New Jersey Administrative Code

(a) The resident's treatment team physician shall order the use of personal restraint, as follows: 1. If someone other than the treatment team physician orders the personal restraint, the treatment team physician shall be contacted as soon as reasonably possible and shall be info…

(a) Clinical staff who have been trained in the appropriate use of restraints shall be physically present in order to continually evaluate and monitor the physical and psychological well-being of the resident being restrained throughout the duration of the intervention. (b) Clini…

(a) Reimbursement for PRTF services provided in accredited facilities shall be on a per diem rate. These rates shall be based on reasonable costs, as defined in the Department of Human Services' Contract Reimbursement Manual and the Contract Policy and Information Manual. Provide…

(a) Beginning on the date of admission, and for each subsequent whole day that a resident is under the care of the PRTF, the provider shall seek reimbursement using the appropriate HCPCS procedure code as defined in N.J.A.C. 10:75-5.2. (b) Providers shall request reimbursement fo…

(a) The New Jersey Medicaid/NJ FamilyCare program utilizes the Centers for Medicare and Medicaid Services' Healthcare Common Procedure Coding System (HCPCS). HCPCS follows the American Medical Association's Physicians' Current Procedural Terminology (CPT) architecture, employing …

IND HCPCS Code Mod Description Maximum Fee Allowance Y9947 Mental health rehabilitation services provided in TJC or DHS/DCF authorized agency accredited RTCs licensed by DCF. Contract pricing Y9948 Mental health rehabilitation services provided in TJC or DHS/DCF authorized agency…

(a) The purpose of this chapter is to set forth the rules governing the provision of Programs of Assertive Community Treatment (PACT) services to New Jersey Medicaid and certain NJ FamilyCare-Plan A beneficiaries and NJ FamilyCare Alternative Benefit Plan beneficiaries. 1. Benefi…

The following words and terms, as used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise: "Adult" means an individual age 18 and older. "Centers for Medicare and Medicaid Services (CMS)" means the agency of the Federal Department o…

(a) To participate in the Medicaid/NJ FamilyCare program, all providers shall be under contract with the Division of Mental Health and Addiction Services (DMHAS) as a provider of PACT services and shall meet the requirements set forth by the DMHAS related to PACT services in acco…

(a) All agencies providing PACT services shall keep, and require individual PACT Teams to keep, such legible records as are necessary to fully disclose the kind and extent of services provided, as well as the medical necessity for such services. (b) The PACT provider shall, at a …

(a) All PACT services shall meet the requirements of N.J.A.C. 10:37J, Programs of Assertive Community Treatment. (b) PACT services shall include mental health services and related supportive services, and shall be provided directly by one or more of the PACT team members. Such se…

(a) Each PACT team shall consist of a minimum of five separate clinical disciplines, including psychiatry, nursing, supportive counseling, substance abuse, and rehabilitation or occupation/vocational services, in accordance with N.J.A.C. 10:37J-2.8. (b) The PACT Director shall pr…

(a) Medicaid and NJ Family Care Plan A and NJ FamilyCare Alternative Benefit Plan beneficiaries age 18 and older shall be eligible to receive PACT services, except for beneficiaries enrolled under the Medically Needy program (N.J.A.C. 10:70). 1. NJ FamilyCare-Plan A adults withou…

(a) Partial care/partial hospitalization (PC/PH) services shall not be available, except if clinically indicated and recommended by the PACT team, for up to the last 30 days before a beneficiary terminates from PACT services. The PACT agency shall obtain prior authorization for s…

(a) No PACT services shall be provided to an eligible beneficiary without prior authorization. The eligible beneficiaries for PACT are described at N.J.A.C. 10:76-2.3(a). (b) For the provision of PACT services, the provider shall obtain prior authorization as follows: 1. The prov…

(a) Providers will be reimbursed on a fee-for-service basis for PACT services provided to an eligible beneficiary, as described at N.J.A.C. 10:76-2.3(a), based on the lower of the provider's usual and customary charge or the established DMAHS contracted reimbursement rate for the…

(a) The New Jersey Medicaid/NJ FamilyCare programs utilize the Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS). HCPCS follows the American Medical Association's Physicians' Current Procedural Terminology (CPT) architecture, employi…

HCPCS Maximum Fee IND Code MOD Description Allowance P H0040 22 Comprehensive PACT Contract services, monthly (adults) Pricing Notes N.J. Admin. Code § 10:76-3.2 Amended by R.2008 d.227, effective 8/4/2008. See: 40 N.J.R. 1731(b), 40 N.J.R. 4592(a). In the "HCPCS Code" column of …

(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 serv…

The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise. "Care management organization" (CMO) means an independent, community-based organization that combines advocacy, service planning and delive…

This subchapter describes the New Jersey Medicaid/NJ FamilyCare program's provisions specifically pertaining to environmental lead inspection/hazard assessment services. Notes N.J. Admin. Code § 10:77-2.1 Amended by R.2003 d.90, effective 3/3/2003. See: 34 N.J.R. 3467(a), 35 N.J.…

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Certified lead inspector/risk assessor" means one who is hired or contracted by the local board of health and who has completed a lead in…

(a) Requirements for a provider to participate in environmental lead inspection or hazard assessment services shall be as follows: 1. An applicant shall be a local board of health; 2. Each local board of health shall enroll and be approved by the New Jersey Medicaid/NJ FamilyCare…

(a) All Medicaid/NJ FamilyCare-Plan A beneficiaries up to 72 months of age and older children who are considered as "high risk" for lead poisoning, shall be screened for such through venous or capillary blood tests. 1. Pursuant to N.J.A.C. 8:44-2.11, clinical laboratories are req…

(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 rehabilita…

(a) All local boards of health shall keep such legible records as are necessary to fully disclose the specific services provided; as well as the necessity for such services; and the place, date, and time the services were provided; and all documentation required pursuant to N.J.A…

This subchapter sets forth the New Jersey Medicaid/NJ FamilyCare programs provisions pertaining to mental health rehabilitation services for children provided under the auspices of the Children's System of Care within the Department of Children and Families. These services are pr…

(a) As part of an individual crisis stabilization plan (see N.J.A.C. 10:77-6) a mobile response agency may contact a non-Joint Commission accredited psychiatric community residence for youth, group home, or residential childcare facility to place a child, youth, or young adult re…

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Children's group homes" means facilities licensed by the Department of Children and Families and that meet the requirements at N.J.A.C. 3…

(a) Requirements for participation as a mental health rehabilitation provider shall be as follows: 1. An applicant shall be licensed by the Department of Children and Families in accordance with N.J.A.C. 3A:55 or 3A:56 and shall provide mental health rehabilitation services. 2. A…

(a) The Division shall consider claims for children, youth, or young adults who are eligible for Medicaid/NJ FamilyCare, and children who are ineligible for Medicaid/NJ FamilyCare, but who are receiving mental/behavioral health services from DCF/CSOC. Children eligible as "medica…

(a) Mental health rehabilitation services for youth shall include the psychiatric and psychological services, including emotional and/or behavioral treatment, drug and alcohol dependency treatment, psychiatric treatment, psychotherapy, and related nursing services, provided by th…

(a) The reimbursement for mental health rehabilitation services for a psychiatric community residence for youth, a residential child care facility, or a group home shall be based on reasonable, negotiated, contracted costs as defined in the Department of Human Services' Contract …

(a) Temporary absence for the purpose of therapeutic or hospital leave shall be approved by the child, youth, or young adult's treatment team and included in the plan of care developed by the facility in accordance with N.J.A.C. 3A:55, Manual of Requirements for Residential Child…

A provider shall not claim reimbursement for mental health personal care services and mental health rehabilitation services for the same child, youth or young adult for the same day of service. Notes N.J. Admin. Code § 10:77-3.8 Recodified from N.J.A.C. 10:77-3.7 by R.2003 d.183,…

(a) All community psychiatric residences for youth, residential child care facilities, and group homes shall keep such legible records as are necessary to fully disclose the kind and extent of services, as well as the medical necessity for such services, and the place, date, and …

(a) This subchapter sets forth the manner in which behavioral assistance services shall be provided to eligible Medicaid/NJ FamilyCare and Children's System of Care beneficiaries under age 21. (b) Behavioral assistance services shall be provided and administered in a manner consi…

(a) The provider shall be responsible for supervising the overall daily management of all facets of the program, including, but not limited to, ensuring: 1. That all provider policies and procedures appropriately reflect the needs of the individuals being served, are implemented …

(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 locat…

(a) Each provider entity shall maintain all records in accordance with Departmental contract rules (see N.J.A.C. 10:3) and in compliance with appropriate Federal and State laws, regulations and rules, including, but not limited to, N.J.A.C. 10:49-9.8. (b) Providers shall keep suc…

(a) A provider entity providing behavioral assistance services shall deliver those services in accordance with the child/youth or young adult's plan of care and shall participate in studies related to consumer satisfaction developed by the Department of Human Services, Children a…

(a) To qualify for Medicaid/NJ FamilyCare reimbursement, approved Medicaid/NJ FamilyCare enrolled behavioral assistance providers shall retain, in a secure location, and in compliance with all applicable laws and regulations, confidential information related to the individuals pr…

(a) Any community agency under contract with the Department of Human Services shall not pay, or contract with, any employee or agency head for the provision of services unless it has first been determined that no criminal history record information exists on file in the State Bur…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Behavioral assistance services" means concrete, outcome-oriented interventions that are components of a written, detailed plan of care …

(a) Providers of behavioral assistance services shall be providers that are licensed in New Jersey to provide medical/mental health services, a medical/mental health practice, or other service provider that includes the appropriate licensed practitioners who can provide, or super…

(a) Children/youth/young adults shall be eligible to receive behavioral assistance services if they are Medicaid/NJ FamilyCare beneficiaries or are ineligible for Medicaid/NJ FamilyCare but are receiving mental health rehabilitation services under DCF/CSOC. (b) Children/youth and…

(a) Any provider entity providing behavioral assistance shall demonstrate regard for the rights of the child, youth or young adult, their families and/or caregivers to exercise choice and to receive culturally appropriate, integrated, coordinated and carefully monitored services …