New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 54 - PHYSICIAN SERVICES
Subchapter 5 - POLICIES AND PROCEDURES FOR PROVISION OF SERVICES PRESCRIBED OR RENDERED BY A PHYSICIAN
Section 10:54-5.31 - Nursing facility services
Current through Register Vol. 56, No. 18, September 16, 2024
(a) An attending physician shall prescribe, and certify in the medical record, the medical necessity for nursing facility services for a Medicaid/NJ FamilyCare program patient.
(b) When physician services are provided to a patient in a nursing facility (formerly known as a skilled nursing facility or an intermediate care facility), reimbursement will not be made to any physician or practitioner, or for therapy or services rendered by an owner, partner, administrator, officer, or stockholder of the company or corporation or anyone who otherwise has a direct or indirect financial interest in the institution; except that:
(c) Annual Resident Reviews (ARR) for individuals identified as having mental illness, who reside in Medicaid certified nursing facilities shall be performed by the individual's attending physician and forwarded to the Office of Utilization Management, Mental Health Services, Division of Medical Assistance and Health Services, PO Box 712, Trenton, New Jersey 08635-0712, for final determination of the need for specialized services.
(d) A more detailed guideline of physician services performed in nursing facilities (NF) can be found in the Long Term Care Facility Services, N.J.A.C. 10:63 (which is usually located in the facility). Assistance is also available to the physician, on a peer basis, from the Medical consultant in the Medical Assistance Customer Center. A director of Medical Assistance Customer Centers is located at N.J.A.C. 10:49, Appendix.