N.J. Admin. Code § 10:52A-4.4 - Length and hours of service

Current through Register Vol. 54, No. 7, April 4, 2022

(a) Length and hours of service for APH shall be as follows:
1. Initial length of service requests for APH shall not exceed a maximum of seven business days, while awaiting prior authorization (PA) approval.
2. Prior authorization for APH is required every 90 days for up to a maximum of six months per beneficiary.
3. Beneficiaries receiving APH services shall receive no less than two hours of services per day and no more than five hours of services per day. Beneficiaries receiving APH services shall receive a maximum of 25 hours of services per week.
(b) Length of service for PH. PH service is limited to 24 months per beneficiary. However, in calculating this 24-month period, time spent in both PH and APH shall be included.
1. Beneficiaries receiving PH services shall receive no less than two hours of services per day and no more than five hours of services per day. Beneficiaries receiving PH services shall receive a maximum of 25 hours of services per week.
(c) Readmission. At the conclusion of the six-month maximum length of stay, any future readmission to an APH program is permitted only if the readmission meets the eligibility requirements in 10:52A-3.1. The initial authorization for readmission shall not exceed a maximum of seven business days while awaiting prior authorization (PA) approval from DMAHS. Prior authorization for readmission to an APH shall be required every 90 days, up to a maximum of six months per beneficiary. In order to be eligible for readmission to PH services, a beneficiary shall be referred by the APH or a designated screening center or be significantly impaired such that a need for PH exists, and receive from the interdisciplinary treatment team certification containing the clinical evidence to justify the necessity for a beneficiary to receive PH services, documenting the beneficiary's specific conditions contained in 10:52A-3.2(c)1, 2 and 3. Readmission is limited to 24 months per beneficiary. However, in calculating this 24-month period, time spent in both PH and APH shall be included.

Notes

N.J. Admin. Code § 10:52A-4.4

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