Current through Register Vol. 56, No. 18, September 16, 2024
(a) An adult beneficiary who chooses to
request to transfer from one ADHS facility to another ADHS facility shall submit a transfer request, in
accordance with (b) below, to:
1. The facility to which the beneficiary
chooses to request to transfer; or
2. The beneficiary's case or
care manager if the beneficiary is a participant of any program listed at
N.J.A.C. 10:164-1.1(b)
that requires case or care management.
(b) A request for transfer to another ADHS facility shall be in writing and
include the following:
1. The beneficiary's name, address, and date of
birth;
2. The name of the ADHS facility at which the beneficiary
is receiving ADHS;
3. The valid reason(s), as identified at (c)
below, upon which the requestor bases the transfer request;
4.
The name of all ADHS facilities the beneficiary has attended, including dates attended; and
5. The signature of the beneficiary and/or the beneficiary's
legally-authorized representative.
(c) Any one of the
following is a valid reason for a transfer to another ADHS facility:
1. The
beneficiary is changing his or her residence;
i. A request to transfer based
on this reason shall contain the address of the beneficiary's new residence;
2. The transportation time between the beneficiary's home and the ADHS
facility to which the beneficiary chooses to request to transfer is shorter than the transportation time
between the beneficiary's home and the ADHS facility in which the beneficiary is enrolled as a participant,
and the beneficiary prefers to have a shorter transportation time;
3. The beneficiary believes that the facility from which the beneficiary
chooses to request to transfer violated his or her rights as a participant of that facility pursuant to
N.J.A.C. 8:43F-4.2;
i. A request to transfer based on this reason shall describe the nature of
the violation; or
4. The transfer is medically
necessary as identified by the beneficiary's attending physician, physician assistant, or advanced practice
nurse;
i. A request to transfer based on this reason shall include the
written statement of the beneficiary's attending physician, physician assistant, or advanced practice nurse
indicating the basis of the medical necessity.
(d) A case or care manager in receipt of a beneficiary's request to
transfer to another ADHS facility shall forward the request to the ADHS facility to which the beneficiary
wishes to transfer with written notification providing the number of days per week the beneficiary may
receive ADHS pursuant to
N.J.A.C. 10:164-1.3(a)3
and 1.4(a)3.
(e) Upon receipt
of a beneficiary's written transfer request and, if applicable pursuant to (d) above, the written notice from
the beneficiary's case or care manager providing the number of days per week the beneficiary may attend the
facility if the request was made pursuant to (a)2 above, the ADHS facility to which the beneficiary chooses
to request to transfer shall submit a pre-numbered prior authorization request form with the original written
transfer request to the Department in accordance with
N.J.A.C.
10:164-1.3(a)3, with the exception that the facility shall
mail the submission to the following address:
Adult Day Health Services Program
Office of Community Choice Options
Division of Aging Services
New Jersey Department of Human Services
PO Box 807
Trenton, NJ 08625-0807
1. Prior
to the submission of the pre-numbered prior authorization request form, the transferee facility shall notify
the ADHS facility from which the beneficiary chooses to request to transfer of the beneficiary's pending
transfer request.
(f) Within 30 days of the date the
Department receives the written transfer request, the Department shall take one of the actions specified in 1
through 4 below and shall notify the beneficiary, the ADHS facility to which the beneficiary chooses to
request to transfer, and if applicable, the beneficiary's case or care manager, of the Department's decision:
1. Approve a transfer request that presents at least one of the valid
reasons provided at (c) above;
2. Approve a transfer request that
does not present one of the valid reasons provided at (c) above, if the Department has not approved a request
to transfer without a valid reason for the beneficiary within one year of receipt of the current
request;
3. Deny a transfer request that does not present one of
the valid reasons provided at (c) above that is submitted within one year of an approval of a previous
submission of a request to transfer without a valid reason in accordance with (f)2 above; or
4. Request additional information if the written transfer request does not
provide the requisite information identified at (b) above.
