N.J. Admin. Code § 10:50-1.2
The following words and terms, when used in this chapter, shall have the following meanings unless the context clearly indicates otherwise.
"Advanced life support-Level 1" means transportation by a ground ambulance vehicle licensed by the Department of Health (DOH) with the provision of medically necessary supplies and services, including the provision of an ALS assessment or at least one ALS intervention.
"Advanced life support-Level 2" means transportation by a ground ambulance vehicle licensed by the Department of Health with the provision of medically necessary supplies and services, including at least three separate administrations of one or more medications by intravenous push/bolus or by continuous infusion, excluding crystalloid fluids; or ground ambulance transportation with the provision of medically necessary supplies and services, as well as the provision of at least one of the following procedures: manual defibrillation/cardioversion, endotracheal intubation, central venous line, cardiac pacing, chest decompression, surgical airway, or intraosseous line.
"Advanced life support assessment" means an assessment performed by an ALS crew as part of an emergency response that was determined necessary because the client's reported medical condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment.
"Advanced life support intervention" means a procedure provided in accordance with New Jersey practice guidelines (see N.J.A.C. 8:41) by an EMT-Paramedic, which includes, but is not limited to, basic life support functions, cardiac monitoring, cardiac defibrillation, telemetered electrocardiography, administration of anti-arrhythmic agents, intravenous therapy, administration of specific medications, drugs and solutions, utilization of adjunctive ventilation devices, or trauma care.
"Air ambulance service" means the provision of emergency or non-emergency medical transportation in an aircraft (fixed wing or rotary wing) certified by and operated in accord with Federal Aviation Administration requirements.
"ALS" means advanced life support.
"Basic life support (BLS)-emergency" means transportation by a ground ambulance vehicle licensed by DOH and the provision of medically necessary supplies and services, including patient stabilization, airway clearance and maintenance, cardiopulmonary resuscitation (CPR), hemorrhage control, initial wound care, fracture stabilization, victim extrication, and other techniques and procedures as defined in the United States Department of Transportation (USDOT) EMT-Basic National Standards Curriculum (obtainable from National Highway Traffic Safety Administration, Office of Emergency Medical Services (NTI-140), 1200 New Jersey Avenue S.E., Washington DC 20590, by accessing their website at www.ems.gov or by calling (202) 3665440).
"Basic life support (BLS)-non-emergency" means transportation by a ground ambulance licensed by DOH with the provision of medically necessary supplies and services for a medically stable individual to and from a medical appointment or discharge home from an inpatient medical facility.
"Beneficiary" means any person meeting the definition of that term contained in N.J.A.C. 10:49-1.3.
"Broker" means an entity under contract or agreement with the Department of Human Services, pursuant to N.J.A.C. 10:50-1.3(e), for the delivery of non-emergency transportation services.
"Division" means the Division of Medical Assistance and Health Services (DMAHS) in the New Jersey Department of Human Services.
"DOH" means the New Jersey Department of Health.
"Emergency condition" means an illness or injury of such magnitude and gravity as to constitute an imminent threat to life or limb or where there may be intractable pain.
"Ground ambulance service" means the provision of emergency or non-emergency medical transportation in a vehicle that is licensed, equipped, and staffed in accord with New Jersey State Department of Health rules, as specified in N.J.A.C. 8:40.
"Independent transportation provider" or "provider" means an air ambulance (rotary wing) service or ground ambulance service provider that is enrolled and authorized in accordance with N.J.A.C. 10:49-3 and this chapter. An independent transportation provider is enrolled independently from any transportation broker and is reimbursed directly from the Medicaid/NJ FamilyCare program on a fee-for-service basis.
"Loaded mile" means mileage accrued when a vehicle is actually carrying a Medicaid/NJ FamilyCare fee-for-service beneficiary.
"Lower mode service" means non-emergency transportation, reserved for sick, infirm or otherwise disabled persons who are under the care and supervision of a physician and whose medical condition requires transportation for medical care.
"Mobile intensive care unit (MICU)" means a specialized emergency services vehicle that is licensed, equipped, and staffed in accordance with DOH rules, as specified at N.J.A.C. 8:41.
"Mobility assistance vehicle (MAV)" means a specialized transport vehicle that is validly licensed, equipped, staffed, and operated in accordance with DOH rules regarding such vehicles at N.J.A.C. 8:40 and 8:41.
"Mobility assistance vehicle service" means the provision of non-emergency health care transportation provided by a transportation broker under contract with the Department of Human Services, in a vehicle that is licensed, equipped, staffed, and operated in accordance with New Jersey State Department of Health rules, as specified at N.J.A.C. 8:40, by certified trained personnel, for sick, infirm or otherwise disabled individuals who are under the care and supervision of a physician and whose medical condition is not of sufficient magnitude or gravity to require transportation by ambulance, but whose medical condition or functional ability, including, but not limited to, any relevant mental/behavioral health issues or intellectual or cognitive limitations, requires transportation from place to place for medical care, and whose use of an alternate form of transportation, such as taxicab, bus, other public conveyance or private vehicle might create a serious risk to life and health.
"Modified livery transportation service" means livery service or MAV service provided by a transportation broker under contract with the Department of Human Services to beneficiaries under 21 years of age who require supervision provided by a qualified broker-supplied attendant.
"Motor Vehicle Commission (MVC)" means the New Jersey Motor Vehicle Commission.
"Multiple loading" means that more than one Medicaid/NJ FamilyCare fee-for-service beneficiary is being transported in the same vehicle at the same time.
"National Plan and Provider Enumerations System (NPPES)" means the system that assigns NPIs, maintains, and updates information about health care providers with NPIs, and disseminates the NPI Registry and NPPES downloadable file. The NPI Registry is an online query system that allows users to search for a health care provider's information.
"National Provider Identifier (NPI) means a unique 10-digit identification number issued to health care providers by the Centers for Medicare and Medicaid Services (CMS).
"Specialty care transport (SCT)" means ground transportation of a critically injured or critically ill beneficiary between medical facilities, in a ground ambulance that is licensed, equipped, staffed, and operated in accordance with DOH rules, as specified at N.J.A.C. 8:41, including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT-Paramedic, when such services require ongoing care that must be furnished by one or more health professionals in an appropriate specialty area, such as emergency or critical care nursing, emergency medicine, respiratory care, cardiovascular care, or a paramedic with additional training.
"Taxonomy code" means a code that describes the provider or organization's type, classification, and the area of specialization.
"Transportation" means the use of an approved vehicle to move a Medicaid/NJ FamilyCare fee-for-service beneficiary from place to place for the purpose of obtaining a Medicaid/NJ FamilyCare-covered service.
"Transportation reimbursement allowance" means that claims are paid on a fee-for-service basis, as indicated in N.J.A.C. 10:50-2, Healthcare Common Procedure Coding System (HCPCS).
"Type 1 NPI" means a code that describes an individual provider in the NPPES system.
"Type 2 NPI" means a code that describes an organizational provider in the NPPES system.
"Waiting time" means that period of actual time, in increments of 15 minutes, beginning 30 minutes following delivery of the beneficiary to his or her destination, for ground ambulance and mobility assistance vehicle service.
N.J. Admin. Code § 10:50-1.2
See: 6 New Jersey Register 12(a), 6 New Jersey Register 150(a).
Amended by R.1978 d.297, effective 8/28/1978.
See: 10 New Jersey Register 282(a), 10 New Jersey Register 443(b).
Amended by R.1980 d.93, effective 3/1/1980.
See: 12 New Jersey Register 21(a), 12 New Jersey Register 193(e).
Amended by R.1985 d.427, effective 8/19/1985.
See: 17 New Jersey Register 1373(a), 17 New Jersey Register 2044(a).
2ii(1)(H) deleted; iii added.
Amended by R.1988 d.262, effective 6/6/1988.
See: 19 New Jersey Register 2103(a), 20 New Jersey Register 1214(a).
Substantially amended.
Amended by R.1990 d.592, effective 12/3/1990.
See: 22 New Jersey Register 1513(a), 22 New Jersey Register 3620(c).
Added definition for "patient."
Amended by R.1992 d.83, effective 2/18/1992.
See: 23 New Jersey Register 3619(a), 24 New Jersey Register 610(a).
Added new definitions for air and ground ambulance service. Deleted general ambulance service definitions, and those definitions for "passenger", "patient" and "physician". Added text to "provider" definition. Other stylistic revisions.
Amended by R.1992 d.447, effective 11/16/1992.
See: 24 New Jersey Register 2517(a), 24 New Jersey Register 4264(a).
Added definitions for: "Loaded mile," "Transportation reimbursement allowance" and "Waiting time."
Amended by R.1994 d.402, effective 8/1/1994 (operative August 15, 1994).
See: 26 New Jersey Register 1425(a), 26 New Jersey Register 3211(b).
Amended by R.1999 d.5, effective 1/4/1999.
See: 30 New Jersey Register 3625(a), 31 New Jersey Register 58(a).
Substituted references to beneficiaries for references to recipients throughout; changed "Invalid coach service" definition to "Mobility assistance vehicle service", and added a second sentence; in "Loaded mile", "Multiple loading" and "Transportation", inserted references to NJ KidCare fee-for-service; in "Transportation", inserted a reference to NJ KidCare-covered service; and in "Waiting time", substituted a reference to mobility assistance vehicle service for a reference to invalid coach service.
Amended by R.1999 d.370, effective 11/1/1999.
See: 31 New Jersey Register 847(a), 31 New Jersey Register 3325(a).
Rewrote "Mobility assistance vehicle service".
Administrative change.
See: 32 New Jersey Register 708(a).
Amended by R.2006 d.213, effective 6/19/2006.
See: 37 N.J.R. 4850(a), 38 N.J.R. 2713(a).
Substituted "FamilyCare" for "KidCare" throughout; in definition "Air ambulance service", substituted "wing or rotary wing" for "wings"; added definitions "Beneficiary", "Division", "Lower mode service", "Mobility assistance vehicle (MAV)", "Modified livery transportation service" and "Motor Vehicle Commission (MVC)"; in definition "Mobility assistance vehicle service", substituted "staffed and operated" for "and staffed"; in definition "Provider", in the first sentence inserted "an", substituted "wing or rotary wing" for "wings", deleted "and" preceding "mobility" and added "or livery service" and added the last sentence; and in definition "Transportation reimbursement allowance", substituted "Healthcare" for "HCFA".