Current through Register Vol. 54, No. 7, April 4, 2022
Reimbursement for intensive in-community mental health rehabilitation services
shall be fee-for-service, based on the level of service required.
(b) All reimbursements shall be restricted to
approved Medicaid/NJ FamilyCare providers and are subject to all Medicaid/NJ
Providers shall seek reimbursement for each separate unit of service using the
appropriate Healthcare Common Procedure Coding System (HCPCS) for the service
A unit of service shall be defined as 15
minutes of face-to-face therapeutic services provided to an individual.
Non-consecutive shorter time periods may not be added together to total 15
1. Time spent providing intensive
in-community services to a beneficiary while being transported shall be
included in the units of service if a staff member other than the driver
provided the therapeutic service while in the vehicle. Travel time to and from
the location of beneficiary contact shall not be included in the units of
services, including, but not limited to, simple transportation, mentoring,
respite care, educational tutoring, and non-therapeutic recreational activities
shall not be reimbursed as intensive in-community services by the Medicaid/NJ
Reimbursement shall be provided for intensive in-community services rendered to
the child/youth or young adult's parent or caregiver as described in
(f) Services shall be billed individually for
each eligible member of a group receiving intensive in-community services in
accordance with the child's authorized plan of care.
(g) The provision of clinical supervision to
the direct care workers shall not be separately reimbursed.
(h) Intensive in-community services that are
within the scope of a direct care staff person shall not be reimbursed at an
increased rate, if delivered by a clinical staff person.
(i) If the professional providing clinical
supervision or other licensed behavioral health care practitioner accompanies
the direct care worker to a service delivery site for the purpose of providing
separate and distinct services to another beneficiary or to another
family/caregiver as a support for the beneficiary at the same location, those
separate and distinct intensive in-community services shall be eligible for
reimbursement at the authorized level of service.