New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 58A - ADVANCED PRACTICE NURSE SERVICES
Subchapter 1 - GENERAL PROVISIONS
Section 10:58A-1.2 - Definitions
The following words and terms, as used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise.
"Advanced practice nurse (APN)" means a person currently licensed to practice as a registered professional nurse who is certified by the New Jersey State Board of Nursing in accordance with N.J.A.C. 13:37-7, and with 45:11-24 and 45 through 52, or similarly licensed and certified by a comparable agency of the state in which he or she practices.
"Advanced practice nurse (APN) services" means those services provided within the scope of practice of a licensed registered professional nurse (R.N.) and the certification as an APN, defined by the laws and rules of the State of New Jersey, or if in practice in another state, by the laws and regulations of that state.
"Ambulatory care facility" means a health care facility or a distinct part of a health care facility, licensed by the New Jersey State Department of Health and Senior Services, which provides preventive, diagnostic and treatment services to persons who come to the facility to receive services and depart from the facility on the same day.
"Centers for Medicare and Medicaid Services (CMS)" means the agency of the Federal Department of Health and Human Services which is responsible for the administration of the Medicaid program in the United States.
"Clinical practitioner" means a physician (including doctor of medicine, osteopathy, dentistry, podiatry, optometry, and chiropractic medicine), advanced practice nurse, certified nurse midwife or clinical psychologist.
"Concurrent care" means care rendered to a beneficiary by more than one clinical practitioner.
"Consultation" means the professional evaluation of a patient by a qualified specialist recognized as such by the Division of Medical Assistance and Health Services (DMAHS) that is requested by the attending clinical practitioner or an authorized State agency. A consultation requested by a beneficiary and/or family members, and not requested by the clinical practitioner or an authorized State agency, is not considered a consultation.
"Discipline" means a branch of instruction or learning, such as medicine, dentistry, advanced practice nursing, or chiropractic.
"Early and Periodic Screening, Diagnosis and Treatment (EPSDT)" means a preventive and comprehensive health program: for Medicaid and NJ FamilyCare-Children's Program Plan A beneficiaries under 21 years of age, including the assessment of an individual's health care needs through initial and periodic examinations (screenings), the provision of health education and guidance and the identification, diagnosis and treatment of health problems; for eligible NJ FamilyCare-Children's Program Plan B and C enrollees, including early and periodic screening and diagnostic medical examinations, dental, vision, hearing and lead screening services and treatment services identified through the examination that are available under the contractor's benefit package or specified services under the fee-for-service (FFS) program (see 10:49-5.6) .
"Federal Funds Participation Upper Limit (FFPUL)" means the maximum allowable cost or "MAC price" as defined by the Centers for Medicare and Medicaid Services (CMS).
"Federally Qualified Health Center (FQHC)" means an entity that is receiving a grant under Section 329, 330, or 340 of the Public Health Service Act, section 1905(l) of the Social Security Act, 42 U.S.C. § 1396 (l); or is receiving funding from such a grant under a contract with the recipient of such a grant and meets the requirements to receive a grant under Section 329, 330, or 340 of the Public Health Service Act; or, based on the recommendation of the Health Resources and Services Administration within the Public Health Service, is determined by the Secretary to meet the requirements for receiving such a grant; or was treated by the Secretary, for purposes of Medicare Part B, as a Federally Funded Health Center as of January 1, 1990.
"HealthStart" means the program of health services provided to pregnant women, infants and small children, as described at N.J.A.C. 10:58A-3.
"HealthStart Maternity Care Services" means a comprehensive package of maternity care services which includes two components, "Medical Maternity Care" and "Health Support Services." (See N.J.A.C. 10:58A-3 for information about HealthStart Services and provider requirements for participation.)
"HealthStart Maternity (Comprehensive) Care Services Provider" means a practitioner who provides HealthStart Maternity Care services either directly, or indirectly through linkage with other practitioners, in independent clinics, hospital outpatient departments, or physicians' offices.
"HealthStart pediatric care provider" means a group of practitioners, a hospital, an independent clinic, or practitioner approved by the New Jersey State Department of Health and Senior Services and the New Jersey Medicaid and NJ FamilyCare-Plan A programs to provide a comprehensive package of pediatric care services.
"Independent clinic" means a facility that is not part of a hospital, but is organized and operated to provide medical care to outpatients.
"Labeler code" means a five-digit numeric code assigned by the Food and Drug Administration, which identifies the firm that manufactures or distributes a specific drug. This code is the first segment of the National Drug Code.
"Mental health clinic" means a freestanding independent community facility or distinct component of a multi-service ambulatory care facility, which meets the minimum standards established by the Community Mental Health Services Act implementing rules at N.J.A.C. 10:37.
"Mental illness," for purposes of the PASRR, refers to a condition, which can be disabling and/or chronic, such as schizophrenia, mood disorder, paranoia, panic, or other severe anxiety disorder, as described, for dates of service before October 1, 2015, in the International Classification of Diseases, Ninth Revision (ICD-9(M)), or for dates of service on or after October 1, 2015, as described in the International Classification of Diseases, 10th Revision (ICD-10 (F00 -F99)), and which can lead to a chronic disability. (See PASRR requirements at 10:58A-2.10 .)
"National Drug Code (NDC)" - means an 11-digit number that identifies a drug product. The first five digits represent the labeler code identifying the drug manufacturer; the next four digits identify the drug product; and the last two digits identify the package size.
"Physician" means a doctor of medicine (M.D.) or osteopathy (D.O.) licensed to practice medicine and surgery by the New Jersey State Board of Medical Examiners or similarly licensed by a comparable agency of the state in which he or she practices.
"Preadmission screening (PAS)" means that process by which all Medicaid eligible beneficiaries seeking admission to a Medicaid certified nursing facility (NF) and individuals who may become Medicaid eligible within six months following admission to a Medicaid certified NF, receive a comprehensive needs assessment by professional staff designated by the Department of Health and Senior Services to determine their long-term care needs and the most appropriate setting for those needs to be met.
"Pre-Admission Screening and Resident Review (PASRR)" means an evaluation or screening to assess potential or actual nursing facility (NF) residents in respect to mental illness and/or mental retardation, in order to assure that the resident is provided with appropriate services, and to ensure that the NF admits residents whose needs can be met by the services normally provided by the facility. PASRR includes two levels of screening, Level I Preadmission Screening and Resident Review and Level II Preadmission Screening and Resident Review, as described at N.J.A.C. 10:58A-2.10.
"Product code" means a four-digit numeric code, assigned by a firm that manufactures and distributes a drug, which identifies a specific strength, dosage form and formulation of the drug. This code is the second segment of the National Drug Code.
"Specialty" means a health care practice within a discipline, such as pediatrics, obstetrics/gynecology or mental health. All APN specializations must be certified by the New Jersey Board of Nursing in accordance with N.J.A.C. 13:37-7.1.
"State appropriations act" means an annual New Jersey State fiscal year appropriations act.
"Unit of measure" or "UOM" means a value of measurement used to define a drug product. Acceptable UOM codes are: F2 (international measure), GM (gram), ML (milliliter) or UN (unit/each).
