N.J. Admin. Code § 10:141-1.10

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:141-1.10 - Payments for supports/services

(a) The Fund is the payer of last resort. Payment shall be made only for those supports where no other benefit, funding, insurance coverage, subsidy, or other source of payment is available and when documentation can be rendered to show a need and a link to the habituation of the traumatic brain injury.

(b) Payment shall be made by the Division upon the completion or delivery of the service or support. In the case of continuing support, payment shall be made on a periodic basis.

(c) Unless otherwise specified, payments shall be made by the Division to the provider of service upon receipt of a bill for service/ support rendered. If an individual provider is employed by or under contract to an agency or institution, payment shall be made to that agency or institution. Qualified private practitioners shall be reimbursed directly.

(d) Where specified under N.J.A.C. 10:141-1.11(a) and with prior approval of the case manager and the Division, payment may be made to the beneficiary as reimbursement for services rendered, with the submission of appropriate receipts.

(e) With prior approval of the case manager and the Division, payments may be advanced to the beneficiary for service/supports if the beneficiary is unable to directly finance the service. Receipts will be required from the beneficiary to verify provision of service/support. No payments will be made for expenses incurred prior to the approval of the Support Plan.

(f) All providers of service/support must be appropriately licensed, certified according to rules and regulations of their profession/service and the State of New Jersey, and/or comply with the provider requirements as specified under N.J.A.C. 10:141-1.11(a).

(g) The Division will make payments based on individually negotiated rates, or on the basis of reasonable and customary charges.

(h) Failure to comply with the provisions of these rules could result in recovery of funds or preclude future payment for support.

N.J. Admin. Code § 10:141-1.10

Amended by 49 N.J.R. 1683(a), effective 6/19/2017