N.J. Admin. Code § 10:67-1.2

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

Section 10:67-1.2 - Definitions

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

"CPT" means that edition of the Current Procedure Terminology most current at the time of reference, as published annually by the American Medical Association, Chicago, Illinois, unless otherwise specified in rule.

"Face-to-face" means direct contact between the provider and the patient during a treatment session, this shall include a telehealth visit.

"National Plan and Provider Enumerations System (NPPES)" means the system that assigns NPIs, maintains and updates information about health care providers with NPIs, and disseminates the NPI Registry and the NPPES Downloadable File. The NPI Registry is an online query system that allows users to search for a health care provider's information.

"National Provider Identifier (NPI)" means a unique 10-digit identification number issued to health care providers by the Centers for Medicare and Medicaid Services (CMS).

"Nursing facility (NF)" means an institution (or distinct part of an institution) certified by the New Jersey State Department of Health and approved for participation in Medicaid/NJ FamilyCare and primarily engaged in providing:

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

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

3. Health-related care and services on a regular basis to patients who because of a mental or physical condition require care and services above the level of room and board. However, the nursing facility is not primarily for the care and treatment of patients with mental diseases which require continuous 24-hour supervision by qualified mental health professionals.

"Physician" means a doctor of medicine (M.D.), osteopathy (D.O.) or podiatric medicine, licensed to practice medicine and surgery by the New Jersey State Board of Medical Examiners, or similarly licensed by comparable agencies of the state in which he or she practices.

"Psychological services" means those services rendered within the scope of the profession of psychology as defined by the laws of the State of New Jersey or by the laws of the state in which the psychologist practices.

"Psychological specialist" means a psychologist who limits his or her practice to his or her specialty and who:

1. Is a Diplomate of the American Board of Professional Psychology (Diplomate Qualified); or

2. Is eligible for or has been notified of admissibility to the examination by the American Board of Professional Psychology (Diplomate Eligible).

"Psychologist" means a practicing professional psychologist who is licensed by the New Jersey State Board of Psychological Examiners or by the comparable state agency in the state in which he or she practices.

"Residential health care facility" means a facility, licensed by the New Jersey State Department of Health, which furnishes food and shelter to four or more persons 18 years of age and older who are unrelated to the owner and which provides dietary services, recreational activities, supervision of self-administration of medications, supervision of and assistance in activities of daily living (ADL), and assistance in obtaining health services to one or more of such persons. As used in this chapter, the term "residential health care facility" means a "boarding home for sheltered care" as defined by the New Jersey State Department of Health.

"Residential treatment center" means a facility that:

1. Has a facility or program accreditation by the Joint Commission, or other accreditation as specified in the Department's rules;

2. Provides 24-hour per day care and treatment for recipients under 22 years of age whose needs are such that they are unable to function appropriately in their homes, schools and communities, and are not able to be served appropriately in less restrictive setting; and

3. Has signed a provider agreement to participate in the Medicaid/NJ FamilyCare program and abide by the rules of the Division.

"Taxonomy code" means a code that describes the provider or organization's type, classification, and the area of specialization.

"Type 1 NPI" means a code that describes an individual provider in the NPPES system.

"Type 2 NPI" means a code that describes an organizational provider in the NPPES system.

N.J. Admin. Code § 10:67-1.2

Amended by R.1998 d.89, effective 2/17/1998.
See: 29 N.J.R. 4615(a), 30 N.J.R. 734(a).
Inserted "CPT" definition.
Amended by R.2006 d.348, effective 10/2/2006.
See: 38 N.J.R. 2007(a), 38 N.J.R. 4219(b).
In introductory paragraph, substituted "chapter" for "manual"; in definition "Nursing Facility (NF)", inserted "and Senior Services" and "/NJ FamilyCare"; rewrote definition "Physician"; in definition "Residential health care facility", inserted "and Senior Services" throughout; and in definition "Residential treatment center", inserted ", or other accreditation as specified in the Department's rules" in 1, and inserted "/NJ FamilyCare" in 3.

Amended by 53 N.J.R. 2224(a), effective 12/20/2021

Amended by 56 N.J.R. 37(a), effective 1/2/2024