New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 142 - PERSONAL PREFERENCE PROGRAM
Subchapter 6 - PARTICIPANT SELF-DIRECTION AND REASSESSMENT
Section 10:142-6.2 - Reassessment requirements

Universal Citation: NJ Admin Code 10:142-6.2

Current through Register Vol. 56, No. 18, September 16, 2024

(a) A personal care assistant nursing reassessment visit shall be conducted on a schedule determined by the Division of Medical Assistance and Health Services or at the discretion of the MCO or Division, as appropriate. A reassessment may be required in the event of a change in the participant's health condition or needs, support system, or the duration of a period of disenrollment from the program if those circumstances affect the need for personal care assistance. The following documents must be submitted in support of a request for reassessment:

1. Certification from a physician indicating a change in condition;

2. Verification indicating the loss of primary support; or

3. Participant request for reinstatement for program eligibility as described in N.J.A.C. 10:142-8.3, where the reassessment approval period has expired.

(b) The nursing reassessment shall be performed by a registered nurse employed or under contract with the MCO, for participants enrolled in managed care, or employed by the Division for participants enrolled in Medicaid fee-for-service benefits.

(c) A participant's eligibility for the Personal Preference Program may be terminated, due to non-compliance with the reassessment requirements, at the discretion of the Division. The MCO shall inform the Division of any situation of non-compliance with the reassessment process, resulting in a termination of the PCA service benefit for participants enrolled in managed care.

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