N.J. Admin. Code § 10:52-2.16

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

Section 10:52-2.16 - Transportation services; hospital-based

(a) Transportation shall be recognized by the Division as a covered outpatient hospital service under the following conditions:

1. Hospital-based emergency ambulance service for inpatient admission or outpatient services. For the definition of "emergency conditions", see 10:49-6.1, Administration, Prior and Retroactive Authorization.

2. When a hospital is under contract with a municipality, county, or other government unit, to provide "911" or rescue squad ambulance service, reimbursement shall only be permitted on a fee-for-service basis under the policies and procedures as defined in 10:50-1.2, Transportation Services.

3. Each hospital providing ambulance service to Medicaid/NJ FamilyCare fee-for-service beneficiaries shall possess all of the following:

i. An approved certificate of need for ambulance service from the New Jersey State Department of Health; and

ii. A provider license and vehicle license(s) for ambulance service from the New Jersey State Department of Health.

(b) Mobile Intensive Care Unit/Advanced Life Support (MICU/ALS) service and associated Ambulance/Basic Life Support (Ambulance/BLS) service shall be considered covered services under the following conditions of participation:

1. A hospital shall possess a "Certificate of Need" from the New Jersey State Department of Health and Senior Services to provide MICU/ALS service;

2. A hospital shall complete a "Memorandum of Understanding," issued by the Division of Medical Assistance and Health Services, before reimbursement can be made to the hospital for this service. The "Memorandum of Understanding" may be obtained from and, when completed, shall be returned to the Division of Medical Assistance and Health Services, Provider Enrollment Unit, PO Box 712, Mail Code #9, Trenton, New Jersey 08625-0712;

3. A hospital providing MICU/ALS service without its own associated Ambulance/BLS service or MICU/ALS transport vehicle, may utilize the service of a volunteer ambulance organization or shall enter into an agreement(s) with a proprietary/nonproprietary Ambulance/BLS company for the purpose of defining the responsibility for service. No reimbursement shall be made when the Ambulance/BLS Service is provided by a volunteer ambulance organization.

i. A copy of the agreement(s) shall be sent to the Division of Medical Assistance and Health Services, PO Box 712, Provider Enrollment Unit, Mail Code #9, Trenton, New Jersey 08625-0712.

ii. The hospital shall bill for the Ambulance/BLS service only upon completion of an agreement.

iii. In the absence of an agreement(s) between the hospital providing the MICU/ALS service and a proprietary/nonproprietary Ambulance/BLS company, the hospital shall bill the Division's fiscal agent for the MICU/ALS service only.

iv. Transportation companies providing Ambulance/BLS associated with, and/or in conjunction with a MICU/ALS service, shall bill charges to the hospital providing the MICU/ALS service.

(c) Medicaid/NJ FamilyCare fee-for-service reimbursement of MICU/ALS services shall be based on Medicare principles of reimbursement, using standard cost reporting procedures, and reasonable cost and charge guidelines.

(d) Reimbursement for transportation services to and from hospital-affiliated medical day care centers are included in the medical day care per diem rate and shall not be billed to the New Jersey Medicaid/NJ FamilyCare program by the hospital separately.

(e) Transportation of inpatient beneficiaries transferred to another facility to receive services not available at the sending location, whether the intent is for the beneficiary to return or not, shall be the responsibility of the sending facility. These costs shall be included in the inpatient claim.

N.J. Admin. Code § 10:52-2.16

Amended by 50 N.J.R. 1261(a), effective 5/21/2018