The New Jersey Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) has increased the minimum hourly rate requirements that Horizon NJ Health and other Medicaid Managed Care Organizations must pay for Personal Care Assistant (PCA) services to individuals Effective July 1, 2019, the new, mandated rate for PCA services to individuals is $18 per hour. As always, providers must bill Horizon NJ Health for such PCA services in 15-minute units using code T1019.

Horizon NJ Health will update our payment system to include the new rate effective July 1, 2019. To account for the new rate, Horizon NJ Health will retroactively adjust any impacted claim payments for dates of service on or after July 1, 2019. You will not need to resubmit claims, as Horizon NJ Health will reprocess based on claims already submitted.

If you have any questions regarding Horizon NJ Health’s implementation of this rate change, please contact your Horizon NJ Health Ancillary Contracting Specialist.