N.J. Admin. Code § 10:77-1.2 - General definitions

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

The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise.

"Care management organization" (CMO) means an independent, community-based organization that combines advocacy, service planning and delivery, and care coordination into a single, integrated, cross-system process, in order to assess, design, implement and manage child-centered and family-focused individual service plans (ISPs) for children, youth and young adults whose needs require intensive care management techniques that cross multiple service systems. See N.J.A.C. 10:73.

"Centers for Medicare & 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 and the State Children's Health Insurance Program (SCHIP) in the United States.

"Child, youth, or young adult" means a Medicaid beneficiary under 21 years of age or a NJ FamilyCare-Plan B or C beneficiary under 19 years of age, or an individual receiving services under the Children's System of Care who is not eligible for Medicaid/NJ FamilyCare who is under 21 years of age.

"Children's System of Care" means the Division established within the Department of Children and Families, which provides a comprehensive approach to the provision of mental health/behavioral health services to eligible children, youth, and young adults.

"Contracted system administrator" (CSA) means an administrative organization contracted by, and serving as an agent of, the Department of Children and Families to provide utilization management, care coordination, quality management, and information management for the Children's System of Care in its administration of the locally managed system of care that provides mental and behavioral health services and supports to eligible children, youth, and young adults.

"County Case Assessment Resource Team" (CART) means a team which is part of a county-based interagency system of individual case planning and service system development. This multi-disciplinary team reviews cases of children with emotional or behavioral disturbances, who are placed residentially, or at risk of psychiatric hospitalization, to determine if a community-based placement is more appropriate. The CART also promotes partnerships with parents, advocates across all child-serving systems and coordinate services.

"Department" means the Department of Human Services (DHS).

"Department of Children and Families" (DCF) means the Department of New Jersey government, created by P.L. 2006, c. 47, that has the goal of ensuring safety, permanency, and well-being for all children and that has direct responsibility for child welfare and other child and family services. DCF includes the Division of Child Protection and Permanency, the Children's System of Care, the Division of Prevention and Community Partnerships, the New Jersey Child Welfare Training Academy, and the Office of Education.

"Division" means the Division of Medical Assistance and Health Services (DMAHS) within the New Jersey Department of Human Services.

"Division of Child Behavioral Health Services" (DCBHS) means the Division established within the Department of Children and Families, which provides a comprehensive approach to the provision of mental health/behavioral health services to eligible children, youth and young adults.

"Family support organization" (FSO) means an independent community-based organization providing services through a contract with the Department of Children and Families. The FSOs are comprised of family members who are involved or have been involved in the system of children's mental health services and who provide direct peer support and advocacy to children and families receiving services under CSOC.

"Healthcare Common Procedure Coding System" (HCPCS) means a nationwide coding system, established and maintained by CMS in accordance with the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191.

"Joint Committee on Accreditation of Healthcare Organizations (JCAHO)" means the organization that evaluates and accredits health care organizations and programs in the United States. Information about JCAHO can be obtained from: Joint Committee on Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181; telephone (630) 792-5000; and on the web at http://www.jcaho.org.

"NJ FamilyCare" means the health insurance coverage program administered by DMAHS under the provisions of Title XIX and Title XXI of the Social Security Act, in accordance with N.J.A.C. 10:49, 10:78, and any other applicable rules of the Division.

"Rehabilitative service" is an optional service that a state may define to include (pursuant to 42 C.F.R. 440.130 ) medical or remedial services recommended by a physician or other licensed practitioner within the scope of practice under State law, for maximum reduction of physical or mental disability and restoration of an individual to his or her best possible functional level.

"Young adult" means, for purpose of eligibility for DCF/CSOC services, an individual, at least 18 years of age and under 21 years of age, who had been receiving mental/behavioral health services under DCF/CSOC prior to becoming 18 years of age, or who is currently receiving services in the child-serving system and who demonstrates a clinical need for the continuation of such services.

"Youth case management" means services provided in accordance with N.J.A.C. 10:37H and 10:73 to facilitate a level of case management that assists children, youth or young adults in accessing and receiving the appropriate level of care, interventions and supports to maintain the optimal functioning level in the community.

Notes

N.J. Admin. Code § 10:77-1.2
Amended by 48 N.J.R. 81(a), effective 1/4/2016

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