Current through Register Vol. 56, No. 18, September 16, 2024
(a) The agency director shall authorize payments
for patient care and allow for a personal needs allowance (PNA) for those clients who were residing in a
non-Medicaid nursing facility on or prior to June 30, 1995 when a physician certifies that the client has a
defect, disease, or impairment (other than psychosis) which necessitates such care, the client is not
eligible for Medicaid, or for nursing facility services under the Medically Needy Program, and there is no
person available who will provide such care without cost to the client. Those WFNJ/GA recipients shall
continue to receive WFNJ/GA nursing facility benefits until such time as the WFNJ/GA nursing facility
benefits are no longer required, or when the client is no longer eligible to receive such WFNJ/GA benefits as
long as the client remains in the same non-Medicaid nursing facility.
1.
Physician certification shall be accomplished by means of Form GA-18, Certification of Need for Patient Care
in Facility Other than Public or Private General Hospital. This form shall be completed in duplicate, by the
attending or staff physician and the operator or superintendent of the appropriate facility. One copy shall
be submitted to DFD for determination of nursing facility care and subsequently, filed in the case record and
the other copy shall be retained by the nursing facility or institution.
2. Payment to the non-Medicaid facility shall not exceed the rates
established by DFD for that facility. The county/municipality shall contact DFD to obtain the per diem rate
for room, board and nursing care. A PNA of $ 35.00 per month shall be allowed to the resident.
i. To determine the all inclusive rate the agency shall be authorized to
pay the non-Medicaid nursing facility, the agency shall calculate the non-Medicaid facility rate established
by the DFD, times the number of days of care for the month, less the payment by or on behalf of the client.
Each month the agency will obtain a current bill for all services rendered during the previous month.
(1) The agency shall authorize per diem payments for periods of up to 10
days during which the client is temporarily absent from the facility for hospitalization, or for periods of
up to 25 days in a calendar year for therapeutic visits.
ii. Prescription drugs, laboratory, x-ray, physician, dental, podiatry
services and supplies are not included in the nursing facility per diem rate. Payment for such services
rendered shall be paid directly to the provider by the fiscal agent in accordance with the rules and
regulations appropriate for the services rendered (see N.J.A.C. 10:49).
