N.J. Admin. Code § 10:60-1.7

Current through Register Vol. 56, No. 11, June 3, 2024

Section 10:60-1.7 - Relationship of the home care provider with the Medical Assistance Customer Center (MACC) and the NJ FamilyCare Managed Care Organization or DHS-designated entity

Prior authorization shall be required for all Medicaid/NJ FamilyCare-eligible individuals and non-Medicaid/NJ FamilyCare eligible individuals applying for nursing facility (NF) services. Managed long-term services and supports (MLTSS) provided under the 1115 New Jersey Comprehensive Medicaid Waiver may require determination of clinical eligibility through the pre-admission screening (PAS) process. Division of Aging Services (DoAS) professional staff will conduct clinical eligibility assessments and/or determinations of individuals in health care facilities and community settings to evaluate eligibility for nursing facility level of care. Counseling on options for care including potential appropriate setting for the delivery of services is conducted by the Office of Community Choice Options (OCCO) or professional staff designated by DoAS.

N.J. Admin. Code § 10:60-1.7

Amended by 50 N.J.R. 1992(b), effective 9/17/2018

Amended by 54 N.J.R. 1721(a), effective 9/6/2022