MedicaidAdministrativeMedium impact
Newsletter Vol. 26, No. 02
New Jersey Medicaid·NJ · Geriatrics, Palliative Care·Provider Notice
Effective date
Feb 1, 2015
We identified it
Jun 20, 2026
Summary
New Jersey redefined Pre-admission Screening (PAS) Action Code 2 with Location Code E to indicate Enhanced At Risk Criteria Pre-admission Screening (EARC-PAS), which now certifies institutional level of care for 90 days instead of 12 months. County Welfare Agencies must request official NJ Choice assessments for individuals who may need long-term nursing facility care beyond 90 days, with assessments scheduled by day 61 if needed. This clarification affects how clinical and financial eligibility determinations are documented and processed for Medicaid nursing facility placements.
Action Required
By February 1, 2015, nursing facility billing and eligibility staff in New Jersey must understand and implement the updated Action Code 2/Location Code E definition for EARC-PAS assessments. When processing Medicaid applications: (1) Billing team and case managers must verify whether a NJ Choice Assessment has been requested or completed within the last 12 months in the state system; (2) If no request exists or a current Action Code 2 appears, submit CP-2 notification to OCCO to initiate clinical eligibility determination; (3) Continue processing financial eligibility concurrently while awaiting clinical determination; (4) For individuals with EARC-PAS, expect OCCO to schedule official NJ Choice assessment by day 61 if long-term placement beyond 90 days is anticipated; (5) Once clinical eligibility is established, the eligibility date may retroactively link to the EARC-PAS assessment date. Refer to Provider FAQs at www.state.nj.us/humanservices/dmahs/home/MLTSS_Provider_FAQs.pdf for facility responsibilities. Failure to properly manage this code transition may result in delays in Medicaid eligibility determinations for long-term services and supports.