N.J. Admin. Code § 10:59-1.12

Current through Register Vol. 56, No. 24, December 18, 2024

Section 10:59-1.12 - Parenteral therapy

(a) Parenteral therapy refers to the administration of a drug by the intravenous or subcutaneous route of administration.

(b) Total parenteral nutrition (TPN) means the administration of a patient's total daily nutritional needs via the parenteral route of administration.

(c) All parenteral therapy services, including total parenteral nutrition (TPN), require prior authorization (see N.J.A.C. 10:59-1.6).

(d) For parenteral therapy other than TPN, coverage through the medical supplier shall be limited to supplies and equipment. Medicaid/NJ FamilyCare fee-for-service maximum fee allowances for drug costs related to TPN solutions shall only be reimbursed to medical suppliers who are also licensed as providers of pharmaceutical services.

1. Coverage for all medical supplies and DME related to TPN therapy shall be based on monthly fee allowances as established by the Division (see N.J.A.C. 10:59-2.3 for monthly fee allowances and unit descriptions).

(e) All drugs related to parenteral therapy shall be covered as pharmaceutical services (see N.J.A.C. 10:51-1.11) and shall only be billed to the Division by providers of pharmaceutical services (see N.J.A.C. 10:51-1.2(d)).

1. Reimbursement of all DME base solutions and supplies related to parenteral therapy shall be based on the mode of parenteral administration.

2. Medicaid/NJ FamilyCare fee-for-service maximum fee allowances for parenteral therapy-related DME shall be based on all-inclusive per diem rates established by the Division (see N.J.A.C. 10:59-2.3 for daily allowances and unit descriptions). The per diem rate includes the cost of the base solution.

(f) When the beneficiary is a nursing facility resident, all parenteral therapy drugs and TPN solutions shall be billed by the Medicaid/NJ FamilyCare pharmacy provider that is under contract with the nursing facility to provide pharmaceutical services.

1. The contracted provider of pharmaceutical services must be licensed to provide parenteral therapy (see N.J.A.C. 10:51-1.2(d) ) and approved as a medical supplier by the Division (see N.J.A.C. 10:59-1.3).

2. All costs for supplies and DME which are used for the administration of parenteral therapy and TPN solutions shall be components of the nursing facility per diem rate and shall not be eligible for fee-for-service reimbursement from the New Jersey Medicaid/NJ FamilyCare programs.

N.J. Admin. Code § 10:59-1.12

Amended by R.2000 d.391, effective 10/2/2000.
See: 32 N.J.R. 2198(a), 32 N.J.R. 3568(a).
Rewrote the section.
Amended by R.2006 d.297, effective 9/5/2006.
See: 38 N.J.R. 1371(b), 38 N.J.R. 3578(a).
Substituted "FamilyCare" for "KidCare" throughout.

Amended by 53 N.J.R. 1278(b), effective 8/2/2021