reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 66 - INDEPENDENT CLINIC SERVICES › Subchapter 4 - FEDERALLY QUALIFIED HEALTH CENTER (FQHC) › Appendix D

Current through Register Vol. 56, No. 14, July 15, 2024
Change In Scope Of Service Application Requirements
The following items must be completed for each change in
				  scope of service incurred by a Federally qualified health center (FQHC). Items
				  below, labeled as A, B, and C, must be submitted in narrative format to the
				  Division of Medical Assistance and Health Services (DMAHS).
The item labeled D is the instructions for the Change in
				  Scope of Service Certification Statement and Reporting Forms 1 through 5. THE
				  INITIAL SUBMISSION MUST INCLUDE SEPARATE FORMS FOR EACH YEAR OF THE PHASE-IN
				  PERIOD IN WHICH THE CHANGE IN SCOPE OF SERVICE OCCURS. Within five months of
				  the completion of each phase-in year, complete the same forms with actual data
				  and send hard copy with disk to DMAHS.
DMAHS reserves the right to request additional information as
				  needed.
A. DESCRIPTION OF THE SERVICE
				AREA AND TARGET POPULATION
1. List
				address(es) where the change in scope of service will occur.
2. Describe the service
				area(s)/community(ies) to be served by the new program.
3. Describe the target population(s) within
				the service area. Attach a copy of the target population submitted to HRSA
				(Form 3) and explain in detail any differences.
4. Describe how many people will be served
				and the number of projected encounters for each location for each year during
				phase-in, up to and including the year in which the new program will be fully
				implemented.
5. Attach a copy of
				the Notice of Grant Award or the approval letter from the Health Resources and
				Services Administration (HRSA) or state that it is not reviewable by
				HRSA.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 66 - INDEPENDENT CLINIC SERVICES › Subchapter 5 - AMBULATORY SURGICAL CENTER (ASC) › Section 10:66-5.1 - Covered services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Medicaid and NJ FamilyCare
				fee-for-service covered procedures in an ambulatory surgical center (ASC) are
				those surgical and medical procedures that appear at
				42 CFR
				416.166, the Federal regulations governing
				ASC services.
(b) Medicaid-covered
				and NJ FamilyCare fee-for-service covered surgical procedures include, but are
				not limited to, those procedures that:
1. Are
				commonly performed in a hospital, but may be safely performed in an ASC;
i. Are not commonly or safely performed in a
				physician's office;
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 66 - INDEPENDENT CLINIC SERVICES › Subchapter 5 - AMBULATORY SURGICAL CENTER (ASC) › Section 10:66-5.2 - Anesthesia services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If a covered
				surgical procedure requires anesthesia, the anesthesia shall be:
1. Local or regional anesthesia; or
2. General anesthesia of 90 minutes or less
				duration.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 66 - INDEPENDENT CLINIC SERVICES › Subchapter 5 - AMBULATORY SURGICAL CENTER (ASC) › Section 10:66-5.3 - Facility services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Facility services include, but are not
				limited to:
1. Nursing services, services of
				technical personnel, and other related services;
2. The use by the patient of the ASC's
				facilities;
3. Drugs, biologicals,
				surgical dressings, supplies, splints, casts, appliances and equipment commonly
				furnished in connection with a surgical procedure. Drugs and biologicals are
				limited to those which cannot be self administered;
4. Diagnostic or therapeutic items and
				services furnished by ASC staff in connection with a covered surgical
				procedure, for example, simple tests such as urinalysis, blood hemoglobin, or
				hematocrit, administered in conjunction with the surgical procedure;
5. Administrative, recordkeeping and
				housekeeping items and services;
6.
				Blood, blood plasma, platelets, etc.; and
7. Material for anesthesia.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 66 - INDEPENDENT CLINIC SERVICES › Subchapter 5 - AMBULATORY SURGICAL CENTER (ASC) › Section 10:66-5.4 - Medical records

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In addition to
				the requirements set forth at
				42 CFR
				416.47, medical records in an ASC shall
				include, but not be limited to:
1. Patient
				identification;
2. Significant
				medical history and results of physical examination;
3. Pre-operative diagnostic studies (entered
				before surgery), if performed;
4.
				Findings and techniques of the operation, including a pathologist's report on
				all tissues removed during surgery, except those exempted by the governing
				body;
5. Any allergies and abnormal
				drug reactions;
6. Entries related
				to anesthesia administration;
7.
				Documentation of properly executed informed consent; and
8. Discharge diagnosis.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 66 - INDEPENDENT CLINIC SERVICES › Subchapter 6 - CENTERS FOR MEDICARE & MEDICAID SERVICES HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) › Section 10:66-6.1 - Introduction

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The New Jersey Medicaid and NJ FamilyCare
				fee-for-service programs utilize the Centers for Medicare & Medicaid
				Services (CMS)'s Healthcare Common Procedure Code System (HCPCS) for 2009,
				established and maintained by CMS in accordance with the Health Insurance
				Portability and Accountability Act of 1996,
				Pub. L.
				104-191, and incorporated herein by reference, as
				amended and supplemented, and as published by PMIC, 4727 Wilshire Blvd., Suite
				302, Los Angeles, CA 90010. Revisions to the Healthcare Common Procedure Coding
				System made by CMS, including, but not limited to, code additions, code
				deletions and replacement codes, will be reflected in this subchapter through
				publication of a notice of administrative change in the New Jersey Register.
				Revisions to existing reimbursement amounts specified by the Department and
				specification of new reimbursement amounts for new codes will be made by
				rulemaking in accordance with the Administrative Procedure Act,
				N.J.S.A.
				52:14B-1 et seq. HCPCS follows the American
				Medical Association's Physicians' Current Procedure Terminology (CPT)
				architecture, employing a five-position code and as many as two two-position
				modifiers. Unlike the CPT numeric design, the CMS-assigned codes and modifiers
				contain alphabetic characters. HCPCS is a two-level coding system.
1. Level 1 codes (narratives found in CPT):
				These codes are adapted from CPT for utilization primarily by physicians,
				podiatrists, optometrists, certified nurse-midwives, independent clinics and
				independent laboratories. CPT is a listing of descriptive terms and numeric
				identifying codes and modifiers for reporting medical services and procedures
				performed by physicians. Copyright restrictions make it impossible to print
				excerpts from CPT procedure narratives for Level I codes. Thus, in order to
				determine those narratives it is necessary to refer to CPT, which is
				incorporated herein by reference, as amended and supplemented. An updated copy
				of the CPT (Level I) codes may be obtained from the American Medical
				Association, P.O. Box 10950, Chicago, IL 60610, or by accessing
www.ama-assn.org
. An updated copy
				of the HCPCS (Level II) codes may be obtained by accessing the HCPCS website at
www.cms.hhs.gov/medicare/hcpcs
or by contacting PMIC, 4727 Wilshire Blvd., Suite 300, Los Angeles, CA
				90010.
2. Level II codes: These
				codes are assigned by CMS for physician and non-physician services that are not
				in CPT. Narratives for Level II codes can be found at
				N.J.A.C.
				10:66-6.3.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 66 - INDEPENDENT CLINIC SERVICES › Subchapter 6 - CENTERS FOR MEDICARE & MEDICAID SERVICES HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) › Section 10:66-6.4 - HCPCS procedure codes-qualifiers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Evaluation and
				management and other procedures:
1. Drawing of
				blood: 36415.
i. Once per visit, per patient.
				(Not applicable if laboratory study, in any part, is performed by the
				clinic.)
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 66 - INDEPENDENT CLINIC SERVICES › Subchapter 6 - CENTERS FOR MEDICARE & MEDICAID SERVICES HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) › Section 10:66-6.5 - HealthStart

Current through Register Vol. 56, No. 14, July 15, 2024
(a) HealthStart
				Maternity Care code requirements are as follows:
1. Separate reimbursement shall be available
				for Maternity Medical Care Services and Maternity Health Support
				Services.
2. Maternity Medical Care
				Services shall be billed as a total obstetrical package when feasible, but may
				also be billed as separate services.
3. The enhanced reimbursement (that is,
				HealthStart procedure codes) for delivery and postpartum care shall be claimed
				only for a patient who received at least one antepartum HealthStart Maternity
				Medical or Health Support Service.
4. The modifier "SB" in the HCPCS lists of
				codes refers to those services provided by certified nurse midwives; include
				the modifier at the end of each code.
5. Laboratory, other diagnostic procedures,
				and all necessary medical consultations are eligible for separate
				reimbursement.
i. Laboratory procedures
				performed by an outside laboratory shall be reimbursed to the laboratory. The
				clinic may submit a claim for a venipuncture using procedure code 36415 when
				necessary to collect blood specimens.
6. HealthStart Maternity Medical Care
				Services codes are as follows:
Data in
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New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 66 - INDEPENDENT CLINIC SERVICES › Appendix - APPENDIX

Current through Register Vol. 56, No. 14, July 15, 2024
FISCAL AGENT BILLING SUPPLEMENT
AGENCY NOTE: The Fiscal Agent Billing Supplement is appended
				as a part of this chapter but is not reproduced in the New Jersey
				Administrative Code. The Fiscal Agent Billing Supplement can be downloaded free
				of charge at
www.njmmis.com
. When revisions
				are made to the Fiscal Agent Billing Supplement, a revised version will be
				placed on the website and copies shall be filed with the Office of
				Administrative Law.
If you do not have access to the Internet and require a copy
				of the Fiscal Agent Billing Supplement, write to:
Molina Medicaid Solutions
PO Box 4801
Trenton, New Jersey 08650-4801 or contact:
Office of Administrative Law
Quakerbridge Plaza, Bldg. 9
PO Box 049
Trenton, New Jersey 08625-0049
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 67 - PSYCHOLOGICAL SERVICES › Subchapter 1 - INTRODUCTION › Section 10:67-1.1 - Scope and purpose

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This chapter outlines the policies and
				the procedures of the New Jersey Medicaid/NJ FamilyCare program related to the
				provision of psychological services to Medicaid/NJ FamilyCare beneficiaries by
				psychologists in private practice reimbursed on a fee-for-service
				basis.
(b) This chapter does not
				apply to psychologists employed by State or county (Governmental) or private
				psychiatric hospitals, independent clinics, or to psychologists employed by
				residential treatment centers under contract with Child Protection and
				Permanency (DCP) within the Department of Children and Families (DCF) and/or
				the Division of Mental Health and Addiction Services ( DMHAS).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 67 - PSYCHOLOGICAL SERVICES › Subchapter 1 - INTRODUCTION › Section 10:67-1.3 - Conditions of participation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) To be approved
				as a Medicaid/NJ FamilyCare provider by the New Jersey Medicaid/NJ FamilyCare
				program, the psychologist or psychologist specialist shall:
1. Complete and submit the Medicaid/NJ
				FamilyCare "Provider Application" (FD-20) and the "Medicaid/NJ FamilyCare
				Provider Agreement" (FD-62).
i. The
				documents, referenced at (a)1 above, are located as Forms #8 and #10 in the
				Appendix of the Administration Chapter (N.J.A.C. 10:49--Appendix) at the end of
				the chapter, and may be obtained from and submitted to:
Gainwell Technologies
Provider Enrollment
PO Box 4804
Trenton, New Jersey 08650-4804
A provider application can also be requested by calling
				  609-588-6036 or downloaded from the DMAHS fiscal agent website at
				  njmmis.com.
ii. Provider
				agreements are approved by the: Chief, Provider Enrollment Unit
Division of Medical Assistance and Health Services
PO Box 712
Trenton, New Jersey 08625-0712
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 67 - PSYCHOLOGICAL SERVICES › Subchapter 1 - INTRODUCTION › Section 10:67-1.4 - Recordkeeping

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Psychologists
				shall keep such individual records as may be necessary to disclose fully the
				kind and extent of services provided and shall make such information available
				when requested by the New Jersey Medicaid/NJ FamilyCare program or its agents.
				The recordkeeping shall document the services provided as they relate to the
				procedure code(s) used for reimbursement purposes (see N.J.A.C. 10:67-3,
				Healthcare Common Procedure Coding System).
(b) For the initial examination, the record
				shall include, as a minimum, the following:
1. Date(s) of service rendered;
2. Signature of the psychologist;
3. Chief complaint(s);
4. Pertinent historical, social, emotional,
				and additional data;
5. Reports of
				evaluation procedures undertaken or ordered;
6. Diagnosis; and
7. The intended course of treatment and
				tentative prognosis.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 67 - PSYCHOLOGICAL SERVICES › Subchapter 1 - INTRODUCTION › Section 10:67-1.5 - Basis of reimbursement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Psychological
				services shall be reimbursed at the lesser of the psychologist's charges or the
				amount in the Maximum Fee Allowance Schedule for psychological services. (See
				10:67-3.2 for the Maximum Fee
				Allowance Schedule.)
(b) The
				Maximum Fee Allowance Schedule is based on the Healthcare Common Procedure
				Coding System (HCPCS). For HCPCS codes and Maximum Fee Allowance Schedule, see
				N.J.A.C. 10:67-3. For billing instructions, see the Fiscal Agent Billing
				Supplement. For instructions on how to obtain a copy of the Fiscal Agent
				Billing Supplement see the Appendix of this chapter.
(c) In no event shall the provider's charge
				to the New Jersey Medicaid/NJ FamilyCare program exceed the charge for services
				rendered by the provider for identical services to other governmental agencies,
				or other groups or individuals in the community.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 67 - PSYCHOLOGICAL SERVICES › Subchapter 1 - INTRODUCTION › Section 10:67-1.6 - Personal contribution to care requirements for NJ FamilyCare Children's Program-Plan C and copayments for NJ FamilyCare-Plan D

Current through Register Vol. 56, No. 14, July 15, 2024
(a) General
				policies regarding the collection of personal contribution to care for NJ
				FamilyCare Children's Program-Plan C and copayments for NJ FamilyCare-Plan D
				fee-for-service are set forth at N.J.A.C. 10:49-9.
(b) Personal contribution to care for NJ
				FamilyCare-Plan C services is $ 5.00 per visit for all types of psychological
				services.
1. Psychological services includes
				services provided in the office, patient's home, or any other site, except a
				hospital, where the child may have been examined or treated by the
				psychologist.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 67 - PSYCHOLOGICAL SERVICES › Subchapter 2 - GENERAL PROVISIONS › Section 10:67-2.1 - General provisions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Psychological
				services reimbursed directly to the psychologist may be provided in settings
				such as an office, home, general hospital (inpatient), residential health care
				facility, nursing facility, or residential treatment center that is not
				enrolled as an approved Medicaid/NJ FamilyCare provider.
(b) The New Jersey Medicaid/NJ FamilyCare
				program will not reimburse for services supervised by, but not performed by the
				psychologist in any setting. Only the psychologist who personally renders the
				psychological service will be reimbursed.
(c) The special reimbursement for
				psychological services will be rendered if the provider meets the specialist
				requirements as defined in
				10:67-1.2 and 1.3.
(d) Except for psychological testing or
				exceptional circumstances which are documented in the patient's medical record,
				only one psychological service shall be reimbursed per day for the same
				beneficiary by the same provider, group, shared health care facility, or
				practitioners sharing a common record.
(e) Payment for a psychological evaluation
				shall include all psychological services provided on that day. No additional
				reimbursement will be made for psychotherapy on the day that a psychological
				evaluation is provided.
(f)
				"Consultation" or "concurrent care" shall not be billed by a psychologist
				specialist for his or her services as a specialist. If a referral from a
				psychologist to a psychiatrist is indicated, the psychiatrist may be reimbursed
				under the provisions of "consultation" or "concurrent care" in the Physician
				Services Manual (N.J.A.C. 10:52) in addition to the psychologist bill, but not
				vice versa.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 67 - PSYCHOLOGICAL SERVICES › Subchapter 2 - GENERAL PROVISIONS › Section 10:67-2.2 - Provisions for services rendered in specific settings including institutional settings

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Psychological services rendered to a
				Medicaid/NJ FamilyCare patient by an approved community mental health agency or
				by an approved independent clinic, or under the auspices of such agency or
				facility, or by a hospital outpatient department shall be billed directly by
				the agency or clinic.
1. All psychological
				services rendered to a patient of a hospital outpatient department shall be
				considered hospital costs, whether or not the psychologist receives
				compensation from the hospital.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 67 - PSYCHOLOGICAL SERVICES › Subchapter 3 - CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) CODE AND MAXIMUM FEE SCHEDULE FOR PSYCHOLOGICAL SERVICES › Section 10:67-3.1 - Introduction

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The New Jersey Medicaid and NJ FamilyCare
				programs adopted the Centers for Medicare & Medicaid Services (CMS)
				Healthcare Common Procedure Coding System (HCPCS) codes for 2006, established
				and maintained by CMS in accordance with the Health Insurance Portability and
				Accountability Act of 1996,
				42
				U.S.C. §
										1320d et seq., and incorporated
				herein by reference, as amended and supplemented and published by PMIC, 4727
				Wilshire Blvd., Suite 300, Los Angeles, CA 90010. Revisions to the Healthcare
				Common Procedure Coding System made by CMS (code additions, code deletions and
				replacement codes) will be reflected in this chapter through publication of a
				notice of administrative change in the New Jersey Register. Revisions to
				existing reimbursement amounts specified by the Department and specification of
				new reimbursement amounts for new codes will be made by rulemaking in
				accordance with the Administrative Procedure Act, N.J.SA. 52:14B-1 et seq. The
				HCPCS Level I codes consist of the American Medical Association (AMA) Current
				Procedural Terminology (CPT) codes, which are assigned to specific procedures
				by the AMA. HCPCS Level II codes are assigned to specific procedures by CMS. An
				updated copy of the CPT codes may be obtained from the American Medical
				Association, P.O. Box 10950, Chicago, IL 60610, or by accessing
www.ama-assn.org
. An updated copy
				of the Level II codes may be obtained by accessing the HCPCS website at
				www.cms.hhs.gov/medicare/hcpcs or by contacting PMIC, 4727 Wilshire Blvd.,
				Suite 300, Los Angeles, CA 90010.
1. The use
				of a procedure code will be interpreted by the New Jersey Medicaid/NJ
				FamilyCare program as a representation that the psychologist personally
				furnished, as a minimum, the service for which it stands.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 67 - PSYCHOLOGICAL SERVICES › Subchapter 3 - CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) CODE AND MAXIMUM FEE SCHEDULE FOR PSYCHOLOGICAL SERVICES › Section 10:67-3.2 - HCPCS Codes and reimbursement rates for psychological services (Level I)

Current through Register Vol. 56, No. 14, July 15, 2024
Maximum Fee
HCPCS
Allowance
MOD
IND
Code
S
$
NS
N
90791
$167.21
$142.13
N
90832
$68.21
$28.83
N
90833
$70.33
$29.69
N
90834
$90.26
$37.83
N
90836
$88.79
$37.12
N
90837
$90.26
$36.73
N
90838
$89.04
$36.73
N
90839
$92.82
N
90846
HA 22
$24.50
N
90847
$113.94
$26.00
N
90847-22
$ 46.00
$ 32.00
N
90853
$27.50
$6.00
N
90887
$22.91
$13.00
N
96105
$ 37.00
$ 26.00
N
96150
$ 14.00
$ 12.00
N
96151
$ 14.00
$ 12.00
N
96152
$ 13.00
$ 11.00
N
96153
$3.68
$3.13
N
96154
$ 13.00
$ 11.00
N
96155
$ 12.00
$ 10.00
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 67 - PSYCHOLOGICAL SERVICES › Subchapter 3 - CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) CODE AND MAXIMUM FEE SCHEDULE FOR PSYCHOLOGICAL SERVICES › Appendix - APPENDIX

Current through Register Vol. 56, No. 14, July 15, 2024
FISCAL AGENT BILLING SUPPLEMENT
AGENCY NOTE: The Fiscal Agent Billing Supplement is appended
				  as part of this chapter but is not reproduced in the New Jersey Administrative
				  Code. When revisions are made to the Fiscal Agent Billing Supplement,
				  replacement pages will be distributed to providers and copies will be filed
				  with the Office of Administrative Law. For a copy of the Fiscal Agent Billing
				  Supplement, access
www.njmmis.com
or write
				  to:
Gainwell Technologies
Provider Services Unit
PO Box 4804
Trenton, New Jersey 08650-4804
or contact:
Office of Administrative Law
Quakerbridge Plaza, Building 9 PO Box 049
Trenton, New Jersey 08625-0049
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 68 - CHIROPRACTIC SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 10:68-1.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
The purpose of this chapter is to provide rules governing the
				  provision of chiropractic services to Medicaid/NJ FamilyCare
				  beneficiaries.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 68 - CHIROPRACTIC SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 10:68-1.2 - Scope of services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Coverage of a chiropractor's services
				shall be limited to treatment by means of manipulation of the spine , which the
				chiropractor is legally authorized by the State to personally perform (see
				42
				CFR 440.60 ). The chiropractor may prescribe
				certain services as outlined at N.J.A.C. 10:68-2, Services Prescribed by the
				Chiropractor.
1. Services may be provided in
				the office, the beneficiaries' home, a nursing facility, or a residential
				health care facility. Services shall not be reimbursed for chiropractic
				services provided in intermediate care facilities for the mentally retarded
				(ICF/MRs) or in residential treatment centers.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 68 - CHIROPRACTIC SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 10:68-1.4 - Application for provider status; chiropractor

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any
				chiropractor may apply to the New Jersey Medicaid/NJ FamilyCare program for
				approval as a provider, if he or she is a chiropractor licensed by the State
				Board of Chiropractic Examiners in accordance with N.J.A.C. 13:44E, or licensed
				by a comparable state agency in the state in which the chiropractor
				practices.
(b) See N.J.A.C.
				10:49-3for additional requirements for provider participation.
(c) An applicant shall complete a Provider
				Application (FD-20; see N.J.A.C. 10:49, Appendix #8) and a Provider Agreement
				(FD-62; see N.J.A.C. 10:49, Appendix #9). The forms may be obtained from, and
				shall be submitted to:
Gainwell Technologies
Provider Enrollment
PO Box 4804
Trenton, NJ 08650-4804
(d) The application and agreement shall be
				accompanied by a photocopy of the applicant's current license as a
				chiropractor.
(e) The applicant
				will receive notification of approval or disapproval from the Division's fiscal
				agent. If approved, the chiropractor shall be furnished with a provider manual
				and assigned a Division provider identification number. The chiropractor shall
				use the assigned provider identification number on all billing documents
				submitted to the Division's fiscal agent.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 68 - CHIROPRACTIC SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 10:68-1.5 - Basis of reimbursement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Reimbursement
				for covered chiropractic services provided to a Medicaid/NJ FamilyCare
				beneficiary is provided on the basis of the customary charge (fee-for-service)
				not to exceed an allowance determined reasonable by the Commissioner of the New
				Jersey State Department of Human Services and contained at
				N.J.A.C.
				10:68-3.2.
1. In no event shall the charge to the New
				Jersey Medicaid/NJ FamilyCare program exceed the charge by the provider for
				identical services to other governmental agencies, or other groups or
				individuals in the community.
2.
				The chiropractor may be reimbursed for an initial diagnostic and/or evaluation
				visit in the absence of manipulation of the spine performed during that
				visit.
3. The procedure codes that
				are used when submitting claims are listed at
				N.J.A.C.
				10:68-3.2, Centers for Medicare &
				Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS). The
				Fiscal Agent Billing Supplement, incorporated herein by reference, provides
				information about the claim form and billing instructions. Claims for services
				rendered shall be submitted by providers in accordance with the Fiscal Agent
				Billing Supplement. Instructions on how to obtain a copy of the Fiscal Agent
				Billing Supplement can be found at N.J.A.C. 10:68 Appendix A.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 68 - CHIROPRACTIC SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 10:68-1.6 - Personal contribution to care requirements for NJ FamilyCare-Plan C

Current through Register Vol. 56, No. 14, July 15, 2024
(a) General
				policies regarding the collection of personal contribution to care for NJ
				FamilyCare-Plan C fee-for-service are set forth at N.J.A.C. 10:49-9.
(b) Personal contribution to care for NJ
				FamilyCare-Plan C services is $ 5.00 for all procedure codes for manipulation
				of the spine.
1. Chiropractic services
				include services provided in each of the settings authorized under
				10:68-1.2(a)1.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 68 - CHIROPRACTIC SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 10:68-1.7 - Recordkeeping

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All chiropractors shall keep such
				individual records as are necessary to fully disclose the kind and extent of
				services provided in accordance with the rules of the Board of Chiropractic
				Examiners at
				N.J.A.C.
				13:44E-2.2 and the Division, at
				N.J.A.C.
				10:49-9.7 and 9.8.
1. This information shall be made available
				upon request of the New Jersey Medicaid/NJ FamilyCare program or its
				agents.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 68 - CHIROPRACTIC SERVICES › Subchapter 2 - SERVICES PRESCRIBED BY THE CHIROPRACTOR › Section 10:68-2.1 - General provisions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Chiropractors may prescribe services
				within the scope of their license to practice and within the limitations of the
				New Jersey Medicaid/NJ FamilyCare programs. The prescriber shall ensure the
				patient's free choice of provider when ordering and/or prescribing services ,
				such as clinical laboratory services, medical supplies , and durable medical
				equipment, physical therapy, pre-fabricated orthoses , and diagnostic radiology
				services (see also
				N.J.A.C.
				13:44E-1.1(c)).
(b) The chiropractor shall include his or her
				Provider Services Number on all written prescriptions.
(c) The chiropractor shall include, on each
				prescription, the patient's diagnosis and, when possible, state the length of
				time estimated for use or need for items , such as durable medical equipment.
				The Division , or its authorized agent , may contact the chiropractor for more
				information about the patient if a prescribed item requires the medical
				supplier to request prior authorization from the New Jersey Medicaid/NJ
				FamilyCare program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 68 - CHIROPRACTIC SERVICES › Subchapter 2 - SERVICES PRESCRIBED BY THE CHIROPRACTOR › Section 10:68-2.2 - Chiropractic services in a nursing facility or residential health care facility by providers in a partnership or corporation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When
				chiropractic services are provided to a Medicaid/NJ FamilyCare beneficiary in a
				nursing facility, payment is not made for those services if provided by an
				owner, administrator, stockholder of the company , or corporation, or by anyone
				who otherwise has a direct financial interest in the institution.
(b) If a Medicaid/NJ FamilyCare beneficiary
				receives care from more than one member of a chiropractic partnership or
				corporation, the maximum payment allowance will be the same as that of a single
				attending chiropractor.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 68 - CHIROPRACTIC SERVICES › Subchapter 2 - SERVICES PRESCRIBED BY THE CHIROPRACTOR › Section 10:68-2.3 - Consultation

Current through Register Vol. 56, No. 14, July 15, 2024
Consultation between chiropractors shall not be reimbursed by
				  the New Jersey Medicaid/NJ FamilyCare program, since there are no chiropractic
				  specialists within the chiropractic discipline (see
				  N.J.A.C.
				  10:68-1.3 for definition of
				  consultation).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 68 - CHIROPRACTIC SERVICES › Subchapter 2 - SERVICES PRESCRIBED BY THE CHIROPRACTOR › Section 10:68-2.4 - Services prescribed by a chiropractor: clinical laboratory services

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				A chiropractor shall not include any charges for laboratory services in a claim
				for reimbursement; however, he or she may order those professional and
				technical laboratory services for Medicaid/NJ FamilyCare beneficiaries that are
				consistent with chiropractic practice. The New Jersey Medicaid/NJ FamilyCare
				program shall reimburse a clinical laboratory for covered services rendered to
				Medicaid/NJ FamilyCare beneficiaries that has met the following requirements:
1. Licensure and/or approval by the New
				Jersey Department of Health or comparable agency in the state in which the
				facility is located, including meeting certificate of need and licensure
				requirements, when required, and all applicable laboratory provisions of the
				New Jersey State Sanitary Code , N.J.A.C. 8:45;
2. Certification as an independent laboratory
				under Title XVIII Medicare program (see
				42 C.F.R. §
											493.1 );
3. Compliance with the requirements for an
				independent clinical laboratory under the Clinical Laboratory Improvement
				Amendments of 1988 (CLIA) (see 1902(a)(9) of the Social Security Act;
				42 U.S.C. §
											1396a(a)(9) ).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 68 - CHIROPRACTIC SERVICES › Subchapter 2 - SERVICES PRESCRIBED BY THE CHIROPRACTOR › Section 10:68-2.5 - Services prescribed by a chiropractor; medical supplies, durable medical equipment , and pre-fabricated orthoses

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Medical
				supplies and durable medical equipment that are essential for the beneficiary's
				condition are reimbursable to an approved durable medical equipment or medical
				supplies provider under the following conditions:
1. The medical supplies and durable medical
				equipment shall be prescribed by a chiropractor, within his or her scope of
				practice, and provided by a medical supplier approved for participation in the
				New Jersey Medicaid/NJ FamilyCare programs, in accordance with N.J.A.C.
				10:59.
2. The medical supplies and
				durable medical equipment provider shall obtain prior authorization from the
				Division or its authorized agent for certain medical supplies and durable
				medical equipment in accordance with N.J.A.C. 10:59.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 68 - CHIROPRACTIC SERVICES › Subchapter 2 - SERVICES PRESCRIBED BY THE CHIROPRACTOR › Section 10:68-2.6 - Services prescribed by a chiropractor; physical therapy services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Physical
				therapy services, when prescribed by a chiropractor under his or her scope of
				practice (see
				13:44E-2.12 ) shall be reimbursed
				to an approved provider, in accordance with this section. Providers shall
				secure prior authorization from the Division or its authorized agent when
				physical therapy services are provided, except when the services are provided
				in a hospital outpatient setting. Initial and subsequent prior authorization
				shall not exceed 60 calendar days. Chiropractors shall not be reimbursed
				directly for physical therapy services.
(b) Physical therapy services are authorized
				only under the following conditions:
1. When
				the chiropractor, in written communication with the physical therapist,
				prescribes through detailed orders which shall be placed on the patient's chart
				prior to the physical therapy treatment being initiated. These orders shall
				include a statement covering the medical necessity for therapy, the objectives
				of the treatment, a therapy prescription including the specific means and
				methods to be used, and the estimated number and frequency of treatments.
i. Physical therapy services shall be
				definitive as to type and scope of procedures to be provided. General
				prescriptions such as "physical therapy three times a week," "physical therapy,
				as needed," or similarly worded blanket authorization shall not be accepted by
				Medicaid as a legitimate prescription since no treatment is named and the
				physical therapist is in effect prescribing the patient's regime.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 68 - CHIROPRACTIC SERVICES › Subchapter 2 - SERVICES PRESCRIBED BY THE CHIROPRACTOR › Section 10:68-2.7 - Services prescribed by a chiropractor; diagnostic radiological services

Current through Register Vol. 56, No. 14, July 15, 2024
The New Jersey Medicaid/NJ FamilyCare program shall reimburse
				  for diagnostic radiological services prescribed by a chiropractor within their
				  scope of practice as determined by the New Jersey State Board of Chiropractic
				  Examiners, or the applicable agency in the state in which the chiropractor
				  practices. Diagnostic radiological services of any type are reimbursable only
				  when provided by a specialist in radiology as recognized by the New Jersey
				  Medicaid/NJ FamilyCare program or by the State Medicaid agency in the state in
				  which the radiologist practices.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 68 - CHIROPRACTIC SERVICES › Subchapter 3 - CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) HEALTHCARE COMMON PROCEDURE CODING SYSTEMS (HCPCS) › Section 10:68-3.1 - Introduction

Current through Register Vol. 56, No. 14, July 15, 2024
The New Jersey Medicaid/NJ FamilyCare programs adopted the
				  Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure
				  Coding System (HCPCS) codes for 2006, established and maintained by CMS in
				  accordance with the Health Insurance Portability and Accountability Act of
				  1996,
				  42 U.S.C. §§
										1320 et seq., and incorporated herein by
				  reference, as amended and supplemented , and published by PMIC, 4727 Wilshire
				  Blvd., Suite 300, Los Angeles, CA 90010. Revisions to the Healthcare Common
				  Procedure Coding System made by CMS (code additions, code deletions , and
				  replacement codes) will be reflected in this chapter through publication of a
				  notice of administrative change in the New Jersey Register. Revisions to
				  existing reimbursement amounts specified by the Department and specification of
				  new reimbursement amounts for new codes will be made by rulemaking in
				  accordance with the Administrative Procedure Act,
				  N.J.S.A.
				  52:14B-1et seq. The HCPCS Level I codes
				  consist of the American Medical Association (AMA) Current Procedural
				  Terminology (CPT) codes, which are assigned to specific procedures by the AMA.
				  HCPCS Level II codes are assigned to specific procedures by CMS. An updated
				  copy of the CPT codes may be obtained from the American Medical Association, PO
				  Box 10950, Chicago, IL 60610, or by accessing
www.ama-assn.org
. An updated copy of the Level
				  II codes may be obtained by accessing the HCPCS website at
www.cms.hhs.gov/medicare/hcpcs
or
				  by contacting PMIC, 4727 Wilshire Blvd., Suite 300, Los Angeles, CA
				  90010.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 68 - CHIROPRACTIC SERVICES › Subchapter 3 - CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) HEALTHCARE COMMON PROCEDURE CODING SYSTEMS (HCPCS) › Section 10:68-3.2 - HCPCS codes for chiropractic services and maximum fee schedule

Current through Register Vol. 56, No. 14, July 15, 2024
HCPCS
Maximum
Code
Description
Fee Allowance
98940
Chiropractic Manipulative Treatment
$ 6.00
Spinal, one or two regions
98941
Chiropractic Manipulative Treatment
$ 6.00
Spinal, three or four regions
98942
Chiropractic Manipulative Treatment
$ 6.00
Spinal, Five regions
Y3433
Initial diagnostic and/or evaluation visit
$ 6.00
by chiropractor
QUALIFIER: The HCPCS codes for an initial diagnostic and/or
				  evaluation visit in the absence of manipulation of the spine during that visit
				  may be billed.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 68 - CHIROPRACTIC SERVICES › Appendix A - FISCAL AGENT BILLING SUPPLEMENT

Current through Register Vol. 56, No. 14, July 15, 2024
AGENCY NOTE: The Fiscal Agent Billing Supplement is appended as
				a part of this chapter but is not reproduced in the New Jersey Administrative
				Code. When revisions are made to the Fiscal Agent Billing Supplement, copies
				will be distributed to providers, placed on the website at www.njmmis.com and
				will be filed with the Office of Administrative Law. The Fiscal Agent Billing
				Supplement may be reviewed and downloaded by accessing: www.njmmis.com. For a
				paper copy of the Fiscal Agent Billing Supplement, write to:
Gainwell Technologies
PO Box 4801
Trenton, New Jersey 08619-4801
or contact:
Office of Administrative Law
Quakerbridge Plaza, Building 9
PO Box 049
Trenton, New Jersey 08625-0049
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 1 - AFDC-RELATED MEDICAID IN NEW JERSEY › Section 10:69-1.1 - Background

Current through Register Vol. 56, No. 14, July 15, 2024
The Personal Responsibility and Work Opportunity
				  Reconciliation Act of 1996,
				  Public Law
				  104-193, enacted August 22, 1996, implemented
				  Federal welfare reform. The new Federal law eliminated the Aid to Families with
				  Dependent Children (AFDC) program and created a Temporary Assistance for Needy
				  Families (TANF) block grant for states to provide time-limited cash assistance.
				  New Jersey's block grant program is established as Work First New Jersey (WFNJ)
				  in accordance with the Work First New Jersey Act,
				  P.L.
				  1997, c. 13, c.14, c.37
				  and c.38. P.L.
				  104-193 also required that the regulations
				  governing a state's eligibility for AFDC-related Medicaid in effect in the
				  State as of July 16, 1996, must continue to determine eligibility for
				  AFDC-related Medicaid. This chapter is the continuation of the appropriate
				  AFDC-related Medicaid rules.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 1 - AFDC-RELATED MEDICAID IN NEW JERSEY › Section 10:69-1.2 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
The purpose of this chapter is to set forth the policies and
				  procedures necessary for the orderly and equitable provision of AFDC-related
				  Medicaid on a Statewide basis. It is binding on the county welfare agencies
				  (CWAs) and enforceable by the Division of Medical Assistance and Health
				  Services (DMAHS). Questions of interpretation shall be resolved by the Division
				  of Medical Assistance and Health Services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 1 - AFDC-RELATED MEDICAID IN NEW JERSEY › Section 10:69-1.3 - Administrative organization

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department
				of Human Services (Department) is the administrative unit of State government,
				which has the responsibility for the Medicaid program and is designated under
				Federal law as the "single State agency."
(b) The Division of Medical Assistance and
				Health Services (DMAHS) is the administrative unit of the Department
				responsible for the general policies governing the administration of medical
				assistance, and for effecting the issuance of rules and administrative
				bulletins to implement statutory provisions and to coordinate the
				administration of medical assistance with the Division of Family Development.
				DMAHS provides for the payment of claims, evaluates health services rendered
				under the program, maintains administrative liaison with the other Departmental
				divisions, and establishes incapacity under the AFDC-related Medicaid
				program.
(c) DMAHS has local
				Medical Assistance Customer Centers (MACCs) throughout the State. The role of
				these offices is to act as a liaison with providers of health services; provide
				information about Medicaid to beneficiaries and members of the community; and
				provide information about Medicaid to, and cooperate with, appropriate agencies
				in order to ensure maximum utilization of the services available through the
				Medicaid program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 1 - AFDC-RELATED MEDICAID IN NEW JERSEY › Section 10:69-1.4 - Aid to Families with Dependent Children (AFDC)-related Medicaid

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The AFDC-related Medicaid program is a
				State program with Federal participation. It is designed to make payments to
				providers for medical care and services on behalf of certain individuals whose
				income is determined to be inadequate to enable them to secure quality medical
				care at their own expense.
(b) The
				AFDC-related Medicaid program is composed of two segments:
1. AFDC-C related Medicaid, through which
				medical assistance is provided for children and their natural or adoptive
				parents or certain designated relatives with whom they were living, when they
				are financially eligible and deprived of parental support and care by reason of
				death, continued absence, or incapacity of one or both parents; and
2. AFDC-F related Medicaid, through which
				medical assistance is provided to families with children when both parents are
				in the home, neither is incapacitated and the principal earner meets the
				Federal definition of unemployment.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.1 - General provisions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any person who believes he or she and his
				or her children are eligible for AFDC-related Medicaid shall be given the
				opportunity to apply without delay. Applicants shall be informed by the CWA
				about the eligibility requirements and their rights and obligations in applying
				for and receiving assistance. The decision to apply rests with the applicant.
				The applicant has the right to withdraw the application before eligibility or
				ineligibility has been determined.
(b) CWA staff shall move with all reasonable
				speed in accepting, processing, and recommending action on applications for
				assistance. If an applicant is eligible, a Health Benefits Identification
				(HBID) Card and/or HBID Emergency Services Letter shall be issued as
				eligibility is established. The agency's standards of promptness for acting on
				applications or redetermining eligibility shall not be a basis for delay in
				granting AFDC-related Medicaid.
(c)
				This subchapter describes briefly the steps followed by the eligibility
				determination worker in determining an applicant's eligibility to receive
				AFDC-related Medicaid.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.2 - Provisions governing the initial contact

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				application process begins with an individual's initial contact with the agency
				and ends with a decision by the CWA as to the eligibility for AFDC-related
				Medicaid. Both the applicant and the eligibility worker have an affirmative
				responsibility in verifying and documenting eligibility.
(b) Initial contact may be an inquiry, a
				referral or an application:
1. Inquiry means
				any request for information about medical assistance programs, which is not a
				request for an application. A record is necessary only when the inquiry
				requires follow-up action.
2.
				Referral means a request from a public or private agency or individual for
				medical assistance on behalf of another individual. All referrals shall be
				recorded with appropriate facts, and the disposition noted.
3. Application means a written request for
				AFDC-related Medicaid by natural or adoptive parent(s), parent-person(s),
				parent-minor, or responsible person acting on his or her behalf.