New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 3 - RESIDENTIAL MENTAL HEALTH REHABILITATION SERVICES › Section 10:77-3.6 - Basis of reimbursement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				reimbursement for mental health rehabilitation services for a psychiatric
				community residence for youth, a residential child care facility, or a group
				home shall be based on reasonable, negotiated, contracted 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. These rates shall not be adjusted in the
				provider's current contract year except for Department-approved adjustments
				that would otherwise have been provided for under the terms of the existing
				contracts if Medicaid/NJ FamilyCare reimbursement for these services had not
				occurred, such as scheduled cost-of-living adjustments.
2. The total amount reimbursed by the
				Division, including room and board, shall be based on the approved negotiated
				contracted rates each provider receives under contract with the Division of
				Mental Health and Addiction Services or the Division of Child Protection and
				Permanency, with any approved Departmental adjustment.
3. All facilities, under their contract, will
				receive at least a minimum per diem reimbursement rate of $ 155.00, provided
				that they meet all other contractual and rule requirements.
4. This negotiated rate for DMAHS
				reimbursement purposes shall be divided into two rates, one for the Title XIX
				Federally reimbursable therapeutic services, and one for the non-reimbursable
				Title XIX services. Non-reimbursable services shall include, but shall not be
				limited to, such costs as personal needs allowances, other non-rehabilitative
				services, and the cost of room and board.
i.
				Reimbursement for clothing that is required as a part of a treatment regimen
				and included in the plan of care shall be included in the reasonable
				costs.
ii. Reimbursement for
				transportation for medically necessary purposes shall be included in the Title
				XIX reimbursable per diem rates. Transportation costs related to meetings and
				conferences will be included in the Title XIX reimbursable per diem rates when
				the primary purpose of such meetings and conferences is the dissemination of
				information for the advancement of patient care or efficient operation of the
				facility.
iii. The non-Title XIX
				reimbursable transportation shall be included in the non-reimbursable HCPCS.
				The cost of non-patient related travel, such as commuting, shall be included in
				the non-Title XIX reimbursable costs.
5. To establish the rates for these two
				HCPCS, the Division shall use the following Federally approved methodology,
				that results in a percentage to determine the amount that is non-Title XIX
				Federally reimbursable. The figure that results from this methodology shall be
				developed for each class of provider and then applied to each provider within
				the class.
i. The amount of reimbursement for
				room and board will be determined from an analysis of the per diem rates as
				follows: The costs of all the providers in each provider group in the selected
				regional area shall be analyzed to determine the percentage of each provider's
				total costs that are used to cover room and board and the percentage of the
				total cost that is used to cover the therapeutic services. The median
				percentage factor may vary depending on the provider group a provider belongs
				to.
ii. The median percentage for
				contracted room and board expenditures in relation to total operating
				expenditures shall be applied to each provider's rates to separately determine
				the reimbursement rates for the therapeutic HCPCS and room and board HCPCS
				procedure codes.
iii. Each year, on
				a rotating basis, a different regional area of the State shall be used to
				determine the median percentage for each provider group for room and board
				services and for therapeutic services.
iv. If a regional area contains too few
				provider groupings to use the median-based methodology, reimbursement for room
				and board will be computed for each individual facility, based on the actual
				costs for the facility.
Example: When applied in the selected region of the State,
				  the methodology determines that the non-Title XIX reimbursable costs (room and
				  board) are 20 percent for Provider Type A. Based on this determination, for
				  provider A, whose current negotiated per diem is $ 200.00, the rate for the
				  Title XIX reimbursable HCPCS (therapeutic services) shall be $ 160.00 ($ 200.00
				  less (200 x .20)). The reimbursement for the non-Title XIX services shall be $
				  40.00.
For provider B, who is the same provider type as provider A,
				  but whose current negotiated per diem is $ 160.00, the rate for the Title XIX
				  reimbursable HCPCS shall be $ 128.00 ($ 160.00 less (160 x .20)). The
				  reimbursement for the non-Title XIX services shall be $ 32.00.