MedicaidPrior AuthHigh impact
Newsletter Vol. 13, No. 63
New Jersey Medicaid·NJ·Provider Notice
Effective date
Aug 24, 2003
We identified it
Jun 20, 2026
Summary
Effective August 24, 2003, New Jersey Medicaid reduced the maximum weekly Personal Care Assistant (PCA) services from 40 hours to 25 hours per beneficiary. Beneficiaries with existing prior authorizations may continue at approved higher levels until expiration. Providers must request new prior authorizations for beneficiaries needing hours exceeding 25 per week, with exemptions available for documented substantial need and waiver program enrollees.
Action Required
By August 24, 2003: Billing team must implement the 25-hour weekly maximum for PCA services in billing system for all beneficiaries WITHOUT active prior authorizations. Verify all existing prior authorizations in system and allow continued billing at approved levels until PA expiration. Update billing logic to flag claims exceeding 25 hours for beneficiaries without valid PA. Beginning 30 days before any current PA expiration, submit new prior authorization requests for beneficiaries requiring hours over 25. Contact Division of Disability Services at (609)-588-2620 to request exemptions for non-waivered beneficiaries with documented substantial need. Failure to comply will result in claim denials for hours exceeding the 25-hour limit without approved prior authorization.