N.J. Admin. Code § 10:37F-2.1

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:37F-2.1 - Admission criteria

(a) First priority for admissions into PC services shall be given to persons with severe and persistent mental illness in accordance with target populations, as defined in N.J.A.C. 10:37-5.2.

1. The provider agency shall utilize the following inclusionary and exclusionary admission criteria, which are designed to assure the clinical appropriateness of each admission.

(b) Inclusionary criteria: In order to be considered eligible for partial care services, an individual must:

1. Demonstrate impaired functioning, that leads to a need to learn critical skills in order to achieve valued community roles and community integration, in at least one of the following domains on a continuing and intermittent basis, for at least one year:

i. Personal self-care;

ii. Interpersonal relationships;

iii. Work;

iv. School;

v. Ability to live in the community; or

vi. Ability to acquire and/or maintain safe, affordable housing and is at risk of requiring a more restrictive living situation;

2. Be 18 years of age or older;

3. Demonstrate or possess clinical evidence to justify the necessity for partial care services. This necessity must be confirmed by the psychiatrist or advanced practice nurse and interdisciplinary treatment team and documented in the record;

4. Demonstrate the need for psychiatric rehabilitation and active treatment of no less than two hours and no more than 25 hours weekly;

5. At the time of referral or as a result of psychiatric evaluation provided or arranged for by the PA, have at least one of the following primary DSM diagnoses:

i. Schizophrenia or Other Psychotic Disorders (298.9);

ii. Major Depressive Disorder (296.xx);

iii. Bipolar Disorders (296.xx, 296.89);

iv. Delusional Disorder (297);

v. Schizoaffective Disorder (295.7); or

vi. Affective Disorders (300.xx);

6. Have a covered psychiatric disorder diagnosis consistent with codes of the DSM, including some 301.XX codes if the personality disorder is considered in the severe range and the individuals are at high risk of psychiatric hospitalization as a result; and

7. At the time of referral, meet one or more of the following criteria:

i. Acute service need:

(1) One or more contacts with a screening center or emergency service mental health program;

(2) Two or more admissions to an inpatient behavioral health program including short term care facilities; or

(3) One psychiatric hospitalization of three months or longer; or

ii. A Global Assessment of Functioning Scale score of between 11 and 70, as found in the DSM.

(c) Exclusionary criteria: A consumer who presents any of the following criteria shall be excluded from participation in partial care services:

1. A primary diagnosis of substance use/dependence;

2. An imminent danger to self, others or property;

3. A primary diagnosis of "developmentally disabled"; or

4. Current participation in a PACT program, unless authorized in accordance with N.J.A.C. 10:76.

N.J. Admin. Code § 10:37F-2.1

Amended by R.2006 d.389, effective 11/6/2006.
See: 38 N.J.R. 1990(a), 38 N.J.R. 4694(b).
Section was "Admission and intake". Rewrote (a)1; inserted new (b) and (c); deleted former (b) and (b)1; and recodified former (b)2 through (c)9 as N.J.A.C. 10:37F-2.2.

Amended by 53 N.J.R. 1842(a), effective 11/1/2021