N.J. Admin. Code § 10:54-7.7

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

Section 10:54-7.7 - PASRR and PAS Screens; Necessity for nursing facility services

(a) The determination of the necessity for NF services shall be performed through Pre-admission Screening (PAS) as mandated by N.J.S.A. 30:4D-17.10. The Regional Staff Nurse (RSN) or other professional staff designated by the DHSS shall determine the necessity for nursing facility services for Medicaid/NJ FamilyCare program beneficiaries and for individuals who may become Medicaid/NJ FamilyCare program beneficiaries within six months following admission to a Medicaid certified facility and for individuals identified as meeting PASRR Level I criteria.

(b) The PASRR Level II Screen prior to NF admission shall be performed by a psychiatrist and forwarded to the Division of Mental Health Services (DMHS) for final determination of the need for specialized services.

1. The hospital discharge planning unit and/or social services department shall immediately arrange through the individual's attending physician, a consultation by a board eligible or board certified hospital staff psychiatrist, who shall also be a Medicaid/NJ FamilyCare participating provider, to conduct the active treatment review and complete the "Psychiatric Evaluation" form. (The "Psychiatric Evaluation" form is not to be completed until such time as the RSN or other professional staff designated by the DHSS has approved placement in an NF.)

2. Within 48 hours of the psychiatrist's review of the beneficiary or potential Medicaid/NJ FamilyCare program beneficiary, the completed "Psychiatric Evaluation" form shall be sent to the Division of Mental Health Services, PO Box 727, Trenton, New Jersey 08625-0727, Attention: PASRR Coordinator.

i. A supply of the "Psychiatric Evaluation" form may be ordered from the PASRR Coordinator in the Division of Mental Health Services or downloaded from the Department's website. (See N.J.A.C. 10:54-7.2(e) )

(c) Annual Resident Reviews (ARR) for individuals identified as having mental illness residing in Medicaid certified nursing facilities shall be performed by the individual's attending physician and forwarded to the Division of Mental Health Services for final determination of the need for specialized services.

1. The MACC will send an NF PASRR Reassessment List to the NF in the first week of every month. The reassessment date is based upon the month the individual was initially admitted to the NF. The attending physician completes the psychiatric evaluation form by the 15th of the following month on those individuals with mental illness.

2. The completed psychiatric evaluation form will be forwarded to the DMHS to be reviewed by DMHS psychiatrists to determine the need for specialized services.

3. The results of the DMHS determination will be returned to the nursing facility to be incorporated in the patient's chart.

N.J. Admin. Code § 10:54-7.7

Amended by R.2001 d.51, effective 2/5/2001.
See: 32 N.J.R. 3929(a), 33 N.J.R. 555(a).
In (c)1, substituted "MACC" for "MDO" in the first sentence; and substituted references to beneficiary and beneficiaries for references to recipient and recipients throughout.
Amended by R.2012 d.124, effective 7/2/2012.
See: 43 N.J.R. 1477(a), 44 N.J.R. 1884(a).
Section was "PASARR and PAS Screens; Necessity for nursing facility services". In (a) and (b)2, inserted "/NJ FamilyCare program" throughout; in (a), the introductory paragraph of (b) and (b)2, and in (b)2i, substituted "PASRR" for "PASARR"; in (a) and (b)1, inserted "or other professional staff designated by the DHSS"; in (a), deleted "Medicaid" preceding "Regional"; in (b)1, inserted "/NJ FamilyCare" and substituted "an" for "a" preceding "NF"; in (b)2i, substituted "or downloaded from the Department's website. (See N.J.A.C. 10:54-7.2(e))" for a period at the end; and in (c)1, substituted "an NF PASRR" for "a NF PASARR" and "15th" for "fifteenth".