New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN
Subchapter 4 - BEHAVIORAL ASSISTANCE SERVICES
Section 10:77-4.11 - Reimbursement

Universal Citation: NJ Admin Code 10:77-4.11

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

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

(b) All reimbursements shall be restricted to approved Medicaid/NJ FamilyCare providers and shall be subject to Medicaid/NJ FamilyCare regulations.

1. Behavioral assistance services rendered in a location which does not meet Title XIX ( 42 U.S.C. § 1396a) requirements as a reimbursable service site shall be reimbursed if it is a part of the approved treatment plan of the child/youth or young adult using the HCPCS code S5125. See 10:77-7.2(c).

(c) Providers use the appropriate Healthcare Common Procedure Codes (HCPCS) for the service provided. See 10:77-7.2(c).

(d) A unit of service shall be defined as 15 consecutive minutes of face-to-face services provided to an individual. Non-consecutive shorter time periods may not be added together to total 15 minutes.

1. Time spent providing behavioral assistance services to a beneficiary while being transported shall be included in the units of service if a staff member is not the driver, but provides the therapeutic service while in the vehicle.

2. Non-therapeutic services, including, but not limited to, simple transportation, mentoring, respite care, educational tutoring, and non-therapeutic recreational activities shall not be reimbursed as behavioral assistance services by the Medicaid/NJ FamilyCare program.

3. Services shall be billed individually for each eligible member of a group receiving behavioral assistance services.

4. Reimbursement shall be provided for behavioral assistance services rendered to the child/youth or young adult's parent or caregiver as described in 10:77-4.6(d).

(e) Reimbursement for behavioral assistance services shall be provided in conjunction with other mental health rehabilitation services provided that each service is a distinct service with its own purpose, goal and expected outcome and is delivered in accordance with an approved plan of care.

(f) The provision of clinical supervision to the direct care workers shall not be separately reimbursed.

(g) Behavioral assistance services that are under the scope of a Direct Care staff shall not be reimbursed at an increased rate if delivered by a clinical staff person.

(h) If the professional providing clinical supervision or other licensed behavioral healthcare practitioner accompanies the direct care worker to a service delivery site for the purpose of providing separate and distinct services to another beneficiary at the same location, those separate and distinct behavioral assistance services shall be eligible for reimbursement at the base rate for the service.

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.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.