Current through Register Vol. 56, No. 24, December 18, 2024
(a)
Eligibility for nursing facility (NF) services will be determined by the
professional staff designated by the Department, based on a comprehensive needs
assessment that demonstrates that the beneficiary requires, at a minimum, the
basic NF services described in
N.J.A.C.
8:85-2.2.
1. Individuals requiring NF services may have
unstable medical, emotional/behavioral and psychosocial conditions that require
ongoing nursing assessment, intervention and/or referrals to other disciplines
for evaluation and appropriate treatment. Typically, adult NF residents have
severely impaired cognitive and related problems with memory deficits and
problem solving. These deficits severely compromise personal safety and,
therefore, require a structured therapeutic environment. NF residents are
dependent in several activities of daily living (bathing, dressing, toilet use,
transfer, locomotion, bed mobility, and eating).
i. Children requiring NF services exhibit
functional limitations identified either in terms of developmental delay
requiring nursing care over and above routine parenting or are limited in terms
of specific age-appropriate physical and cognitive activities, functional
abilities (ADL) or abnormal behavior, as demonstrated by performance at home,
school or recreational activities.
(1)
Children who have achieved developmental milestones within appropriate time
frames and who require only well child care and/or treatment of acute, time
limited illnesses or injuries shall not be eligible for NF
services.
2. NF
residents shall be those individuals who require services which address the
medical, nursing, dietary and psychosocial needs that are essential to
obtaining and maintaining the highest physical, mental, emotional and
functional status of the individual. Care and treatment shall be directed
toward development, restoration, maintenance, or the prevention of
deterioration. Care shall be delivered in a therapeutic health care environment
with the goal of improving or maintaining overall function and health status.
The therapeutic environment shall ensure that the individual does not decline
(within the confines of the individual's right to refuse treatment) unless the
individual's clinical condition demonstrates that deterioration was
unavoidable.
(b) All
Medicaid participating NFs shall provide or arrange for services in accordance
with statutory and regulatory requirements under 42 CFR 483 and Department of
Health and Senior Services licensing rules at N.J.A.C. 8:39. Reimbursement of
NF services is discussed in N.J.A.C. 8:85-3.
(c) NF services shall be delivered within an
interdisciplinary team approach. The interdisciplinary team shall consist of a
physician and a registered professional nurse and may also include other health
professionals as determined by the individual's health care needs. The
interdisciplinary team performs comprehensive assessments and develops the
interdisciplinary care plan.
