Current through Register Vol. 56, No. 6, March 18, 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.
