N.J. Admin. Code § 10:52-1.14

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:52-1.14 - Social Necessity Days

(a) Payment for "Social Necessity Days" shall be made to hospitals for a maximum of 12 calendar days per hospitalization for a Medicaid/NJ FamilyCare-Children's Program fee-for-service beneficiary child admitted with the diagnosis of child abuse or suspected child abuse, if special circumstances (social necessity) prevent the discharge or transfer of the patient and the hospital has taken effective action to initiate discharge or transfer of the patient.

1. For these cases, it is not necessary for the day of admission to be at the acute level of care.

2. Effective action is defined as telephone notification to the county welfare agency (CWA), or Division of Child Protection and Permanency *(CP&P) local* office, or other responsible officials as may be designated, within 48 hours of the time that the stay is determined to be no longer medically necessary. This telephone contact *then* shall be confirmed in writing within three working days. A copy of the written notification shall be submitted with all claims for which reimbursement is claimed for special circumstances (social necessity).

3. Medicaid/NJ FamilyCare-Children's Program reimbursement for social necessity shall be made to hospitals paid in accordance with the DRG rate setting methodology in N.J.A.C. 10:52-5 through 7 and 9 prior to August 3, 2009, and in accordance with N.J.A.C. 10:52-14on or after August 3, 2009.

i. Payment for Social Necessity Days will be made at the Statewide average per diem rate paid to Medicaid participating nursing facilities (NF) as determined on January 1 of each calendar year.

N.J. Admin. Code § 10:52-1.14

Amended by 50 N.J.R. 1261(a), effective 5/21/2018