MedicaidCoverageMedium impact
Newsletter Vol. 18, No. 19
New Jersey Medicaid·NJ · Palliative Care, Geriatrics·Provider Notice
Effective date
Jun 17, 2008
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid extends hospice room and board benefits to Medically Needy beneficiaries who elect Medicare hospice while residing in nursing facilities. Reimbursement is at 95% of approved NF rates, with hospice providers responsible for managing room and board payments to facilities. A temporary manual claims submission process is in effect pending permanent system implementation.
Action Required
Immediately: Hospice providers in NJ must implement manual claims submission process for Medically Needy beneficiaries electing Medicare hospice. Providers must: (1) Verify Medically Needy eligibility with County Welfare Agency (CWA) Liaison before billing; (2) Obtain completed Hospice Eligibility Form (FD-383), Election of Hospice Benefits Statement (FD-378), and Physician Certification Form (FD-385) and maintain in beneficiary medical records; (3) For HCPCS codes T2046 (room and board per diem), Y6337 (therapeutic leave), and Y6338 (bed hold), submit CMS 1500 claims with dates of service on or after June 17, 2008 to: NJ Division of Medical Assistance and Health Services – Office of Reimbursement, 7 Quakerbridge Plaza Room 302, Mercerville NJ 08619 (courier) or PO Box 712, Trenton NJ 08625 (US Mail), marked 'Attn: Hospice Program – MEDICALLY NEEDY'; (4) Include contact person name, phone, and email with each submission. Claims submitted to standard channels will be rejected. Continue this manual process until DMAHS issues new permanent procedures. Failure to follow this process will result in claim denials. Contact Marcia Harrison at 609-588-4693 with questions.