Newsletter Vol. 36, No.05

By June 30, 2025: Billing team must update rate tables in the billing system to reflect new tiered reimbursement rates effective July 1, 2025. If your organization operates as an Assisted Living Residence or Comprehensive Personal Care Home in New Jersey, verify your facility's current Medicaid/NJ FamilyCare enrollment percentage tier (0–100%) and ensure the corresponding per diem rate is applied to all claims with dates of service on or after July 1, 2025. For Medicaid Partner Communities: Document that your facility qualifies for the two-year highest-tier rate period and flag in the billing system to apply the $126.10 (ALR) or $116.10 (CPCH) per diem automatically. If your facility is newly enrolled as an ALR or CPCH Medicaid provider, submit your land use restriction agreement to the Division of Medical Assistance and Health Services (address provided in policy) within 3 months of enrollment to qualify as a Medicaid Partner Community. Update provider records and billing software to recalculate tiers each July 1st based on average daily Medicaid census from October–December of the previous year. Monitor www.njmmis.com for updated rate confirmations. Contact Gainwell Technologies Provider Services at 1-800-776-6334 with questions. Failure to apply correct tiered rates will result in underbilling or claim denials.