N.J. Admin. Code § 10:52-2.8

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:52-2.8 - Substance use disorder treatment facilities; free- standing

(a) Division requirements for substance use disorder treatment facilities are located in N.J.A.C. 10:66, Independent Clinic Services. Services provided to a Medicaid/NJ FamilyCare fee-for-service beneficiary by a free standing hospital-affiliated substance use disorder treatment facility shall be covered only if those services are eligible for Federal Financial Participation under the Medicaid Program (Title XIX of the Social Security Act) or the NJ FamilyCare program (Title XXI of the Social Security Act) and the following conditions are met:

1. The treatment is prescribed or certified by a physician or an advance practice nurse (APN); and

2. The treatment is provided in a substance use disorder treatment facility licensed or approved by the New Jersey State Department of Health pursuant to N.J.S.A. 26:2G-21 et seq., and N.J.A.C. 10:161A for residential services, N.J.A.C. 10:161B for outpatient services, and/or N.J.A.C. 10:161B-11for opioid treatment services, as applicable; and

3. The staff of the treatment facility includes a medical director.

(b) Payment for outpatient services provided in a free-standing substance use disorder treatment facility shall be made on a fee-for-service basis. The services include mental health services, methadone maintenance, and other related health services. The Division's payment shall be accepted as payment in full for Medicaid/NJ FamilyCare-Plans A and B. For NJ FamilyCare-Plan C, the Division's payment shall be considered as payment in full except for the Division's requirements regarding the personal contribution to care responsibilities of the NJ FamilyCare-Plan C beneficiaries which are codified at N.J.A.C. 10:49-9 and N.J.A.C. 10:52-4.7. Mental health and substance use disorder services for beneficiaries of NJ FamilyCare-Plans A, B and C who are also clients of the Division of Developmental Disabilities are provided by their MCO.

(c) Inpatient and outpatient substance use disorder services for Plan D beneficiaries shall be limited to detoxification.

(d) Approved centers shall submit claims only for those procedure codes which correspond to the allowable services included in their New Jersey Medicaid/NJ FamilyCare provider approval letter. Room, board, and other residential services shall not be covered. Claims for reimbursement shall be submitted to the fiscal agent in an accepted format approved by the fiscal agent.

N.J. Admin. Code § 10:52-2.8

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