Exhibit 2I - NJSI ASAM Residential LOC Authorization Parameters.pdf
PDF 108 KB Posted
- Solicitation number
- 25DPP01060
- Issued by
- Mercer County, New Jersey
About this file
This document is the Exhibit 2I - New Jersey Statewide Initiative (NJSI) ASAM Residential LOC Authorization Parameters, which outlines the authorization parameters for various residential addiction treatment services under the NJSI program for State Fiscal Year 2025. The document provides details on the service assessment, ASAM level of care, CPT codes, maximum units per authorization, authorization timeframe, daily and weekly limits, and the authorization value for each service type, which includes Halfway House (7, 14, and 30 days), Long Term Residential Tier 2 (7, 14, and 30 days), and Short Term Residential (7 and 14 days).
The document also includes the shared service name, ASAM level of care authorization parameters, and the fee-for-service rates for the Adult Residential services, which are $99.43 for Short Term Residential, $161.33 for Halfway House, and $244.78 for Long Term Residential Tier 2. Additionally, the document indicates that there are annual client limits for these services, but the specific numbers are not provided.
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Text version
Exhibit 2I - New Jersey Statewide Initiative (NJSI) ASAM Residential LOC Authorization Parameters SFY 2025 Effective 07/01/2024 Revised 04/08/2024
Service Assessment Halfway House (7 days)
Halfway House (14 days)
Halfway House (30 days)
Long Term Residential
Tier 2 (7 days)
Long Term Residential
Tier 2 (14 days)
Long Term Residential
Tier 2 30 days)
Short Term Residential
(7 days)
Short Term Residential (14 days)
Modality/Type Pre-Admission Residential Residential Residential Residential Residential Residential Residential Residential
ASAM LOC N/A Level 3.1 Level 3.1 Level 3.1 Level 3.5 Level 3.5 Level 3.5 Level 3.7 Level 3.7
CPT Code H0001 HF H2034 HF H2034 HF H2034 HF H0026T2 HF H0026T2 HF H0026T2 HF H0018 HF H0018 HF
Maximum units per Authorization 4 7 14 30 7 14 30 7 14
Authorization time frame (days) 30 7 14 30 7 14 30 7 14
Unit 30 minutes Per diem Per diem Per diem Per diem Per diem Per diem Per diem Per diem
Daily Limits 4 1 1 1 1 1 1 1 1
Weekly Limits 4 7 7 7 7 7 7 7 7
# of days at which initial ERL needed N/A
# of days at which ERL can be submitted N/A
Authorization RED ZONE (67% of annual allocation) N/A
Adult Annual Client Limits (units) N/A
Rate Per Unit 28.49$
Authorization Value 113.96$ $ 696.01 $ 1,392.02 $ 2,982.90 $ 1,129.31 $ 2,258.62 $ 4,839.90 1,713.46$ 3,426.92$
Shared Service Name N/A
ASAM Level of Care Authorization Parameters
N/A
New Jersey Statewide Initiative (NJSI) Fee for Service - Adult Residential
N/A
Short Term Residential
$ 99.43
Halfway House
N/A
Long Term Residential
$ 161.33
N/A
N/A
$ 244.78
N/A
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File details come from the government source that posted it. Updated .