New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 52 - HOSPITAL SERVICES MANUAL
Subchapter 2 - POLICIES AND PROCEDURES RELATED TO SPECIFIC SERVICES
Section 10:52-2.10 - Psychiatric services; partial hospitalization

Universal Citation: NJ Admin Code 10:52-2.10

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

(a) Partial hospitalization (PH) means a psychiatric service whose primary purpose is to maximize the client's independence and community living skills in order to reduce unnecessary hospitalization. It is directed toward the acute and chronically disabled individual. A PH program shall provide, as listed below, a full system of services necessary to meet the comprehensive needs of the individual Medicaid/NJ FamilyCare fee-for-service beneficiary. These services shall include:

1. Assessment and evaluation;

2. Service procurement;

3. Therapy;

4. Information and referral;

5. Counseling;

6. Daily living education;

7. Community organization;

8. Pre-vocational therapy;

9. Recreational therapy; and,

10. Health-related services.

(b) Pre-vocational therapy, recreational therapy, and health related services, as required in (a) above, may be provided directly or arranged by partial hospitalization staff through other programs' elements or agencies. To avoid duplication of payment, these services shall not be billed separately from the claim submitted for partial hospitalization reimbursement.

(c) The requirements of the PH program shall include the following:

1. PH shall serve ambulatory, non-residential patients who spend only a part of a 24-hour period (a minimum of two hours and a maximum of five hours of active participation per day in active programming exclusive of meals) in the hospital.

2. A PH program shall be available daily for five days a week, with additional planned activities each week, during evening and/or weekend hours, as needed. Individual clients need not attend every day but as needed.

3. The staff of the PH program shall include a director who shall be a qualified professional from the specialties of psychiatry, psychology, social work, psychiatric nursing, vocational rehabilitation, or a related field, with training and/or experience in direct service provision and administration. A qualified psychiatrist shall be available to the PH program on a regularly scheduled basis. Other staff deemed necessary to implement a PH program shall include qualified mental health professionals, para-professionals, and volunteers.

(d) Authorization for PH services for individuals aged 18 and older who have no involvement with the Children's System of Care within the Department of Children and Families (DCF/CSOC), shall be obtained in accordance with N.J.A.C. 10:52A, Adult Acute Partial Hospital and Partial Hospital Services.

(e) Authorization for PH services for individuals under age 18, and individuals at or over the age of 18 and under the age of 21 who had been receiving services from the (DCF/CSOC) prior to their 18th birthday, shall be obtained as follows:

1. CSOC behavioral healthcare providers may include a referral for PH services in their plans of care. These referrals shall be submitted to the Contracted Systems Administrator (CSA) for approval.

2. If approved, the CSA shall provide the PH provider an authorization number to be used when requesting reimbursement from the Medicaid/NJ FamilyCare programs or any other entities designated by DCBHS to provide reimbursement.

3. Authorization for PH services shall not exceed six months without written permission from CSOC or the CSA.

4. For lengths of stay in the PH program exceeding six months, requests for authorization shall be considered on a case-by-case basis by the DCF or the CSA. The request for authorization shall include sufficient documentation to indicate progress previously made towards the defined treatment goals and justification for the need for continued PH services. In no case shall continued authorizations for PH services exceed 12 months without a discharge plan that provides for a transition to other community-based interventions and supports within the following three months.

(f) Mental health services provided by or through the partial hospitalization program shall not include:

1. Student education, including preparation of school-assigned classwork or homework; or

2. Incentive programs, including, but not limited to, non-therapeutic token economies and subcontract work responsibilities.

(g) The Division shall not reimburse a hospital and/or any other provider for providing both PH services and medical day care center services to the same beneficiary on the same day.

(h) The Division shall not reimburse a hospital for any mental health service (including medication management) provided in addition to PH services provided to the same beneficiary on the same day.

(i) Additional requirements related to Partial Hospitalization (PH) services and Adult Acute Partial Hospitalization (APH) services available to eligible Medicaid/NJ FamilyCare beneficiaries age 18 and older are found at N.J.A.C. 10:52A.

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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