Exhibit 2C - ISI ASAM Ambulatory & Residential LOC Authorization Parameters.pdf
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- Solicitation number
- 25DPP01060
- Issued by
- Mercer County, New Jersey
About this file
This document is the Interim Services Initiative (ISI) ASAM Ambulatory and Residential Level of Care (LOC) Authorization Parameters for State Fiscal Year 2024, effective July 1, 2024, revised on April 8, 2024. It outlines the authorization parameters for various interim services, including ISI Care Management, Psychoeducational Group Services Specific to Interim Services, and Residential Med - True (IWM) ASAM LOC. The document specifies the maximum units per authorization, authorization timeframe, unit definitions, daily/weekly/monthly limits, and the number of days at which an initial Exceptional Rate Limit (ERL) is needed and can be submitted. The authorization values range from $52.88 to $211.20 per authorization, and the rates per unit range from $6.61 to $26.40.
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Exhibit 2C - Interim Services Initiative (ISI) ASAM Ambulatory and Residential LOC Authorization Parameters SFY 2024 Effective 07/01/24 Revised 04/08/24
Service ISI Care Management
Psychoeducational Group Services
Specific to Interim Services
Psychoeducational Group Services
Specific to Interim Services
Psychoeducational Group Services
Specific to Interim Services
Type/Modality Pre-Admission Ambulatory Residential Residential Med - True (IWM)
ASAM LOC N/A N/A N/A N/A
CPT Code ISICARM Z3355 Z3355 Z3355
Maximum units per Authorization 8 8 8 8
Authorization time frame (days) 30 30 30 30
Unit 15 Minutes Per service Per service Per service
Daily Limits 8 1 1 1
Weekly Limits 8 2 2 2
Monthly Limites 8 8 8 8
# of days at which initial ERL needed N/A 30 30 30
# of days at which ERL can be submitted N/A 14 14 14
Authorization RED ZONE (67% of annual allocation) N/A N/A N/A N/A
Adult Annual Client Limits (units) N/A N/A N/A N/A
Rate Per Unit $ 26.40 6.61$ 6.61$ 6.61$
Authorization Value $ 211.20 52.88$ 52.88$ 52.88$
Shared Service Name N/A
Interim Services Initiative (ISI) Fee for Service - Adult Co-occurring Capable
Authorization Parameters
Interim Services
Page 1 of 2 DMHAS ISI
Exhibit 2C - Interim Services Initiative (ISI) ASAM Ambulatory and Residential LOC Authorization Parameters
SFY 2024
Effective 07/01/24 Revised 04/08/24
Service Psychoeducational Group Services
Unit 90 minutes
Weekly Limits See LOC Limits
Rate per unit $6.61
Max units per diem 1
CPT Code Z3355
Page 2 of 2 DMHAS ISI
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