New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 37J - PROGRAMS OF ASSERTIVE COMMUNITY TREATMENT
Subchapter 2 - PROGRAM OPERATION
Section 10:37J-2.3 - Eligibility
Universal Citation: NJ Admin Code 10:37J-2.3
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The PA shall provide PACT services to eligible consumers.
(b) The PA shall consider as eligible any consumer who meets all of the following criteria:
1. Has a serious and persistent
mental illness of at least 12 months duration;
2. Poses a high clinical risk of
hospitalization, as evidenced by a recent history of psychiatric hospital
admission in the following priority order:
i.
Two or more State psychiatric hospital admissions within the past 18
months;
ii. One State psychiatric
hospitalization within the past 18 months, in addition to one or more other
psychiatric hospital admissions (including voluntary admissions) within the
past 18 months;
iii. One State
psychiatric hospital admission within the past 18 months, in addition to
multiple (two or more) screening center admissions within the past 18
months;
iv. Two short-term care
facility (STCF) admissions, or two county psychiatric hospital admissions, or a
combined total of two, within the past 18 months;
v. One STCF admission or one county
psychiatric hospital admission, in addition to one or more other psychiatric
hospital admissions (including voluntary admissions) within the past 18
months;
vi. One STCF admission or
one county psychiatric hospital admission, in addition to multiple (two or
more) screening center admissions within the past 18 months; or
vii. Multiple (two or more) involuntary
psychiatric hospital admissions to private psychiatric hospitals within the
past 18 months;
3. Has
at least one of the following primary DSM 5 diagnoses:
i. Schizophrenia or Other Psychotic Disorders
(298.9);
ii. Major Depressive
Disorders (296.xx);
iii. Bipolar
Disorders (296.xx, 296.89);
iv.
Delusional Disorder (297.); or
v.
Schizoaffective Disorder (295.7);
4. Has impaired functioning in at least one
of the following domains on a continuing or intermittent basis for at least one
year:
i. Personal self-care;
ii. Interpersonal relationships;
iii. Work; or
iv. Ability to acquire and maintain safe,
affordable housing and at risk of requiring a more restrictive living
situation; and
5. Has
demonstrated lack of benefit from, or refusal to participate in, ICMS and/or
another intensive ambulatory or residential mental health services for a period
of at least six months.
(c) The PA shall obtain Division approval for each PACT consumer prior to enrollment, which shall only be denied if it is documented that one or more of the criteria is not met.
(d) The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is incorporated herein by reference, as amended and supplemented into this chapter. Copies of the DSM may be obtained from the American Psychiatric Association, 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209-3901.
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