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