Summary
New Jersey Medicaid providers must implement Patient Self-Determination Act (OBRA) compliance requirements, including maintaining written advance directive policies, providing written notifications to patients about their healthcare decision-making rights at time of admission/enrollment, documenting advance directive status in medical records, and ensuring staff education. This is a regulatory compliance mandate affecting all Medicaid-participating providers in New Jersey.
Get alerts when payers change rules like this one
We check New Jersey Medicaid and other payers every day and email you when a change matches your specialty and state.
Get New Jersey Medicaid alertsPolicy Monitoring is free. No card required.
What to do
Action · 9 steps
01REQUIREMENTS:
Immediate (Ongoing Compliance):
- Billing/administrative team must ensure front desk and intake staff provide written advance directive information to ALL adult Medicaid patients at the following touchpoints: hospital admission, nursing facility admission, before home health/personal care services begin, upon initial hospice enrollment, and upon HMO enrollment.
02- Medical records team must document in each patient's medical record whether or not an advance directive has been executed.
03This documentation is required for all adult Medicaid patients.
04- Providers and billing staff must never condition care provision or discriminate against patients based on advance directive status.
05- HR/Compliance must ensure ALL staff (clinical and administrative) receive education on advance directive requirements and Patient Self-Determination Act provisions.
06One-Time Setup:
- Legal/Compliance team must develop and maintain written policies and procedures regarding patient rights to make medical decisions and formulate advance directives, consistent with New Jersey State law.
07- Provider must include written statement of New Jersey law (provided by Department of Health) regarding patient rights in all patient information materials.
08- For religious affiliated institutions: develop and document institutional policies defining circumstances where advance directive implementation will be declined based on conscientious objection; include in written policy statement.
09Consequences: Failure to comply with Patient Self-Determination Act requirements may result in loss of Medicaid program participation, regulatory sanctions, and potential denial of claims for services provided without proper advance directive notification and documentation.
Original notice
Newsletter Vol. 2, No. 04
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 2, No. 01HighEffective Jan 1, 2025 · Provider NoticeNewsletter Vol. 2, No. 02HighEffective Jan 1, 2024 · ReimbursementNewsletter Vol. 2, No. 03MediumNo effective date · CodingNewsletter Vol. 2, No. 05LowNo effective date · Provider NoticeBrowse every New Jersey Medicaid change in the policy list