N.J. Admin. Code § 13:44K-9.2

Current through Register Vol. 56, No. 21, November 4, 2024

Section 13:44K-9.2 - Financial arrangements with clients and third-party payors

(a) Fees for occupational therapy services shall be reasonable and commensurate with the status and experience of the occupational therapist offering like services or treatment in the geographic area and shall be consistent with the provisions of 13:44K-9.4 prohibiting excessive fees.

(b) Prior to the initiation of occupational therapy services, the occupational therapist or his or her designee shall explain to the client in an understandable manner the financial arrangements for the services that will be provided. The information provided to the client shall include the following:

1. The fee for services or the basis for determining the fee to be charged;

2. Whether the licensee will accept installment payments or assignment of benefits from a third party payor;

3. That insurance coverage may not be available in all circumstances; and

4. The financial consequences, if any, of missed sessions.

(c) An occupational therapist shall not require a client or a third party payor to pay:

1. A fee for preparing an insurance claim form;

2. Interest on an unpaid account unless the client has been notified of this policy, in writing, prior to the initiation of occupational therapy services;

3. A full or partial fee for unkept appointments unless the client has been notified of this policy, in writing, prior to the initiation of occupational therapy services; or

4. A fee for any occupational therapy service not documented in a client record in a manner consistent with 13:44K-10.1.

(d) An occupational therapist shall prepare and maintain a written list of current fees for standard services and, upon request, shall provide the list to clients. The list shall include the following information:

1. Whether Medicaid clients are accepted;

2. Whether Medicare clients are accepted;

3. Whether other third-party payor plans are accepted; and

4. Whether special fee categories are available, such as for senior citizens or for members of designated groups, such as preferred provider plan members.

(e) An occupational therapist shall provide a copy of a written fee schedule to any interested person upon request. When the fee is set by a medical, health, educational, or social agency, an occupational therapist shall inform the client about how to obtain a copy of the written fee schedule.

N.J. Admin. Code § 13:44K-9.2

Amended by 51 N.J.R. 769(b), effective 5/20/2019