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Medicaid Update: Adult Medical Day Care Services May Occur at Home if Medical Day Care Facility is Closed due to COVID-19 Emergency

Medicaid Update

Volume 30  No. 04                                                                              
                March 2020

TO: Managed Care Organizations – For Action
Licensed Adult and Pediatric Day Care Facilities – For Action 

SUBJECT: Medical Day Care Service Delivery during COVID-19 Emergency

EFFECTIVE: Effective  March  18,  2020  and  until  the  end  of  the  COVID-19 Emergency 

PURPOSE: To notify Medical Day Care providers of service delivery guidelines during  
the  COVID  -19  Emergency  for  Medicaid/NJ  FamilyCare enrolled members.

BACKGROUND: Effective March 18, 2020 until the end of the COVID-19 Emergency period DMAHS the 
Medical Day Care guidelines have been adjusted to ensure members receive services when the Medical 
Day Care facility is closed.

ACTION: Effective March 18, 2020 and until the end of the COVID-19 emergency period, a 
Pediatric Medical Day Care provider (PMDC) or an Adult Medical Day Care (AMDC) provider which has 
closed its site due to the COVID-19 emergency may offer telephonic and in-home services as follows:

Providers will make telephonic outreach to assess wellness and detect developing needs of the 
Medicaid/NJ FamilyCare members they are authorized to serve.  With consent of the member, the 
provider will deliver meals and supplies to a member’s home at the level authorized by their 
Medicaid/NJ FamilyCare health plan (e.g. authorization of three days AMDC per week equals home 
delivery of three meals per week).   The provider will also initiate face-to-face visits by 
appropriately credentialed professionals when agreed upon by  the  member  and  the  provider.   
Providers  will  coordinate  member  needs  with  the member’s Medicaid/NJ FamilyCare health plan.

Submission of a claim for AMDC when the site is closed during the COVID-19 emergency requires 
appropriate documentation of: a) telephonic contact with the member, b) delivery of meal or 
supplies as requested by the member, and c) face-to-face visit as requested by  the  member.   
Providers  will  continue  to  bill  with  the  code  for  which  they  have authorization from the 
Medicaid/NJ FamilyCare health plan, and that code will represent services delivered both 
telephonically and directly to the home, rather than in the usual site  of  service,  for  the  
COVID-19  emergency  period.   Medicaid/NJ  FamilyCare  health plans  will pay these  claims  at  
the provider’s  contracted  rate. Provider may not bill  for service  unless  affirmative  contact  
is  made  with  the  member,  and  providers  must discontinue outreach if requested to do so by
the member or if advised that alternate home-based services have been authorized by the MCO.
For program integrity purposes, this service will be reviewed post-payment.

If  you  have  any  questions  concerning  this  Newsletter,  please  contact  DXC  Provider 
Services at 800-776-6334 or email the DMAHS Provider Relations Resource account with specific 
questions at

Previous Article DDD Policy Guidance on Visits to Residential Provider Homes during the COVID-19 Emergency
Next Article Medicaid Update: Upon Pharmacist Approval 90-Day Maintenance Medication of Non-Dangerous Controlled Substances Permitted During COVID-19 Emergency
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