N.J. Admin. Code § 10:52-2.8 - Substance use disorder treatment facilities; free- standing
(a)
Division requirements for substance use disorder treatment facilities are
located in N.J.A.C. 10:66, Independent Clinic Services. Services provided to a
Medicaid/NJ FamilyCare fee-for-service beneficiary by a free standing
hospital-affiliated substance use disorder treatment facility shall be covered
only if those services are eligible for Federal Financial Participation under
the Medicaid Program (Title XIX of the Social Security Act) or the NJ
FamilyCare program (Title XXI of the Social Security Act) and the following
conditions are met:
1. The treatment is
prescribed or certified by a physician or an advance practice nurse (APN);
and
2. The treatment is provided in
a substance use disorder treatment facility licensed or approved by the New
Jersey State Department of Health pursuant to
N.J.S.A.
26:2G-21 et seq., and N.J.A.C. 10:161A for
residential services, N.J.A.C. 10:161B for outpatient services, and/or N.J.A.C.
10:161B-11fo r opioid treatment services, as applicable; and
3. The staff of the treatment facility
includes a medical director.
(b) Payment for outpatient services provided
in a free-standing substance use disorder treatment facility shall be made on a
fee-for-service basis. The services include mental health services, methadone
maintenance, and other related health services. The Division's payment shall be
accepted as payment in full for Medicaid/NJ FamilyCare-Plans A and B. For NJ
FamilyCare-Plan C, the Division's payment shall be considered as payment in
full except for the Division's requirements regarding the personal contribution
to care responsibilities of the NJ FamilyCare-Plan C beneficiaries which are
codified at N.J.A.C. 10:49-9 and
N.J.A.C.
10:52-4.7. Mental health and substance use
disorder services for beneficiaries of NJ FamilyCare-Plans A, B and C who are
also clients of the Division of Developmental Disabilities are provided by
their MCO.
(c) Inpatient and
outpatient substance use disorder services for Plan D beneficiaries shall be
limited to detoxification.
(d)
Approved centers shall submit claims only for those procedure codes which
correspond to the allowable services included in their New Jersey Medicaid/NJ
FamilyCare provider approval letter. Room, board, and other residential
services shall not be covered. Claims for reimbursement shall be submitted to
the fiscal agent in an accepted format approved by the fiscal agent.
Notes
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