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
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.
(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:
(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.