N.J. Admin. Code § 10:77-6.10

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

Section 10:77-6.10 - Reimbursement

(a) Reimbursement for mobile response services shall be fee-for-service. For the first 72 hours of service, a flat fee-for-service rate per episode shall be provided and shall cover all the services provided during this time period except for temporary placement in a community residence for youth, group home or residential childcare facility. Reimbursement for temporary placement shall be provided directly to the facility in which the child, youth or young adult is placed. Providers shall bill one unit of service per episode.

1. Mobile response services provided to children, youth or young adults who were discharged into the community from receiving mobile response services within three days of the last billable episode shall be provided by the mobile response agency without additional reimbursement.

2. Mobile response services provided to a child, youth or young adult who had been discharged from receiving stabilization management services shall initiate a new course of treatment, beginning with mobile response services, and shall be reimbursed accordingly.

(b) Stabilization management services provided after the first 72 hours, for a period not to exceed eight weeks, shall be fee-for-service and shall cover only the mobile response agency's monitoring and management of the child, youth or young adult's ICP. The unit of service shall be 15 minutes of continuous services provided directly to, or on behalf of, the child, youth or young adult, including collateral contacts and activities necessary to develop, implement, coordinate, monitor and support the ICP. The provider may bill for a maximum of 64 units (16 hours) over the eight-week period, as authorized by the CSA. The provider shall bill only for the amount of time actually provided for stabilization management on each date of service.

(c) For children, youth or young adults receiving care management organization (CMO) or youth case management (YCM) services, mobile crisis response services may be provided by a mobile response agency (see N.J.A.C. 10:77-6.6) for up to 72 hours, spanning up to four days. For children, youth or young adults receiving CMO or YCM services, stabilization management services shall be included in the individualized service plan developed and implemented by the CMO or YCM agency. Reimbursement for stabilization management services for children, youth and young adults who are receiving CMO or YCM services shall not be made to mobile response agencies.

(d) Individual Medicaid/NJ FamilyCare enrolled providers rendering services included in the authorized ICP shall receive reimbursement in accordance with the provider-specific rules relative to their provider type, including, but not limited to, meeting all provider qualification, prior authorization and service delivery requirements.

N.J. Admin. Code § 10:77-6.10

Recodified from N.J.A.C. 10:77-6.9 and amended by R.2008 d.251, effective 8/18/2008.
See: 40 N.J.R. 1040(a), 40 N.J.R. 4807(a).
In the introductory paragraph of (a), inserted "except for temporary placement in a community residence for youth, group home or residential childcare facility" and inserted the third sentence; in (a)1, inserted "from receiving mobile response services"; in (a)2, inserted "receiving", "services" following "management", and ", beginning with mobile response services,"; in (b), inserted "of continuous services provided directly to, or on behalf of, the child, youth or young adult, including collateral contacts and activities necessary to develop, implement, coordinate, monitor and support the ICP"; and in (c), inserted "or youth case management (YCM)", updated the N.J.A.C. reference, inserted "or YCM" twice, deleted "crisis" preceding the first occurrence of "stabilization" and substituted "individualized service plan developed and implemented by the CMO or YCM agency" for "Individualized Service Plan and coordinated by the Child-Family Team". Former N.J.A.C. 10:77-6.10, Required records for each beneficiary, recodified to N.J.A.C. 10:77-6.11.