Medicaid Update: Adult Medical Day Care Services May Occur at Home if Medical Day Care Facility is Closed due to COVID-19 Emergency
Volume 30 No. 04
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 firstname.lastname@example.org.