N.J. Admin. Code § 10:60-5.8

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

Section 10:60-5.8 - Eligibility for managed long-term supports and services (MLTSS)/private duty nursing (PDN) services

(a) MLTSS/private duty nursing is available only to a beneficiary who meets nursing facility level of care criteria (see N.J.A.C. 10:60-6.2), is based on medical necessity, and is prior approved by the NJ FamilyCare MCO in a plan of care prepared by a MLTSS care manager. Private duty nursing is individual, continuous nursing care in the home, and is a service available to a beneficiary only after enrollment in MLTSS.

(b) MLTSS/PDN services are only appropriate when the following requirements are satisfied:

1. An individual must exhibit a severity of illness that requires complex skilled nursing interventions on a continuous ongoing basis.

i. "Ongoing" means that the beneficiary requires the provision of skilled nursing intervention on an ongoing basis, up to 24 hours per day/seven days per week.

ii. "Complex" means the degree of difficulty and/or intensity of treatment/procedures.

iii. "Skilled nursing interventions" means procedures that require the knowledge and experience of licensed nursing personnel, or a trained primary caregiver.

2. There must be a capable adult primary caregiver residing with the individual who accepts ongoing 24-hour responsibility for the health and welfare of the beneficiary;

3. The adult primary caregiver must agree to be trained, or have been trained, in the care of the individual and must agree to receive additional training for new procedures and treatments if directed to do so by a State agency;

4. The adult primary caregiver must agree to provide a minimum of eight hours of care to the individual during every 24-hour period; and

5. The home environment must accommodate the required equipment and licensed PDN personnel.

N.J. Admin. Code § 10:60-5.8

Amended by 50 N.J.R. 1992(b), effective 9/17/2018