New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 60 - HOME CARE SERVICES › Subchapter 2 - HOME HEALTH AGENCY (HHA) SERVICES › Section 10:60-2.5 - Basis of payment for home health services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Effective for services rendered on or after January 1, 1999, home health agencies shall be reimbursed the lesser of reasonable and customary charges or the service-specific unit rates described in this subsection. The following are the service-specific Statewide unit rates by each service:
Revenue
Base amount
Code
Description
Per Unit
420
Physical Therapy
$ 24.06
430
Occupational Therapy
$ 23.81
440
Speech Therapy
$ 20.27
550
Skilled Nursing
$ 29.14
560
Medical Social Services and Dietary/Nutritional Services
$ 25.90
570
Home Health Aide
$ 6.22
(b) Effective January 1, 2000, and thereafter, the reimbursement rates shall be the service-specific Statewide per unit rates found in (a) above, incrementally adjusted each January 1, beginning on January 1, 2000, using Standard and Poor's DRI Home Health Market Basket Index, published in the New Jersey Register as a notice of administrative change, in accordance with N.J.A.C. 1:30-2.7, and posted on the DMAHS' fiscal agent's website
http://www.njmmis.com
under "Rate and Code Information". Home health agencies shall maintain both unit and visit statistics for all services provided to Medicaid/NJ FamilyCare fee-for-service beneficiaries.
(c) Effective January 1, 1999, home health agencies shall bill the Medicaid/NJ FamilyCare fiscal agent as follows:
1. The unit of service shall be a 15 minute interval of a skilled nursing visit, a home health aide visit, a speech therapy visit, a physical therapy visit, an occupational therapy visit, a nutrition visit, or a medical social service visit, as defined at N.J.A.C. 10:60-1.2. A home health agency shall not bill when a Medicaid/NJ FamilyCare fee-for-service beneficiary is not home or cannot be found, and hands-on medical care was not provided;
2. The service-specific Statewide rate shall be billed for each full 15 minute interval of face-to-face service in which hands-on medical care was provided to a Medicaid/NJ FamilyCare fee-for-service beneficiary;
i. For instance, one unit of service shall be billed for services provided from the initial minute through 29 minutes. The second unit of service shall be billed for services provided from 30 minutes through 44 minutes. The third unit of service shall be billed for services provided from 45 minutes to 59 minutes and the fourth unit of service shall be billed for services provided from 60 minutes through 74 minutes;
3. Items including, but not limited to, nursing supervision, travel time, paperwork, and telephone contact at the home are included in the service-specific Statewide rate and, therefore, the time associated with these items is not billed directly;
4. A separate line shall be billed for each day the service is provided. A home health agency shall not "span bill" for services;
5. Routine supplies shall be considered visit overhead costs and billed as part of a unit of service. Non-routine supplies shall be billed using Revenue Code 270 on the institutional claim form and HCPCS codes in accordance with N.J.A.C. 10:59-2;
6. A home health agency shall only bill the revenue codes listed in (a) above and Revenue Code 270. No other revenue codes will be reimbursed for home health services.