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N.J.A.C. 10:60-3.8 - Limitations on personal care assistant services

New JerseyregulationNJ Department of Human Services, Division of Medical Assistance and Health Services (DMAHS)

What this rule requires your agency to do

  • 1PCA services must not be reimbursed if the personal care assistant resides in the beneficiary's home (except as specifically provided).(N.J.A.C. 10:60-3.8 - Limitations on personal care assistant services)
  • 2PCA services must not be reimbursed when provided in excluded settings including residential health care facilities, Class C boarding homes, hospitals, nursing facilities, DDD group/congregate living programs, adult/pediatric day health care centers, TBI community residential facilities, and Adult Family Care / Assisted Living Program / Assisted Living Residence.(N.J.A.C. 10:60-3.8 - Limitations on personal care assistant services)
  • 3PCA services provided by a family member are generally not reimbursable (no exceptions for legally responsible relatives); case-by-case exceptions require the PCA to be a currently certified homemaker/home health aide, an employee of the requesting home health agency, and directly supervised by an RN employed by the provider agency, with renewals requested annually.(N.J.A.C. 10:60-3.8 - Limitations on personal care assistant services)
  • 4PCA services must not be approved for respite care, stand-alone supervision, companionship, child care/babysitting, parenting tasks, mental-health service needs, diagnoses without functional limitations, acute short-term diagnoses expected to heal, or needs limited to non-hands-on care.(N.J.A.C. 10:60-3.8 - Limitations on personal care assistant services)
  • 5PCA units of service unused for any reason must not be saved and carried over for use on a subsequent date.(N.J.A.C. 10:60-3.8 - Limitations on personal care assistant services)
  • 6PCA services are limited to a maximum of 40 hours per calendar work week and must be prior authorized; additional hours require case-by-case approval by DDS or DMAHS.(N.J.A.C. 10:60-3.8 - Limitations on personal care assistant services)

Applies to: personal care

NJ Medicaid rule imposing coverage limitations on PCA services, including excluded settings, family-member restrictions, the 40-hour weekly cap, prior authorization, and prohibition on carrying over unused units.

Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.