New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 76 - PROGRAMS OF ASSERTIVE COMMUNITY TREATMENT (PACT) SERVICES
Subchapter 2 - PROGRAM OPERATIONS
Section 10:76-2.6 - Reimbursement methodology
Current through Register Vol. 56, No. 6, March 18, 2024
(a) Providers will be reimbursed on a fee-for-service basis for PACT services provided to an eligible beneficiary, as described at 10:76-2.3(a), based on the lower of the provider's usual and customary charge or the established DMAHS contracted reimbursement rate for the service.
(b) A unit of service shall be defined as one calendar month of services, with full reimbursement being provided for the month services are initiated and no reimbursement being provided for the month services are terminated, regardless of the quantity of services provided in either of those months.
(c) For months of service other than the first and last months, a minimum of two hours of face-to-face contact with, or on behalf of, the beneficiary shall be provided.
(d) Providers shall seek reimbursement by submitting a CMS-1500 claim form, in accordance with DMAHS rules at N.J.A.C. 10:49.