New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 73 - CASE MANAGEMENT SERVICES
Subchapter 4 - YOUTH CASE MANAGEMENT YCM SERVICES
Section 10:73-4.10 - Basis of reimbursement

Universal Citation: NJ Admin Code 10:73-4.10

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

(a) Reimbursement for YCM services shall be fee-for-service.

(b) All reimbursement shall be restricted to approved Medicaid/NJ FamilyCare YCM providers and shall be subject to all applicable Medicaid/NJ FamilyCare rules, including N.J.A.C. 10:49 and these rules.

(c) A unit of service shall be defined as 15 minutes of face-to-face services or other collateral contact and activities that support the provision of youth case management services described at 10:73-4.6(b), provided directly to, or on behalf of, the child, youth or young adult receiving services. Non-consecutive shorter time periods shall not be added together to total 15 minutes. Transportation of a beneficiary shall not be included.

1. Examples of face-to-face services or other collateral contact and activities which can be included in calculating billable units of YCM services shall include, but are not limited to:
i. Preparing and reviewing a written service plan to address the needs of the child, youth, or young adult;

ii. Aiding in identifying and/or accessing local, State or Federal benefit programs for which the child, youth or young adult may be eligible, including telephone contact and/or working face-to-face with the child, youth, or young adult and his or her family to complete a PE application for Medicaid/NJ FamilyCare benefits; assisting the family in completing a Medicaid/NJ Family Care application; as well as assisting the family in applying for any other benefits for which they may be eligible;

iii. Communicating with current service providers to monitor the child, youth or young adult's progress towards attaining the goals of the service plan;

iv. Identifying and contacting potential service providers to meet the needs of the child, youth or young adult;

v. Preparing referral information for potential service providers;

vi. Completing paperwork and data entry for prior authorization; and

vii. Completing service documentation and progress notes.

(d) When the child, youth or young adult is not the primary focus of the activity or the activity is not a reimbursable service, as specified in N.J.A.C. 10:73-5 and this subchapter, the activity shall not be included in calculating billable units of YCM services. Examples of non-billable activities shall include, but shall not be limited to:

1. Travel time to and from billable activities;

2. Waiting time;

3. Transportation of the child, youth or young adult, if no other YCM documented services are provided during the transportation;

4. Supervision or supervisory time; and

5. Administrative activities such as meetings or trainings.

(e) Providers shall seek reimbursement for YCM services using the appropriate Healthcare Common Procedure Codes (HCPCS). (See N.J.A.C. 10:73-5.)

(f) 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.

(g) In the event a YCM child, youth, or young adult is hospitalized or admitted to a hospital for treatment of behavioral health/mental health needs or into a Joint Committee-accredited psychiatric treatment facility during a prior authorization period, the Medicaid/NJ FamilyCare program shall not be charged for YCM services rendered during the hospitalization or residency.

(h) Providers of YCM services shall not bill for services provided while the child, youth or young adult is receiving CMO services, except that any services provided in the month in which the individual is discharged from the CMO may be billed.

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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