Exhibit 2S - SJI ASAM Residential LOC Authorization Parameters.pdf
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- Solicitation number
- 25DPP01060
- Issued by
- Mercer County, New Jersey
About this file
This document is an Exhibit outlining the South Jersey Initiative (SJI) ASAM Residential Level of Care (LOC) Authorization Parameters for Fiscal Year 2025, effective July 1, 2024. It details the authorization parameters for various residential substance abuse treatment modalities, including Halfway House, Long Term Residential Tier 2, Short Term Residential, and Inpatient Withdrawal Management. The document specifies the ASAM LOC, CPT codes, maximum units per authorization, authorization time frames, unit definitions, daily and weekly limits, and the number of days when an Early Re-Authorization Request (ERL) is needed or can be submitted. The document also provides the authorization value and rate per unit for each modality.
The document appears to be a fee-for-service authorization guide for adult residential ASAM level of care services under the South Jersey Initiative (SJI). It outlines the specific parameters and authorization limits for each treatment modality, which will be used to guide the approval of residential substance abuse treatment services for the SJI program in Fiscal Year 2025.
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Text version
Exhibit 2S - South Jersey Initiative (SJI) ASAM Residential LOC Authorization Parameters SFY 2025 Effective 07/01/24 Revised 04/08/24
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)
Inpatient Withdrawal
Management
Modality/Type Pre-Admission Residential 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 Level 3.7 WM
CPT Code H0001 HF H2034 HF H2034 HF H2034 HF H0026T2 HF H0026T2 HF H0026T2 HF H0018 HF H0018 HF H0010 HF
Maximum units per Authorization 4 7 14 30 7 14 30 7 14 5
Authorization time frame (days) 30 7 14 30 7 14 30 7 14 5
Unit 30 minutes Per diem 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 1
Weekly Limits 4 7 7 7 7 7 7 7 7 7
# of days at which initial ERL needed N/A 5
# of days at which ERL can be submitted N/A 3
Authorization RED ZONE (67% of annual allocation) N/A N/A
Adult Annual Client Limits (units) N/A N/A
Rate Per Unit 28.49$ 475.42$
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$ 2,377.10$
Shared Service Name N/A
Detox - Free-Standing
Residential (Sub-Acute)
South Jersey Initiative (SJI) Fee for Service - Adult Residential
ASAM Level of Care Authorization Parameters
Halfway House
N/A
$ 99.43
Long Term Residential Short Term Residential
N/A
$ 244.78
N/A
$ 161.33
N/A
35 7
N/AN/A
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