New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 79B - COMMUNITY SUPPORT SERVICES FOR ADULTS WITH MENTAL ILLNESS
Subchapter 2 - PROGRAM STANDARDS
Section 10:79B-2.4 - Conditions on claims for reimbursement for services
Current through Register Vol. 56, No. 18, September 16, 2024
(a) All units of service shall be a full 15 minutes of face-to-face contact. No rounding up is permitted.
(b) Group services are restricted to a maximum of six clients.
(c) Span billing is not permitted. Providers shall complete a separate claim line for each calendar date on which services were provided and shall include the total number of units of service that were provided on that date for each type of staff qualifications/credentials.
(d) Non-consecutive shorter time periods shall not be added together to total 15 minutes.
(e) Non-consecutive complete units rendered on the same day shall be totaled and paid.
(f) Clients may be billed for a total of seven hours (28 units) per day. Psychiatrist units are limited to eight units per day and APN services to 12 units per day. The remaining service providers (RN and masters, BA and LPN, Associate Degree, high school, and peers) may provide the balance of services up to 28 units per day.
(g) Providers may not bill for CSS that are provided while the individual is enrolled in programs of assertive community treatment (PACT), adult mental health rehabilitation (AMHR), or targeted case management (integrated case management services (ICMS) or project for assistance in transition from homelessness (PATH)).
(h) Services shall not be provided, and are not reimbursable, if provided to a client attending a partial care program for the same hours the client attends the partial care program.
(i) Services may not be billed for clients who are hospitalized prior to the date of their discharge.
(j) Transportation of a client is not reimbursable as a service. Any provision of services provided to a CSS client during travel shall be indicated in the IRP prior to the travel and shall have corresponding documentation supporting what service was provided, by whom, to whom, and the expected outcome of the intervention.
(k) Reimbursement shall be provided only if services are provided in accordance with the IRP and meet all provisions of this chapter and N.J.A.C. 10:37B.
