Exhibit 2F - MATI ASAM Ambulatory LOC Authorization Parameters.pdf
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- Solicitation number
- 25DPP01060
- Issued by
- Mercer County, New Jersey
About this file
This document contains the ASAM Ambulatory LOC Authorization Parameters for the Medically Assisted Treatment Initiative (MATI) program for State Fiscal Year 2025, effective July 1, 2024. It outlines the authorization parameters for three service modalities: Pre-Admission Ambulatory, Intensive Outpatient, and Partial Care. The parameters include the ASAM LOC, CPT codes, maximum units per authorization, authorization timeframe, daily and weekly limits, and the number of days required for an initial ERL and ERL submission. The document also provides the authorization value, shared service name, and rate per unit for each modality.
The document specifies that there are no authorization "red zones" or annual client limits for these services. The pricing information indicates that the rate per unit ranges from $28.49 for Pre-Admission Ambulatory to $109.38 for Intensive Outpatient and $78.23 for Partial Care.
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Text version
Exhibit 2F - Medically Assisted Treatment Initiative (MATI) ASAM Ambulatory LOC Authorization Parameters SFY 2025 Effective 07/01/2024 Revised 04/08/2024
Service Assessment Intensive Outpatient
Partial Care
Modality/Type Pre-Admission Ambulatory Ambulatory
ASAM LOC N/A Level 2.1 Level 2.5
CPT Code H0001 HF H0015 HF H2036 HF
Maximum units per Authorization 4 18 22
Authorization time frame (days) 30 30 30
Unit 30 minutes Per diem Per diem
Daily Limits 4 1 1
Weekly Limits 4 4 5
# of days at which initial ERL needed N/A 60 60
# of days at which ERL can be submitted N/A 50 50
Authorization RED ZONE (67% of annual allocation) N/A N/A N/A
Adult Annual Client Limits (units) N/A N/A N/A
Rate Per Unit 28.49$ 109.38$ 78.23$
Authorization Value 113.96$ 1,968.84$ 1,721.06$
Shared Service Name N/A
Intensive Outpatient and
Opioid Maintenance -
Intensive Outpatient
Partial Hospitalization/
Care
Fee for Service - Adult Co-occurring Capable Ambulatory ASAM Level of Care Authorization Parameters
Medically Assisted Treatment Initiative (MATI)
Page 1 of 1 DMHAS MATI
MATI
File details come from the government source that posted it. Updated .