N.J. Admin. Code § 10:60C-6.2

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

Section 10:60C-6.2 - Reassessment requirements

(a) A personal care assistant nursing reassessment visit shall be conducted on a schedule determined by the Division of Medical Assistance and Health Services or at the discretion of the MCO or Division, as appropriate. A reassessment may be required in the event of a change in the participant's health condition or needs, support system, or the duration of a period of disenrollment from the program, if those circumstances affect the need for personal care assistance. The following documents must be submitted in support of a request for reassessment:

1. Certification from a physician indicating a change in condition;

2. Verification indicating the loss of primary support; or

3. Participant request for reinstatement for program eligibility as described at N.J.A.C. 10:60C-8.3, where the reassessment approval period has expired.

(b) The nursing reassessment shall be performed by a registered nurse employed or under contract with the MCO, for participants enrolled in managed care, or employed by the Division for participants enrolled in Medicaid/NJ FamilyCare fee-for-service benefits.

(c) A participant's eligibility for the Personal Preference Program may be terminated, due to non-compliance with the reassessment requirements, at the discretion of the Division. The MCO shall inform the Division of any situation of non-compliance with the reassessment process, resulting in a termination of the PCA service benefit for participants enrolled in managed care.

N.J. Admin. Code § 10:60C-6.2

Amended and recodified from 10:142-6.2 by 56 N.J.R. 2294(a), effective 12/2/2024