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N.J. Admin. Code § 10:60-2.5 - Basis of payment for home health services
New JerseyregulationNJ DHS, Division of Medical Assistance and Health Services (DMAHS)· effective 2022-09-06
What this rule requires your agency to do
- 1Home health agencies must maintain both unit and visit statistics for all services provided to Medicaid/NJ FamilyCare fee-for-service beneficiaries.(N.J. Admin. Code § 10:60-2.5 - Basis of payment for home health services)
- 2Home health agencies must bill the unit of service as a 15-minute interval and must not bill when the beneficiary is not home or cannot be found and hands-on medical care was not provided.(N.J. Admin. Code § 10:60-2.5 - Basis of payment for home health services)
- 3Home health agencies must submit a legible, complete cost report for each fiscal year, due on or before the last day of the fifth month following the close of the period (45 days following termination or change of ownership).(N.J. Admin. Code § 10:60-2.5 - Basis of payment for home health services)
- 4Failure to submit an acceptable cost report on a timely basis may result in suspension of payments until an acceptable cost report is received.(N.J. Admin. Code § 10:60-2.5 - Basis of payment for home health services)
- 5Home health agencies must not span bill; a separate line must be billed for each day the service is provided, and only the listed revenue codes plus Revenue Code 270 will be reimbursed.(N.J. Admin. Code § 10:60-2.5 - Basis of payment for home health services)
Applies to: personal care
Establishes the service-specific statewide unit rates and billing rules for home health services, including the 15-minute unit definition, the prohibition on span billing and on billing when hands-on care is not provided, and the requirement to file annual cost reports.
Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.