N.J. Admin. Code § 10:60A-3.3

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

Section 10:60A-3.3 - PMDC clinical eligibility for Medicaid/NJ FamilyCare beneficiaries being discharged from a neonatal intensive care unit

(a) The Department shall waive the requirement at N.J.A.C. 10:60A-3.4(a) that professional staff designated by the Department perform a functional assessment prior to admission to a PMDC facility for a Medicaid/NJ FamilyCare beneficiary being discharged from a NICU if:

1. The PMDC facility nursing director, with input from the nursing director of the NICU, performs an assessment and determines that the child is medically complex and/or technology-dependent and documents, in writing, the results of the assessment, which writing shall contain, at a minimum, a summary of findings supporting that determination;

2. Based on the PMDC nursing director's determination, the PMDC facility administrator notifies the Division, in writing, of the facility's intention to admit the Medicaid/NJ FamilyCare beneficiary by following the requirements for notification contained in, and submitting, the documentation required at N.J.A.C. 10:60A-3.4(b)1 i and provides a copy of the PMDC nursing director's written assessment; and

3. Within 20 business days following the Medicaid/NJ FamilyCare beneficiary's admission to the PMDC facility, the facility administrator transmits, by regular mail, a copy of the Medicaid/NJ FamilyCare beneficiary's discharge summary from the NICU to the Division.

(b) Upon the Division's receipt of the notice required at (a)2 above and the discharge summary required at (a)3 above, the Department shall transmit a written notice to the PMDC facility administrator that the Department has approved the Medicaid/NJ FamilyCare beneficiary's receipt of PMDC and shall mail a copy of the written notice to the Medicaid/NJ FamilyCare beneficiary's parent and to the fiscal agent.

(c) The written approval the Department issues pursuant to (b) above shall be effective for 90 days following the date of the Medicaid/NJ FamilyCare beneficiary's admission to the PMDC facility.

(d) Reauthorization of PMDC services for a PMDC beneficiary who was discharged from a NICU and admitted to a PMDC facility in accordance with (a) above shall be in accordance with N.J.A.C. 10:60A-3.4(c).

N.J. Admin. Code § 10:60A-3.3

Amended and Recodified from 10:166-3.3 by 56 N.J.R. 262(a), effective 2/20/2024