New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 73 - CASE MANAGEMENT SERVICES
Subchapter 2 - ADULT CASE MANAGEMENT PROGRAM/MENTAL HEALTH (CMP/MH)
Section 10:73-2.9 - Basis of payment for adult CMP/MH services

Universal Citation: NJ Admin Code 10:73-2.9

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

(a) Reimbursement for services covered under the CMP/MH in accordance with this subchapter shall be determined by the Commissioner of the Department of Human Services. The provider of CMP/MH services shall be compensated on a fee-for-service basis. Reimbursement will be based upon HCPCS Codes as specified in N.J.A.C. 10:73-5. The provider shall submit a claim form and shall identify the services performed by the use of procedure codes based on the Centers for Medicare & Medicaid Services Healthcare Common Procedure Coding System (HCPCS).

(b) A beneficiary who receives case management services shall be entitled to receive other approved mental health services that are rendered by authorized providers.

(c) Each provider shall charge for all services to all beneficiaries, except as provided by legislation, except that no charge shall be made directly to the Medicaid/NJ Family Care beneficiary.

(d) In no event shall the charge to the New Jersey Medicaid/NJ FamilyCare program exceed the charge by the provider for identical services to other groups or individuals in the community.

1. Payment for CMP/MH services shall not duplicate payments made to public agencies or private entities under other program authorities for this same purpose, including, but not limited to, the Home and Community Based Service Waiver programs. Payment for CMP/MH services shall not duplicate payment for case management services which are an integral part of another provider service.

(e) See 10:49-7.2 for requirements for timely submission of claims.

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