MedicaidCoverageHigh impact
Newsletter Vol. 7, No. 64
New Jersey Medicaid·NJ · Psychiatry, Geriatrics·Provider Notice
Effective date
Oct 15, 1997
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is eliminating Annual Resident Review (ARR) requirements for nursing facility residents with serious mental illness (SMI) or mental retardation (MR) effective October 15, 1997. Nursing facilities must now conduct reviews only when residents experience a significant change in condition, and must report such changes to state mental health/developmental disability authorities. The same HCPCS billing codes and fee schedules used for ARRs apply to Change in Condition assessments.
Action Required
By October 15, 1997: Medicaid billing team must immediately cease processing Annual Resident Review (ARR/MI and ARR/MR) claims for nursing facility residents with SMI or MR diagnoses. Stop submitting ARR billing on encounter forms and in billing system for all Medicaid-certified nursing facilities. Update billing system workflows to remove ARR/MI and ARR/MR codes from routine submission batches. Any ARRs already 'in progress' should be completed and retained in medical records, but no new ARRs should be initiated. Begin training nursing facility partners that Change in Condition assessments (using same billing codes as previous ARRs) are now the only allowable psychiatric/developmental disability reassessment claims. Verify that nursing facilities understand they must clinically determine when DMHS or DDD review is needed and submit referral documentation (including updated 1994 Psychiatric Evaluation form) within 7 days of completing reassessment. Failure to comply will result in denial of ARR claims on or after the effective date.