N.J. Admin. Code § 10:75-4.1

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

Section 10:75-4.1 - Basis of reimbursement

(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. Providers have access to these manuals as indicated at 10:3-3.3(e)12. 1.

PRTFs shall submit claims only for those procedure codes that correspond to the allowable services included in their Medicaid/NJ FamilyCare provider application approval letter. Claims for reimbursement shall be submitted on the CMS-1500 claim form to:

Molina Medicaid Solutions

PO Box 4808

Trenton, New Jersey 08650-4808

(b) The reimbursement rate shall include medically necessary PRTC services. These services shall include, but shall not be limited to:

1. Room and board costs;

2. Clothing that is required as part of a treatment regimen;

3. Temporary absence from the facility due to authorized therapeutic or hospital leave days (see N.J.A.C. 10:75-1.6); and

4. Transportation necessary for treatment purposes.

(c) Reimbursement for all PRTC services shall not exceed Federal upper payment limits as defined in 42 C.F.R. 447.325.

N.J. Admin. Code § 10:75-4.1

Amended by 49 N.J.R. 101(a), effective 1/3/2017