Current through Register Vol. 56, No. 18, September 16, 2024
(a) The
reimbursement for rehabilitative service-environmental lead inspection or
hazard assessment service shall be based on the provider's usual and customary
charge or the maximum fee allowance at
N.J.A.C.
10:77-7.2(a), whichever is
less.
(b) To be reimbursable as a
rehabilitative service, the local board of health's environmental lead
inspection or hazard assessment service shall meet the following conditions:
1. The service shall be provided by the local
boards of health and performed by a DOH certified lead inspector/risk
assessor;
2. The service shall be
provided in the primary residences of Medicaid/NJ FamilyCare-Plan A
beneficiaries who are children identified as having EBLLs. The purpose of the
environmental lead inspection or hazard inspection is to identify the source(s)
of lead contamination; and
3. The
environmental lead inspection or hazard inspection shall include tests
performed by the certified lead inspector/risk assessor designed to locate lead
hazards.
i. Laboratory testing and analysis
of substances, such as water and paint, shall not be included as reimbursable
environmental lead inspection or hazard assessment
services.
(c)
Only claims for Medicaid/NJ FamilyCare-Plan A-eligible individuals referred
through the Department of Health to the local boards of health can be
considered for reimbursement by the Medicaid/NJ FamilyCare program.
1. The provider shall request the
beneficiary's Medicaid/NJ FamilyCare-Plan A Health Benefits Identification
(HBID) Card and verify Medicaid/NJ FamilyCare-Plan A eligibility for the date
of service before submitting a claim to the Medicaid/NJ FamilyCare program. For
additional information regarding verification of beneficiary eligibility, refer
to N.J.A.C.
10:49-2.11.
(d) A claim for environmental lead inspection
shall be submitted on a CMS 1500 claim form to Gainwell Technologies, the
Medicaid/NJ FamilyCare fiscal agent at the following address:
Gainwell Technologies
PO Box 4808
Trenton, New Jersey 08650-4808
1. Claims shall include a procedure code(s)
(HCPCS) reflecting the service(s) provided and the corresponding fee for the
service(s). See
N.J.A.C.
10:77-7.2(a).
2. Upon receipt of the CMS 1500 claim form,
the Medicaid/NJ FamilyCare fiscal agent will process the claim and reimburse
the local board of health the Federal share (50 percent for Medicaid and 65
percent for certain NJ FamilyCare-Plan A beneficiaries) of the amount approved
by Medicaid/NJ FamilyCare (N.J.A.C. 10:77-7),
the remaining cost of this mandated service, as specified at N.J.A.C. 8:51,
shall be the responsibility of the local board of health.
