N.J. Admin. Code § 10:60A-2.2

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

Section 10:60A-2.2 - Evaluation of provider and quality assurance

(a) The Department shall conduct an evaluation of the quality and effectiveness of the services a PMDC facility provides to a PMDC beneficiary at the time professional staff designated by the Department conduct a review for reauthorization of service on-site at the PMDC facility pursuant to N.J.A.C. 10:60A-3.4(c).

(b) As part of the process of reauthorization of service for a PMDC beneficiary, professional staff designated by the Department shall review:

1. The PMDC beneficiary's most current interdisciplinary plan of care for conformance with N.J.A.C. 8:43J-5;

2. The services being provided to the PMDC beneficiary and their conformity with a PMDC beneficiary's interdisciplinary plan of care and N.J.A.C. 10:60A-5;

3. The most current interdisciplinary team's assessment of the PMDC beneficiary's progress or lack of progress in meeting the objectives prescribed by the PMDC beneficiary's interdisciplinary plan of care and any documentation by the PMDC facility staff of reasons, if any, for the PMDC beneficiary's lack of progress; and

4. The PMDC beneficiary's attendance record and reasons for absences, if any, with particular attention to an intervening hospitalization or illness.

(c) Professional staff designated by the Department performing a review for reauthorization of service for a PMDC beneficiary may contact parents of PMDC beneficiaries and, as appropriate, PMDC beneficiaries themselves to inquire as to appropriateness of care and satisfaction with services provided.

(d) Professional staff designated by the Department performing an on-site evaluation in connection with the reauthorization of service for a PMDC beneficiary shall notify the Division of Health Facilities Evaluation and Licensing of the Department of Health if the on-site evaluation reveals that the PMDC facility is providing substandard services and/or inadequate documentation of these services, not complying with N.J.A.C. 8:43J or otherwise violating any law or regulation applicable to the provision of PMDC.

1. Upon such notification, the Division of Health Facilities Evaluation and Licensing shall undertake enforcement action pursuant to N.J.A.C. 8:43J and 8:43E, as appropriate.

N.J. Admin. Code § 10:60A-2.2

Amended and Recodified from 10:166-2.2 by 56 N.J.R. 262(a), effective 2/20/2024