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N.J. Admin. Code § 10:60-3.7 - Basis of payment for personal care assistant services
New JerseyregulationNJ Division of Medical Assistance and Health Services (DMAHS)· effective 2022-09-06
What this rule requires your agency to do
- 1A provider shall not charge the New Jersey Medicaid/NJ FamilyCare programs in excess of current charges to other payers.(N.J. Admin. Code § 10:60-3.7 - Basis of payment for personal care assistant services)
- 2The initial service visit shall be rounded up to one full unit; beyond the initial unit, 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.(N.J. Admin. Code § 10:60-3.7 - Basis of payment for personal care assistant services)
- 3For non-managed-care beneficiaries, a unit of PCA service is defined as 60 minutes; where PCA services are provided to the same beneficiary multiple times on the same date, the provider shall add non-continuous units of time together to reach a billing total.(N.J. Admin. Code § 10:60-3.7 - Basis of payment for personal care assistant services)
- 4Reimbursement rates are all-inclusive maximum allowable rates; no direct or indirect cost above the established rates may be reimbursed, and the provider shall reflect its standard charge on the CMS 1500 Claim Form even though actual payment may differ.(N.J. Admin. Code § 10:60-3.7 - Basis of payment for personal care assistant services)
Applies to: personal care
Sets the per-unit fee-for-service payment basis, unit definition, time-rounding rules, and claim/charge requirements for PCA services.
Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.