New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 77A - ADULT MENTAL HEALTH REHABILITATION SERVICES PROVIDED IN/BY COMMUNITY RESIDENCE PROGRAMS
Subchapter 2 - PROGRAM OPERATIONS
Section 10:77A-2.5 - Basis of reimbursement
Current through Register Vol. 56, No. 18, September 16, 2024
(a) Reimbursement for AMHR services provided in or by community residence programs to eligible Medicaid and NJ FamilyCare beneficiaries shall be based on the site-specific levels of care delivered by each provider, in accordance with this chapter.
(b) Reimbursement will be on a fee-for-service basis for each level of care, billable in either per-diem or quarter-hour units of service as applicable and as enumerated in this chapter and the billing supplement to this chapter. The rates shall be all-inclusive and shall be based on the range of services included in the service definition. The fee shall not include non-treatment and/or non-rehabilitation-related services, including, but not limited to, room and board, recreational and vocational services.
(c) Providers will be reimbursed on a per diem basis for services provided by all Level A+, A and D programs and those Level B programs that are group homes.
(d) Providers shall be reimbursed for quarter-hour units of service for rendering services at all Level C programs and at those Level B programs that are supervised apartments. A quarter-hour unit of service is defined as 15 consecutive minutes of service.
(e) Medicaid/NJ FamilyCare reimbursement will not be provided for both mental health personal care assistant (PCA) services and AMHR services provided in or by a community residence program for the same beneficiary on the same date of service. Medical or physical PCA services rendered to a beneficiary will be reimbursed, if all other applicable requirements are met.
(f) Medicaid/NJ FamilyCare reimbursement will not be provided for Programs of Assertive Community Treatment (PACT) services provided to the same beneficiary on the same date of service.
(g) If a beneficiary is required to remain in a residence while awaiting transfer to a more appropriate facility (see N.J.A.C. 10:77A-2.3) , the provider shall request reimbursement at the lesser of: