N.J. Admin. Code § 10:60-5.10

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

Section 10:60-5.10 - Basis for reimbursement for MLTSS/PDN services

(a) A provider of private duty nursing services shall be reimbursed by the New Jersey Medicaid/ NJ FamilyCare program on a fee-for-service basis for services provided as authorized by the individual's service plan prepared by the waiver case manager. Providers shall be precluded from receiving additional reimbursement for the cost of these services above the fee established by the Medicaid/NJ FamilyCare program.

1. All costs associated with the provision of private duty nursing services by home health agencies shall be included in the routine Medicare/Medicaid cost-reporting mechanism.

(b) The CMS 1500 Claim Form is used when billing for private duty nursing services.

1. The provider at all times shall reflect its standard charges on the CMS 1500 Claim Form even though the actual payment may be different.

(c) Home health services are billed on the institutional claim form (see Fiscal Agent Billing Supplement).

(d) See N.J.A.C. 10:60-11 for codes to be used when submitting claims for waiver/private duty nursing services.

N.J. Admin. Code § 10:60-5.10

Amended by 50 N.J.R. 1992(b), effective 9/17/2018