N.J. Admin. Code § 10:60-3.7

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:60-3.7 - Basis of payment for personal care assistant services

(a) Personal care assistant services shall be reimbursed on a per unit, fee-for-service basis for weekday, weekend, and holiday services. Nursing assessment and reassessment visits under this program shall be reimbursed on a per visit, fee-for-service basis.

1. When provided to beneficiaries who are not enrolled in a managed care organization, personal care assistant (PCA) services shall be reimbursed on a fee-for-service basis and a unit of service is defined as 60 minutes. When PCA services are provided to the same beneficiary on the same date of service multiple times throughout the day, the provider shall add non-continuous units of time together to reach a billing total. The initial service visit shall be rounded up to one full unit of service. Beyond the initial unit of service, all service times shall be added together and service times totaling more than 30 minutes shall be rounded up to one unit and service times totaling 30 minutes or less shall be rounded down.

(b) Personal care assistant services reimbursement rates (see N.J.A.C. 10:60-11) are all inclusive maximum allowable rates. No direct or indirect cost over and above the established rates may be considered for reimbursement. At all times the provider shall reflect its standard charge on the CMS 1500 Claim Form (see Fiscal Agent Billing Supplement, Appendix A, incorporated herein by reference) even though the actual payment may be different. A provider shall not charge the New Jersey Medicaid/NJ FamilyCare programs in excess of current charges to other payers.

(c) For reimbursement purposes only, a weekend means a Saturday or Sunday; a holiday means an observed agency holiday which is also recognized as a Federal or State holiday.

N.J. Admin. Code § 10:60-3.7

Amended by 50 N.J.R. 1992(b), effective 9/17/2018

Amended by 54 N.J.R. 1721(a), effective 9/6/2022