MedicaidAdministrativeMedium impact
Newsletter Vol. 26, No.17
New Jersey Medicaid·NJ·Reimbursement
Effective date
Dec 1, 2016
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid now allows assisted living facilities (ALR and CPCH) to bill Fee-for-Service rates for eligible residents who are pending managed care enrollment, effective December 1, 2016. Providers must notify the Division and receive approval before billing the established per diem rates using codes T2031 and T2031_U1.
Action Required
Assisted living providers with NJ Medicaid residents pending MCO enrollment must: 1) Submit monthly excel spreadsheets to mahs.provider-inquiries@dhs.state.nj.us with client details including name, DOB, Medicaid ID, county, financial eligibility date, clinical eligibility date, and facility name, 2) Wait 10 business days for approval notification, 3) Bill Molina using T2031 ($73.13 per diem for ALR) or T2031_U1 ($63.13 per diem for CPCH) for approved periods only, 4) Stop FFS billing once client enrolls in MCO and bill the managed care plan instead.