N.J. Admin. Code § 10:53A-5.1 - Introduction

Current through Register Vol. 54, No. 7, April 4, 2022

(a) The New Jersey Medicaid/NJ FamilyCare program adopted the Centers for Medicare & Medicaid Services' Healthcare Common Procedure Coding System (HCPCS). The HCPCS procedure codes as listed in this subchapter are relevant to certain Medicaid/NJ FamilyCare fee-for-service hospice services.
(b) For a complete description of the basis of payment for the HCPCS codes listed below, refer to 10:53A-4.2, Basis of payment-hospice providers in this chapter. Section 1814(i)(1)(C)(ii) of the Social Security Act authorizes the rates and provides for annual increases in payment rates for hospice services. The Federally predetermined prospective annual rates are calculated based on the annual hospice rates established by Medicare. Section 1814(i)(2)(B) of the Act provides for an annual increase in the hospice cap amounts. Hospice payment rates for care and services are in effect from October 1 of one year to September 30 of the following year. For the "cap" amounts, the fiscal year ends on October 31 of the calendar year. In addition, Section 1814(i)(2)(D) of the Act requires that providers submit their claim for hospice services provided at an individual's home only on the basis of the geographic location at which the services are furnished.
(c) States have the flexibility to establish hospice rates at amounts no lower than the Medicare allowable hospice rate. The New Jersey Medicaid/NJ FamilyCare program is setting hospice rates for the four "levels of care" at the prospective predetermined levels which are determined by CMS.
(d) The rates marked with an asterisk are adjusted for regional differences in wages, in accordance with 42 CFR 418.306, using indices based on regions listed initially in the Federal statute as referenced in (b) above. Specific directions for calculating individual hospice rates for the four levels of hospice care (routine, continuous, inpatient respite and general inpatient care); for the co-payment for inpatient respite care; and for the annual update of the rates and the wage indices, can be found in the Federal Register, published annually, in accordance with 42 CFR 418.306, or by contacting the United States Department of Health and Human Services, Centers for Medicare and Medicaid Administration.


N.J. Admin. Code § 10:53A-5.1
Amended by R.1997 d.479, effective 11/17/1997.
See: 29 N.J.R. 3441(a), 29 N.J.R. 4853(a).
In (d), rewrote the second sentence and deleted the third sentence.
Amended by R.2003 d.320, effective 8/4/2003.
See: 34 N.J.R. 2899(a), 35 N.J.R. 3568(a).
Rewrote the section.
Amended by R.2008 d.226, effective 8/4/2008.
See: 40 N.J.R. 1582(a), 40 N.J.R. 4578(a).
In (a), substituted "Centers for Medicare & Medicaid Services' Healthcare" for "Health Care Financing Administration's (HCFA)" and inserted "fee-for-service".

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