N.J. Admin. Code § 10:94-2.2

Current through Register Vol. 56, No. 24, December 18, 2024

Section 10:94-2.2 - Emergency services

(a) The determination of an eye emergency, for example, acute glaucoma, retinal detachment, ruptured globe or lacerated lid, or sudden loss of vision, shall be made by a physician.

(b) The Commission for the Blind and Visually Impaired shall pay for emergency surgery at a freestanding same-day surgical center or, if no other option is available on an emergency basis, a hospital that agrees to accept the ambulatory care center fee schedule as set forth in N.J.A.C. 10:91-7.1 may be utilized on a case-by-case basis, if all of the following conditions are met:

1. The Commission is notified prior to the surgery being performed, even if the patient is at the surgical center, if it is a medical emergency;

2. The patient is subsequently determined to be eligible for assistance from the Commission pursuant to N.J.A.C. 10:91-2.1 and 2.6; and

3. If the particular surgical procedure is not listed on the Commission's medical fee schedule (see N.J.A.C. 10:91-7.1), caseworkers should follow the procedures outlined in N.J.A.C. 10:91-7.1(c).

(c) CBVI shall not pay hospitalization cost.

(d) If client's surgery must take place at a hospital as inpatient, clients shall be advised to apply to the hospitals' indigent program, if needed, for the cost of the same (see N.J.A.C. 10:94-2.5(a) ).

(e) Caseworkers shall advise surgical centers and physicians of the conditions listed in (b) above as soon as emergency patients are referred to them.

(f) There shall be no payment for surgeries that have occurred prior to the Commission's authorization for payment, except as the conditions of emergency surgery, described in (b) above apply and the service center manager or designee have given prior authorization for the procedure.

(g) When an emergency occurs at a time that Commission offices are closed, surgical centers or physicians shall fax to the appropriate service center, the patient's name, address, telephone number, eye information, recommended treatment, and need for financial assistance with emergency surgery. In addition, surgical centers or physicians shall follow-up with a phone call to the appropriate service center on the next business day. Service center phone numbers are available on the CBVI website, http://www.state.nj.us/humanservices/cbvi/facilities/.

(h) The Commission shall assist eligible clients with eye medication as follows:

1. The Commission shall pay for any pharmaceutical prescription for the purpose of treatment of ocular disease only one time, covering up to a three-month supply per prescription. The financial need standard shall apply pursuant to N.J.A.C. 10:91-3;

2. Clients shall be referred to other resources, such as Medicaid, Pharmaceutical Assistance for the Aged and Disabled (PAAD) New Jersey Family Care, or a "needy patient" service of a pharmaceutical company; and

3. Medication shall always be sent to a client's doctor, never to a client directly or to any other party in instances where a client receives "needy patient" service from a pharmaceutical company.

(i) The Commission shall pay for emergency transportation for eye care for eligible clients by the least costly, suitable conveyance in the absence of other immediately available resources. Clients shall be referred by caseworkers to other resources, such as Medicaid, New Jersey Family Care, community volunteer services, or county paratransits, for assistance.

N.J. Admin. Code § 10:94-2.2

Amended by 47 N.J.R. 1867(c), effective 7/20/2015