that: 1. The agency or organization has not complied with Federal and State requirements for Area Agencies on Aging, as delineated in 42 U.S.C.…

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, nur…

(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 procedu…

Notes N.J. Admin. Code § 10:166-1.11 Recodified from N.J.A.C. 10:63-1.11 and repealed by R.2005 d.389, effective 1/17/2006. See: 36 New Jersey Register 4700(a), 37 New Jersey Register 1185(a), 38 New Jersey Register 674(a). Section was "NF authorization process". Recodified from …

(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 …

(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 Ca…

(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…

(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 co…

(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 car…

(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, N.J.S.A. 30:13…

(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 …

The following words and terms, when used in this chapter, shall have the following meanings unless the context clearly indicates otherwise. "Advance directive" means a written instruction relating to the provision of health care when the individual is incapacitated, such as a liv…

(a) An NF shall comply with the following requirements in order to be eligible to participate in the New Jersey Medicaid program. An in-State NF shall: 1. Be licensed by the Department in accordance with N.J.A.C. 8:39; 2. Be certified by the Department, and in the case of both Me…

(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…

Notes N.J. Admin. Code § 10:166-1.5 Recodified from N.J.A.C. 10:63-1.5 and amended by R.2005 d.389, effective 1/17/2006. See: 36 N.J.R. 4700(a), 37 N.J.R. 1185(a), 38 N.J.R. 674(a). Section was "Occupancy level"; in introductory paragraph (a), substituted "beneficiaries" for "and…

(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 tha…

(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, N.J.S.A. 52:14B-…

(a) Pursuant to N.J.S.A. 30:4D-17.10, 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 wit…

(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 …

(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 N.J.A.C. 8:85-…

(a) All facilities shall assist Medicaid beneficiaries to obtain dental care though a licensed dentist, who shall provide, or make provision for: 1. Appropriate consulting services; 2. In-service education to the facility; 3. Policies concerning oral hygiene; and 4. Routine and e…