N.J. Admin. Code § 10:52A-4.15

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:52A-4.15 - Quality assurance reviews

(a) DMAHS shall conduct quality assurance reviews of all hospital-based mental health programs annually or more frequently, as required by DMAHS if deficiencies in the program are identified by DMAHS staff.

(b) DMAHS shall notify a program of any noncompliance findings revealed during the quality assurance review within 20 days of the review having been completed.

(c) A program shall respond in writing to any notification of findings within 30 days of notice.

(d) The program response shall include a corrective action plan to address and prevent all incidences of non-compliance.

(e) The corrective action plan shall include, but may not be limited to:

1. A timeline detailing remediation of noncompliance issues;

2. A detailed description of those steps determined necessary by the provider to ensure compliance with the corrective plan; and

3. Individuals and titles responsible for ensuring compliance with that plan.

(f) DMAHS shall review the corrective action plan submitted by the program. If the corrective action plan does not adequately address the deficiencies identified in a quality assurance review, DMAHS shall return the plan to the program for revision. Any program deficiencies identified by DMAHS shall be rectified by the program within 30 days of receipt.

(g) DMAHS has the authority to restrict and/or terminate program admissions of NJ FamilyCare/Medicaid or Work First New Jersey (WFNJ)/General Assistance (GA) beneficiaries because of provider noncompliance with Medicaid standards, such as, but not limited to, actions taken by DMHS, quality assurance reviews conducted by DMAHS and immediate health and safety concerns.

(h) Programs may be subject to follow-up visits by DMAHS staff based on the outcome of quality assurance reviews conducted by DMAHS.

N.J. Admin. Code § 10:52A-4.15