N.J. Admin. Code § 10:54-7.1

Current through Register Vol. 56, No. 24, December 18, 2024

Section 10:54-7.1 - Pre-admission screening for nursing facility (NF) placement

(a) The following words and terms, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise.

"Pre-admission screening" (PAS) means that process by which all Medicaid/NJ FamilyCare program beneficiaries and individuals who may become Medicaid/NJ FamilyCare program beneficiaries within six months following admission to a Medicaid certified nursing facility (NF), who are seeking admission to a Medicaid certified NF, receive pre-admission screening by professional staff designated by the New Jersey Department of Health and Senior Services (DHSS) to determine the appropriateness of placement prior to admission to an NF, pursuant to N.J.S.A. 30:4D-17.10. ( P.L. 1988, c. 97.)

"Pre-admission screening and resident review (PASRR)" means that process by which mentally ill (MI) or mentally retarded (MR) individuals, applying for admission or continued stay are screened to determine the need for specialized services and for appropriateness of NF services.

"PASRR Level I" means the identification of individuals diagnosed with a serious mental illness (MI) or mental retardation (MR).

"PASRR Level II" is the function of evaluating and determining whether nursing facility (NF) services and specialized services are needed.

"PASRR specialized services for mentally ill individuals" means requiring inpatient psychiatric care.

"Nursing facility (NF)" means an institution (or distinct part of an institution) certified by the State Department of Health and Senior Services for participation in Title XIX Medicaid and primarily engaged in providing:

1. Nursing care and related services for beneficiaries who require medical, nursing care, and social services;

2. Rehabilitative services for the rehabilitation of injured, disabled, or sick; or,

3. Health related care and services on a regular basis to beneficiaries who, because of mental or physical condition, require care and services above the level of room and board; and for the care and treatment of mental disease.

"Regional Staff Nurse (RSN)" means a registered professional nurse employed by the Department of Health and Senior Services or the Department of Human Services who performs health needs assessments as required by the regulations contained in this chapter.

"Service Authorization (SA) and Interim Plan of Care (IPOC)" means the plans and documents that have replaced what was formerly called the Health Service Delivery Plan (HSDP).

1. The Service Authorization (SA) reflects the level of care determination and authorization or denial for services authorized by DHSS professional staff upon completion of the Pre-Admission Screen (PAS) assessment process.

2. The Interim Plan of Care (IPOC) is an initial plan of care prepared by professional staff designated by DHSS during the PAS assessment process. The IPOC reflects the potential service options discussed and identifies next steps by the consumer in order to access services. The SA and IPOC shall be forwarded to the authorized care setting and are to be attached to the beneficiary's medical record.

"Track of care" means the setting and scope of Medicaid/NJ FamilyCare program services approved by the RSN or other professional staff designated by the DHSS following assessment of the Medicaid/NJ FamilyCare program beneficiary or potential 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.

(b) The determination of the necessity of NF services shall be performed through the Pre-admission Screening (PAS) as mandated by N.J.S.A. 30:4D-17.10. Pre-admission Screening (PAS) authorization is required prior to admission to a Medicaid certified NF for a Medicaid/NJ FamilyCare program beneficiary or an individual who may become a Medicaid/NJ FamilyCare program beneficiary within six months following placement in a Medicaid certified NF and for individuals identified as meeting PASRR Level I criteria. The Regional Staff Nurse (RSN) or other professional staff designated by the DHSS shall assess each individual need for long-term care services, evaluate the appropriate setting for the delivery of services and authorize appropriate placement (Track of Care).

(c) PAS authorization shall be required for the Pre-admission Screening and Resident Review (PASRR) of individuals identified as having mental illness or mental retardation. The PASRR assessment and authorization process shall be subsumed within the State's PAS protocols. (See N.J.A.C. 10:52-1.9(d) )

N.J. Admin. Code § 10:54-7.1

Amended by R.2001 d.51, effective 2/5/2001.
See: 32 N.J.R. 3929(a), 33 N.J.R. 555(a).
In "Pre-admission screening", substituted "Medical Assistance Customer Center" for "Medicaid District Office"; and substituted references to beneficiary and beneficiaries for references to recipient and recipients throughout.
Amended by R.2012 d.124, effective 7/2/2012.
See: 43 N.J.R. 1477(a), 44 N.J.R. 1884(a).
In definition "Pre-admission screening", in the introductory paragraph of definition "Track of care" and in (b), inserted "/NJ FamilyCare Program"; in definition "Pre-admission screening", substituted "professional staff designated by the New Jersey Department of Health and Senior Services (DHSS)" for "the Medical Assistance Customer Center" and "c. 97" for "c.97"; substituted definition "Pre-admission screening and resident review (PASRR)" for definition "Pre-admission screening and annual resident review (PASARR)", definition "PASRR Level I" for definition "PASARR Level I", definition "PASRR Level II" for definition "PASARR Level II" and definition "PASRR specialized services for mentally ill individuals" for definition "PASARR specialized services for mentally ill individuals"; deleted definition "Health Services Delivery Plan (HSDP)"; rewrote definition "Regional Staff Nurse (RSN)"; added definition "Service Authorization (SA) and Interim Plan of Care (IPOC)"; in definition "Track of care", in the introductory paragraph, inserted "or other professional staff designated by the DHSS" and deleted "Medicaid" following "potential", and in paragraph 2, deleted a comma from the end; in (b) and (c), substituted "PASRR" for "PASARR" throughout; in (b), substituted the second occurrence of "The" for "the Medicaid" and "long-term" for "long term", inserted "or other professional staff designated by the DHSS" and deleted a comma following the third occurrence of "services"; and in (c), deleted "Annual" preceding "Resident" and deleted a period at the end.