Current through Register Vol. 56, No. 18, September 16, 2024
(a) This chapter is concerned with the
provision of, and reimbursement for, medically necessary Medicaid/NJ FamilyCare
fee-for-service covered rehabilitative services, specifically, environmental
lead inspection and hazard assessment services and mental health rehabilitation
services for children, youth, and young adults, in accordance with the New
Jersey Medicaid/NJ FamilyCare fee-for-service program rules, including those
mental health rehabilitation services provided under the auspices of the
Department of Children and Families' (DCF) Children's System of Care
(CSOC).
(b) Medically necessary
services shall meet all applicable State and Federal Medicaid and State
Children's Health Insurance Program (SCHIP) laws, and all applicable rules as
specified in the appropriate provider services manual of the New Jersey
Medicaid/NJ FamilyCare program. The SCHIP program in New Jersey is known as NJ
FamilyCare.
(c) The chapter is
divided into seven subchapters and an appendix, as follows:
1.N.J.A.C.
10:77-1 contains general provisions to
rehabilitative services, including introductory general provisions and general
definitions;
2.N.J.A.C.
10:77-2 contains definitions, provisions for
provider participation, basis for reimbursement, policies and procedures, and
recordkeeping requirements pertaining to the specific Medicaid/NJ
FamilyCare-Plan A-covered rehabilitative service: environmental lead inspection
service;
3.N.J.A.C.
10:77-3 contains definitions, provisions for
provider participation, basis for reimbursement, policies and procedures, and
recordkeeping requirements pertaining to the specific mental health
rehabilitation services provided in psychiatric community residences for youth,
group homes, or residential childcare facilities, available to children, youth,
or young adults who are Medicaid/NJ FamilyCare beneficiaries or children,
youth, or young adults who are ineligible for Medicaid/NJ FamilyCare but are
receiving mental health rehabilitation services under DCF/CSOC.
4.N.J.A.C.
10:77-4 contains the definitions, provisions
for provider participation, basis for reimbursement, policies and procedures,
and recordkeeping requirements pertaining to the specific Medicaid/NJ
FamilyCare-covered mental health rehabilitation service of behavioral
assistance services available to children, youth, or young adults who are
Medicaid/NJ FamilyCare beneficiaries or children, youth, or young adults who
are ineligible for Medicaid/NJ FamilyCare but are receiving mental health
rehabilitation services under DCF/CSOC.
5.N.J.A.C.
10:77-5 contains the definitions, provisions
for provider participation, basis for reimbursement, policies and procedures,
and recordkeeping requirements pertaining to the specific Medicaid/NJ
FamilyCare-covered mental health rehabilitation service of intensive
in-community services; available to children, youth, or young adults who are
Medicaid/NJ FamilyCare beneficiaries or children, youth, or young adults who
are ineligible for Medicaid/NJ FamilyCare but are receiving mental health
rehabilitation services under DCF/CSOC.
6.N.J.A.C.
10:77-6 contains the definitions, provisions
for provider participation, basis for reimbursement, policies and procedures,
and recordkeeping requirements pertaining to the specific Medicaid/NJ
FamilyCare-Plan A-covered mobile response and stabilization management services
for children; available to children, youth, or young adults who are Medicaid/NJ
FamilyCare beneficiaries or children, youth, or young adults who are ineligible
for Medicaid/NJ FamilyCare but are receiving mental health rehabilitation
services under DCF/CSOC.
7.N.J.A.C.
10:77-7 pertains to the Centers for Medicare
and Medicaid Services' Healthcare Common Procedure Coding System (HCPCS). The
HCPCS contains procedure codes and maximum fee allowances corresponding to the
Medicaid/NJ FamilyCare and CSOC reimbursable services of this chapter;
and
8. The chapter Appendix
pertains to the Fiscal Agent Billing Supplement. The Fiscal Agent Billing
Supplement contains billing instructions and samples of forms (claim forms,
prior authorization forms, and consent forms) used in the billing
process.
