N.J. Admin. Code § 10:77-5.11 - Reimbursement

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

(a) 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 FamilyCare regulations.
(c) Providers shall seek reimbursement for each separate unit of service using the appropriate Healthcare Common Procedure Coding System (HCPCS) for the service provided. See 10:77-7.2(e).
(d) 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 minutes.
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 service.
2. Non-therapeutic 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 FamilyCare program.
(e) Reimbursement shall be provided for intensive in-community services rendered to the child/youth or young adult's parent or caregiver as described in 10:77-5.6(b).
(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.


N.J. Admin. Code § 10:77-5.11

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