N.J. Admin. Code § 10:77-6.11

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

Section 10:77-6.11 - Required records for each beneficiary

(a) Each provider entity shall maintain all records in accordance with Department of Human Services contract rules (see N.J.A.C. 10:3) and in compliance with appropriate Federal and State laws, regulations and rules, including, but not limited to, N.J.A.C. 10:49-9.8, and any applicable rules of the Department of Children and Families.

(b) Providers shall maintain any and all information required by the Department of Human Services, the Department of Children and Families, or authorized designee of either Department, or the contracted system administrator for services rendered to a child, youth, or young adult receiving services from the Children's System of Care.

(c) Providers shall maintain the following data in support of all mobile response services claims:

1. The name and address of the beneficiary;

2. The name and title of the individual providing the service;

3. The exact date(s), location(s) and time(s) of service; and

4. The length of face-to-face contact, excluding travel time to or from the location of the beneficiary contact.

(d) Providers shall maintain the following data in support of all stabilization management claims:

1. The name and address of the beneficiary;

2. The name and title of the individual providing the service;

3. The exact date(s), location(s) and time(s) of service;

4. The type of activity/service provided in accordance with, or in support of, the goals of the service plan; and

5. The length of face-to-face contact, excluding travel time to or from the location of the beneficiary contact.

(e) The provider shall maintain an individual service record for each child/youth or young adult, which shall contain, at a minimum, the following information:

1. The dates of service and the number of care hours received;

2. The child, youth or young adult's diagnosis;

3. The reason for referral and involvement;

4. The original, and all amendments to, the individualized service plan;

5. Documentation of any and all crisis or emergency situations that occur during the provision of stabilization management services (if applicable), including a summary of the corrective action taken and resolution of the situation; and

6. Weekly quantifiable progress notes toward defined goals as stipulated in the child/youth or young adult's service plan.

(f) All providers shall meet all Management Information Systems specifications as provided by the contracted system administrator (CSA) or other Department of Human Services or Children and Families-designated agent.

(g) Providers shall make the records described in (a) through (f) above available to the Department of Human Services, the Division of Medical Assistance and Health Services, the Division of Mental Health and Addiction Services, the Department of Children and Families, the Children's System of Care, the Division of Child Protection and Permanency, the contracted system administrator, or other authorized State agents, as requested.

N.J. Admin. Code § 10:77-6.11

Amended by 48 N.J.R. 81(a), effective 1/4/2016