N.J. Admin. Code § 10:77-1.1 - Purpose and scope

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

(a) This chapter is concerned with the provision of, and reimbursement for, medically necessary Medicaid-covered and NJ FamilyCare fee-for-service covered rehabilitative services, specifically, environmental lead inspection/hazard assessment services and mental health rehabilitation services for children, youth, and young adults, in accordance with the New Jersey Medicaid and NJ FamilyCare fee-for-service program rules, including those mental health rehabilitation services provided under the auspices of the Department of Children and Families' (DCF) Children's System of Care (CSOC).
(b) Medically necessary services shall meet all applicable State and Federal Medicaid and NJ FamilyCare laws, and all applicable rules as specified in the appropriate provider services manual of the New Jersey Medicaid/NJ FamilyCare program.
(c) The chapter is divided into seven subchapters and an appendix, as follows:
1.N.J.A.C. 10:77-1 contains general provisions to rehabilitative services, including introductory general provisions and general definitions;
2.N.J.A.C. 10:77-2 contains definitions, provisions for provider participation, basis for reimbursement, policies and procedures, and recordkeeping requirements pertaining to the specific Medicaid-covered and NJ FamilyCare-Plan A-covered rehabilitative service: environmental lead inspection service;
3.N.J.A.C. 10:77-3 contains definitions, provisions for provider participation, basis for reimbursement, policies and procedures, and recordkeeping requirements pertaining to the specific mental health rehabilitation services provided in psychiatric community residences for youth, group homes, or residential childcare facilities, available to children, youth, or young adults who are Medicaid/NJ FamilyCare beneficiaries or children, youth, or young adults who are ineligible for Medicaid/NJ FamilyCare but are receiving mental health rehabilitation services under DCF/CSOC.
4.N.J.A.C. 10:77-4 contains the definitions, provisions for provider participation, basis for reimbursement, policies and procedures, and recordkeeping requirements pertaining to the specific Medicaid/NJ FamilyCare-covered mental health rehabilitation service of behavioral assistance services available to children, youth, or young adults who are Medicaid/NJ FamilyCare beneficiaries or children, youth, or young adults who are ineligible for Medicaid/NJ FamilyCare but are receiving mental health rehabilitation services under DCF/CSOC.
5.N.J.A.C. 10:77-5 contains the definitions, provisions for provider participation, basis for reimbursement, policies and procedures, and recordkeeping requirements pertaining to the specific Medicaid/NJ FamilyCare-covered mental health rehabilitation service of intensive in-community services; available to children, youth, or young adults who are Medicaid/NJ FamilyCare beneficiaries or children, youth, or young adults who are ineligible for Medicaid/NJ FamilyCare but are receiving mental health rehabilitation services under DCF/CSOC.
6.N.J.A.C. 10:77-6 contains the definitions, provisions for provider participation, basis for reimbursement, policies and procedures, and recordkeeping requirements pertaining to the specific Medicaid-covered and NJ FamilyCare-Plan A covered mobile response and stabilization management services for children; available to children, youth, or young adults who are Medicaid/NJ FamilyCare beneficiaries or children, youth, or young adults who are ineligible for Medicaid/NJ FamilyCare but are receiving mental health rehabilitation services under DCF/CSOC.
7.N.J.A.C. 10:77-7 pertains to the Centers for Medicare and Medicaid Services' Healthcare Common Procedure Coding System (HCPCS). The HCPCS contains procedure codes and maximum fee allowances corresponding to the Medicaid/NJ FamilyCare and CSOC reimbursable services of this chapter; and
8. The chapter Appendix pertains to the Fiscal Agent Billing Supplement. The Fiscal Agent Billing Supplement contains billing instructions and samples of forms (claim forms, prior authorization forms, and consent forms) used in the billing process.

Notes

N.J. Admin. Code § 10:77-1.1
Amended by 48 N.J.R. 81(a), effective 1/4/2016

The following state regulations pages link to this page.



State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.