New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 50 - TRANSPORTATION SERVICES MANUAL
Subchapter 1 - GENERAL PROVISIONS
Section 10:50-1.4 - Services covered by the New Jersey Medicaid/NJ FamilyCare program

Universal Citation: NJ Admin Code 10:50-1.4

Current through Register Vol. 56, No. 18, September 16, 2024

(a) All non-emergency medical transportation services shall be provided by an independent transportation broker under contract with the Department of Human Services. These services may include, but are not limited to:

1. Ground ambulance service (non-emergency);

2. Mobility assistance vehicle service;

3. Livery services, including modified livery services;

4. All lower-mode transportation services, including arranging for transportation by taxi, train, bus, plane, other public conveyance, or mileage reimbursement for the use of an individual's vehicle; and

5. Fixed wing air transportation services.

(b) All emergency ground transportation services and all rotary wing air ambulance services are provided by independent transportation providers enrolled in accordance with N.J.A.C. 10:49-3.2 and this chapter.

1. For beneficiaries enrolled in managed care, all emergency transports, including ground and rotary wing air transports, as well as their associated loaded mileage costs, shall be the responsibility of the managed care organization.

(c) Ground ambulance service is a covered service under the following conditions:

1. When such service is not free and available in the community;

2. When the service is the least expensive mode of transportation suitable to the individual's needs, as indicated in N.J.A.C. 10:50-1.6(a);

3. When the service is provided as specified in the rules of DOH at N.J.A.C. 8:40 or 8:41, as applicable;

4. When the use of any other method of transportation is medically contraindicated;

5. The ambulance crew shall comply with the duties of staff as specified in New Jersey State Department of Health and Senior Services rule N.J.A.C. 8:40-6.4;

6. Hospital-based Mobile Intensive Care Unit/Advanced Life Support (MICU/ALS) service and associated Ambulance/Basic Life Support (Ambulance/BLS) service are reimbursable by the Medicaid/NJ FamilyCare fee-for-service program only when billed on a single claim by the hospital providing the MICU/ALS service. Transportation companies providing the Ambulance/BLS service associated with a MICU/ALS run shall bill the hospital providing the MICU/ALS service and shall not bill the Medicaid/NJ FamilyCare program directly for this service.
i. A non-hospital-based MICU/ALS services provider acting on behalf of a hospital or consortium to provide MICU/ALS services to Medicaid/NJ FamilyCare beneficiaries may bill the Medicaid/NJ FamilyCare program directly for this service if the entity has received a Certificate of Need approval and has been licensed by DOH as an MICU/ALS service provider in accordance with N.J.A.C. 8:41-2. Existing prohibitions on additional reimbursement to nursing homes for such services and on reimbursement for services provided by volunteer ambulance organizations and existing provisions regarding Ambulance/BLS services remain intact. See N.J.A.C. 10:50-1.6(k) and 10:52-2.16(b)3.

7. The Division will pay, on behalf of eligible Medicaid/NJ FamilyCare beneficiaries who are also eligible for Medicare, the full amount of any Medicare deductible and coinsurance costs for covered MICU/ALS and Ambulance/BLS services provided to such beneficiaries. Code A0434 shall be used when submitting claims for such ambulance specialty care transport services. See N.J.A.C. 10:50-2.2(a).

(d) An air ambulance (fixed wing or rotary wing), under extenuating circumstances, may be used as a carrier to transport the sick, injured, or disabled Medicaid/NJ FamilyCare fee-for-service beneficiary.

1. The service is restricted to the emergency condition where transportation by air is medically considered the only acceptable form of travel and the conditions are such that its utilization is feasible. The Division retains the option to utilize this form of transportation in such situations where, at the program's discretion, it could represent a significant cost savings when compared to ground ambulance or mobility assistance vehicle service involving trips covering similarly long distances.
i. For fee-for-service beneficiaries needing rotary wing air ambulance services, these services shall be provided by independent air ambulance providers.

ii. For fee-for-service beneficiaries needing fixed wing air ambulance services, the air ambulance service shall be arranged through the transportation broker but reimbursed fee-for-service.

2. The service shall be provided as specified in the rules of DOH at N.J.A.C. 8:41, Advanced Life Support Services, Mobile Intensive Care Programs, Specialty Care Transport Services, and Air Medical Services.

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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