N.J. Admin. Code § 10:60-2.2

Current through Register Vol. 56, No. 23, December 2, 2024

Section 10:60-2.2 - Certification of need for home health services

(a) To qualify for payment of home health services by the New Jersey Medicaid/NJ FamilyCare fee-for-service program, the beneficiary's need for services shall be certified in writing to the home health agency by the attending physician/ practitioner. The nurse or therapist shall immediately record and sign verbal orders and obtain the physician's/practitioner's counter signature, within 30 days of the date of the order.

(b) Except as provided in (b)1 below, home health services shall not be provided or reimbursed, except when provided in accordance with all of the certification and face-to-face encounter provisions of Sections 6407(a) and (d), 3108 and 10605 of the Patient Protection and Affordable Care Act, 111 Pub.L. 148, as amended and supplemented, incorporated herein by reference, 42 U.S.C. § 1395n, incorporated herein by reference, and 42 CFR 424.22(a) and (b), incorporated herein by reference.

1. Telehealth technology may be used to provide the face-to-face encounter required under (b) above.

2. The "face-to-face encounter" between an authorized physician/practitioner and a NJ Medicaid/ FamilyCare beneficiary for the initial certification for the provision of home care services must occur no more than 90 days prior to the date home care is started or within 30 days of the start of home care, including the date of the encounter.

i. Recertification of the need for home care services shall be done at least every 60 days and must be signed and dated by the physician/practitioner who reviews the plan of care. A face-to-face encounter is not required for recertification.

3. An authorized physician/practitioner must provide the home care provider the date, time, and location of the "face-to-face encounter" and his or her signature confirming that the encounter was conducted.

4. Home care providers are required to maintain proof of a "face-to-face encounter" including the date, time, location, and signature of the authorizing physician/practitioner. Such documentation may be subject to review by the New Jersey Department of Human Services or its authorized agent.

5. Failure to comply with the "face-to-face encounter" and documentation requirements in (b) and (b)2, 3, and 4 above, may result in the recoupment of Medicaid/NJ FamilyCare payments for home care services.

(c) For beneficiaries who are enrolled in managed care, all home health services must be determined to be medically necessary and prior authorized by the MCO before services are rendered.

N.J. Admin. Code § 10:60-2.2

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