reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 140 - PERSONAL ASSISTANCE SERVICES PROGRAM › Subchapter 4 - INDIVIDUAL BUDGETS AND FEES › Section 10:140-4.4 - Standards for adjustments in consumer cost share obligation

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Adjustments in consumer cost share obligation shall be based on verifiable
				expenses that result from the consumer's disability that are non-routine in
				nature and are due to unforeseen and emergent circumstances. Items that can be
				considered for reduction of cost share shall be limited to:
1. Unreimbursed or unreimbursable medical
				expenses;
2. Transportation
				expenses;
3. Adaptations to home or
				vehicle that promote access or safety and are related to the consumer's
				disability;
4. Expenses paid by the
				consumer for personal care services that are beyond the services provided by
				the program, but meet the definition of personal care services utilized by the
				program;
5. Adaptive or assistive
				technology to compensate for a disability;
6. Expenses related to the care of a
				certified service animal; or
7.
				Unreimbursed costs related to the repair of a mobility device or adaptive
				equipment.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 140 - PERSONAL ASSISTANCE SERVICES PROGRAM › Subchapter 4 - INDIVIDUAL BUDGETS AND FEES › Section 10:140-4.5 - Procedures for requesting adjustments in consumer cost share obligation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A consumer requesting adjustments in
				consumer fees shall submit a written request and justification to the county
				designated agency. Within 60 days following the date that the required forms
				for completing the adjustment are received by the consumer from the county
				designated agency, the consumer shall submit verification of expenses pursuant
				to 10:140-4.4.
(b) Upon receipt of a written request and
				justification for a consumer fee adjustment, the county designated agency shall
				review the request and submit to the State Program Administrator materials
				pertaining to the request along with a recommendation regarding the
				appropriateness of the request and the amount of the adjustment.
(c) Upon receipt of the information described
				in 10:140-4.5(b),
				the State Program Administrator shall review the request and recommendation and
				render a decision based on the facts presented.
(d) Upon receipt of a decision by the county
				designated agency from the State Program Administrator, the county designated
				agency shall provide the consumer with written notice regarding the disposition
				of the request for an adjustment in consumer fee.
(e) Adjustments in consumer fee which are
				approved shall be effective as of the first day of the calendar month
				succeeding the month in which the written request is received by the county
				designated agency.
(f) A consumer
				requesting adjustment in his or her consumer fee shall continue to pay the
				original percentage of the total cost of service assessed pursuant to
10:140-4.3(a)
, (b), (c), and (d), pending the consumer's submission of written
				justification and verification of expenses under (a) and (b) above and approval
				by the State Program Administrator of the consumer's request for an adjustment
				under (c) above.
1. In the event a consumer
				has an outstanding cost share balance owed to the Program, the approval of an
				adjustment (reduction) in fees shall be contingent upon the consumer's
				completion of a repayment plan to retire the debt, which must be approved by
				the county designated agency and designated State agency.
2. Failure to complete the cost share
				repayment plan as described in (f)1 above and/or make restitution in the
				accordance with the plan shall result in suspension from the Program until such
				time the remaining debt is retired in full.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 140 - PERSONAL ASSISTANCE SERVICES PROGRAM › Subchapter 5 - PERSONAL ASSISTANTS › Section 10:140-5.1 - Requirements for personal assistants/domestic household employees

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All persons
				desiring to serve as personal assistants under the Personal Assistance Services
				Program shall be at least 18 years of age or of age to obtain working
				papers.
(b) Personal assistants are
				considered to be domestic household employees as defined by the Internal
				Revenue Service at I.R.C. § 31.3306(c)(2)-1(a)(2), and shall adhere to all
				criteria associated with that designation.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 140 - PERSONAL ASSISTANCE SERVICES PROGRAM › Subchapter 6 - CONSUMER INFORMATION AND PERSONAL ASSISTANT TRAINING › Section 10:140-6.1 - Training requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Newly eligible
				consumers for the Personal Assistance Services Program shall complete one
				mandatory training course entitled Orientation to PASP to be offered by the
				designated training agency, under contract with the Division. Consumers who
				have been previously trained may attend a refresher course as they deem it to
				be necessary.
1. Training will be available in
				lecture format and in self-paced format.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 140 - PERSONAL ASSISTANCE SERVICES PROGRAM › Subchapter 6 - CONSUMER INFORMATION AND PERSONAL ASSISTANT TRAINING › Section 10:140-6.3 - Compensation for attendance at training courses

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The rates of
				compensation for attendance at all training courses offered under the Personal
				Assistance Services Program shall be established by the designated State agency
				at a standardized rate.
(b)
				Personal assistants shall be issued a stipend upon completion of training
				referenced in
				10:140-6.1(b)  at
				the rate of $ 10.00 per hour by the designated training agency responsible for
				the administration of the Statewide training program under contract with the
				designated State agency.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 140 - PERSONAL ASSISTANCE SERVICES PROGRAM › Subchapter 7 - COMPLIANCE WITH LAWS › Section 10:140-7.1 - Requirements of fiscal intermediary service organization

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				fiscal intermediary service organization shall abide by all laws and
				regulations concerning employment of persons hired to administer or work in the
				Personal Assistance Services Program including, but not limited to, the
				Rehabilitated Convicted Offenders Act,
				2A:168A-1 et seq., and the
				Immigration Reform and Control Act of 1986 (P.L. 99-603).
(b) At the consumer's discretion, they may
				choose to have the fiscal intermediary service organization conduct a
				background check on a prospective employee. The cost of the background check
				shall be reflected on the CMP and be deducted from the consumer's cash
				allotment.
(c) The fiscal
				intermediary service organization shall establish a separate accounting
				regarding receipt and use of cost share fees collected to ensure that cost
				share funds are used to expand or enhance program services in that county.
				These funds shall not supplant any existing allocation. This separate
				accounting and supporting documentation shall be made available to the
				designated State agency.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 140 - PERSONAL ASSISTANCE SERVICES PROGRAM › Subchapter 7 - COMPLIANCE WITH LAWS › Section 10:140-7.2 - Duties of county designated agency

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Under the
				direction of the designated State agency, the county designated agency serves
				in the role of a coordinator providing primary front-line support and guidance
				to consumers, and shall perform the following duties:
1. Ensure that the operation and performance
				of the county's personal assistance program is in compliance with law and rules
				as specified by the designated State agency;
2. Provide information and outreach for the
				Personal Assistance Services Program;
3. Complete the necessary forms to determine
				eligibility of applicants and provide appropriate assistance to applicants and
				consumers in completing all necessary forms;
4. Determine cost share amount when
				applicable;
5. Maintain and update
				individual consumer files;
6.
				Designate a staff person to serve as a contact person for applicants, eligible
				consumers and personal assistants involved in the program and document such
				contacts;
7. Refer applicants and
				eligible consumers to other agencies, programs and services for which they may
				be eligible and request that they make application where appropriate;
8. Maintain fiscal and program records for
				the program;
9. Serve as liaison to
				the designated State agency for the Program;
10. Coordinate activities with the designated
				training agency to ensure completion of mandatory training requirements for
				consumers and personal assistants, according to
10:140-6.1
;
11. Explains the components and operation of
				the Program and assists the consumer in understanding the responsibilities and
				options involved under the cash model, as described in the Application for
				Service and Agreement of Understanding;
12. Develops an awareness of the consumer's
				personal assistance needs, including an awareness of any informal supports and
				the individual's preferences and choices;
13. Gathers information and maintains data on
				formal and informal support systems, community resources, and personal
				assistance services and shares the information with consumers at their
				request;
14. Assists consumers in
				completing a Plan of Service to determine personal assistance needs and with
				the development of a Cash Management Plan;
15. Advises the consumer regarding locating
				services or equipment, recruiting, hiring and firing workers, and using the
				fiscal intermediary service;
16.
				Assists consumers in locating sources of training and technical
				assistance;
17. Interacts and
				collaborates with staff from other Program components (fiscal intermediary,
				etc.) for Program coordination; and
18. Conducts periodic evaluation of consumer
				progress on Program effectiveness.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 140 - PERSONAL ASSISTANCE SERVICES PROGRAM › Subchapter 7 - COMPLIANCE WITH LAWS › Section 10:140-7.4 - County designated agency disqualification

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A county
				designated agency may be disqualified from participation in Personal Assistance
				Service Program funding for good cause including, but not limited to, the
				following:
1. Failure or refusal to comply
				with program rules and/or contract requirements; or
2. Refusal to furnish the designated State
				agency with required reports, or to make available for review such files and
				records as required.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 140 - PERSONAL ASSISTANCE SERVICES PROGRAM › Subchapter 7 - COMPLIANCE WITH LAWS › Section 10:140-7.5 - Disqualification appeal process

Current through Register Vol. 56, No. 14, July 15, 2024
If the designated State agency seeks to disqualify a county
				  designated agency from participation in the Personal Assistance Services
				  Program for failure to comply with
				  10:140-7.4(a)1 
				  and 2, said county designated agency shall be afforded an opportunity to
				  request an administrative hearing, pursuant to the Administrative Procedure
				  Act, 52:14B-1 et seq., and the Uniform
				  Administrative Procedure Rules, N.J.A.C. 1:1.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 141 - TRAUMATIC BRAIN INJURY FUND › Subchapter 1 - GENERAL PROVISIONS; REQUIREMENTS › Section 10:141-1.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
The purpose of this chapter is to provide information about
				  the operation of the Traumatic Brain Injury Fund, establish criteria for
				  eligibility, and establish a standard methodology for determining the amount
				  and type of supports and services to be allocated to individuals in the State
				  of New Jersey who have survived a traumatic brain injury. The Fund provides
				  financial assistance to New Jersey residents who have survived neurotrauma with
				  a traumatic brain injury. As a payer of last resort, the Fund will provide
				  support and financial assistance to assist with the costs of post-acute care,
				  services, and supports to foster independence for its beneficiaries. The act
				  establishing the Fund,
				  N.J.S.A.
				  30:6F-5 et seq., also requires the Brain
				  Injury Association of New Jersey to coordinate public information and
				  prevention education related to the Fund and to traumatic brain
				  injury.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 141 - TRAUMATIC BRAIN INJURY FUND › Subchapter 1 - GENERAL PROVISIONS; REQUIREMENTS › Section 10:141-1.3 - Administration of the Fund

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				procedures and methods will be used for the administration of the Fund:
1. The Division of Disability Services shall
				administer the Fund for the Department.
2. A committee known as the TBI Fund Review
				Committee shall be established within the Division of Disability Services,
				Department of Human Services, to implement the provisions of the Fund.
				Responsibilities of the Committee shall be:
i. Reviewing requests for services and
				supports under the Fund;
ii.
				Rendering decisions on support plans;
iii. Hearing initial reconsiderations for
				services and supports, which were previously denied by the Review
				Committee;
iv. Developing policies
				and procedures; and
v. Identifying
				problems associated with the administration of the Fund.
3. The Committee shall periodically report to
				the New Jersey Advisory Council on Traumatic Brain Injury on the status of
				applications, problems, and other issues related to the Fund.
4. The Committee shall be comprised of seven
				members, to be nominated by their respective bodies or interest groups and
				appointed by the Commissioner of Human Services or designee, as follows:
i. Two TBI Advisory Council
				members;
ii. A family member of an
				individual with a traumatic brain injury;
iii. A survivor of traumatic brain
				injury;
iv. A representative of the
				Brain Injury Alliance of New Jersey;
v. A professional clinician in the field of
				traumatic brain injury; and
vi. The
				Director of the Division or designee.
5. The Committee shall elect a chair from its
				members. The chair shall direct the activity of a Committee meeting.
6. Committee members may serve for two-year
				terms, and may be eligible for reappointment.
7. Committee members may be replaced as
				necessary in the event that they are no longer able to serve.
8. Committee members must recuse themselves
				from any decisions related to a conflict of interest with any applicant,
				beneficiary or provider.
9.
				Committee members will not be compensated for service to the Committee, but
				will be reimbursed for travel and other reasonable expenses connected with
				performing the work of the Committee.
10. The Committee shall meet at least
				quarterly to review applications, and to conduct business.
11. The Division shall contract with case
				management companies/agencies to initially assess the applicant's
				appropriateness for the Fund, and to prepare a support plan in conjunction with
				the applicant and their family. The Division will make payments to contracted
				agencies/organizations based on individually negotiated rates.
12. The cost of case management will be
				considered as an administrative expense of the Fund, and will not to be applied
				against the benefits provided to a beneficiary.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 141 - TRAUMATIC BRAIN INJURY FUND › Subchapter 1 - GENERAL PROVISIONS; REQUIREMENTS › Section 10:141-1.4 - Expenditure caps and limitations

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Services
				provided to an individual by the Fund will not exceed a lifetime total of $
				100,000.
(b) Expenditures for an
				individual shall not exceed $ 15,000 to be expended in any 12-month period,
				known as a funding year.
(c) An
				applicant may apply to the Fund for a waiver of these expenditure limits where
				the applicant can demonstrate extraordinary hardship to the satisfaction of the
				Committee. Hardship circumstances to be considered may include, but are not
				limited to, loss of income, extreme medical need, and potential functional
				decline of the applicant. Waivers will be at the discretion of the Committee,
				and will be considered only in emergent circumstances or cases of extreme
				hardship.
(d) Funding awarded to a
				beneficiary that has not been utilized at the end of a funding year shall be
				returned to the Fund, and shall not be counted against the beneficiary's annual
				and lifetime caps.
(e) During
				periods where the Fund has insufficient financial resources to meet its
				obligations, the Division may, at its discretion, lower the annual cap per Fund
				beneficiary found in (b) above for a period not to exceed 12 months.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 141 - TRAUMATIC BRAIN INJURY FUND › Subchapter 1 - GENERAL PROVISIONS; REQUIREMENTS › Section 10:141-1.5 - Eligibility for services and supports

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Applicants to
				the Fund must meet the following eligibility requirements. Responsibility for
				adherence to the criteria shall be vested with the Division Director, and shall
				remain an administrative function of the Division:
1. Clinical requirements:
i. The applicant has survived a traumatic
				brain injury as defined in this chapter;
ii. The applicant requires, and is
				requesting, post acute care services/support directly related to the traumatic
				brain injury;
iii. It has been
				established, by clinical opinion, that the provision of the requested
				service/support will restore, enhance or maintain function; and
iv. Clinical documentation of need shall be
				provided by a practitioner other than the practitioner rendering the care or
				service;
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 141 - TRAUMATIC BRAIN INJURY FUND › Subchapter 1 - GENERAL PROVISIONS; REQUIREMENTS › Section 10:141-1.6 - Application process for the services/supports of the Fund

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				following process shall be used to apply for assistance under the Fund:
1. An individual shall contact 888-285-3060
				for an application to the Fund.
i. Following
				an initial screening to determine that the prospective applicant meets basic
				eligibility criteria for the Fund, Division staff will forward application
				forms to the applicant or designee.
ii. Division staff shall offer assistance to
				the applicant in completing the application if necessary.
iii. Applications shall be available in
				alternative formats, upon request.
iv. Requests for applications shall be taken
				in any commonly accepted form.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 141 - TRAUMATIC BRAIN INJURY FUND › Subchapter 1 - GENERAL PROVISIONS; REQUIREMENTS › Section 10:141-1.7 - Approval and denial of supports/services from the Fund

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				following shall be the procedure and method for approval and denial for
				services:
1. The Committee shall review
				completed support plans and may take the following actions on each support plan
				for services:
i. Confirm eligibility and
				approve the support plan as presented;
ii. Confirm eligibility and modify the
				support plan;
iii. Confirm
				eligibility and hold the support plan, pending the receipt of further
				information; or
iv. Deny
				eligibility and/or the support plan as presented.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 141 - TRAUMATIC BRAIN INJURY FUND › Subchapter 1 - GENERAL PROVISIONS; REQUIREMENTS › Section 10:141-1.8 - Service coordination under the Fund

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Basic or simple
				services/supports shall not require the ongoing involvement of a service
				coordinator, and can be arranged directly by the beneficiary.
(b) Elaborate or complicated
				services/supports shall require a service coordinator be involved with the
				beneficiary to arrange, monitor and evaluate services.
(c) The service coordinator shall recommend
				any major changes to the support plan, service provider or expenditure limits,
				prior to implementation of any changes which shall require Division
				authorization.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 141 - TRAUMATIC BRAIN INJURY FUND › Subchapter 1 - GENERAL PROVISIONS; REQUIREMENTS › Section 10:141-1.9 - Responsibilities of the case manager

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Beneficiaries
				meeting the requirement for case management shall receive it as a covered
				service of the Fund. A case manager shall:
1.
				Make an initial visit to the beneficiary to advise and assist the beneficiary
				in accessing supports and implementing a support plan;
2. Maintain telephone contact with the
				beneficiary and make subsequent visits on a mutually agreed basis, with
				Division authorization, to determine compliance with the support plan. The
				level of case management will depend on the complexity and cost of the support
				plan;
3. Contact the provider(s) of
				service to determine the progress of the beneficiary, and to obtain reports
				related thereto;
4. Be responsible
				for educating the beneficiary/family on methods and options to maintain,
				enhance, or increase independence;
5. Assist the beneficiary/provider in
				modifying the service plan as necessary, within the fiscal limits approved in
				the support plan; and
6. Make a
				final report to the Division on the outcome of supports and a recommendation if
				further support may be required. If additional service or support is
				desired/required, the beneficiary will be required to reapply to the Fund.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 141 - TRAUMATIC BRAIN INJURY FUND › Subchapter 1 - GENERAL PROVISIONS; REQUIREMENTS › Section 10:141-1.10 - Payments for supports/services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Fund is the
				payer of last resort. Payment shall be made only for those supports where no
				other benefit, funding, insurance coverage, subsidy, or other source of payment
				is available and when documentation can be rendered to show a need and a link
				to the habituation of the traumatic brain injury.
(b) Payment shall be made by the Division
				upon the completion or delivery of the service or support. In the case of
				continuing support, payment shall be made on a periodic basis.
(c) Unless otherwise specified, payments
				shall be made by the Division to the provider of service upon receipt of a bill
				for service/ support rendered. If an individual provider is employed by or
				under contract to an agency or institution, payment shall be made to that
				agency or institution. Qualified private practitioners shall be reimbursed
				directly.
(d) Where specified under
				N.J.A.C.
				10:141-1.11(a)  and with
				prior approval of the case manager and the Division, payment may be made to the
				beneficiary as reimbursement for services rendered, with the submission of
				appropriate receipts.
(e) With
				prior approval of the case manager and the Division, payments may be advanced
				to the beneficiary for service/supports if the beneficiary is unable to
				directly finance the service. Receipts will be required from the beneficiary to
				verify provision of service/support. No payments will be made for expenses
				incurred prior to the approval of the Support Plan.
(f) All providers of service/support must be
				appropriately licensed, certified according to rules and regulations of their
				profession/service and the State of New Jersey, and/or comply with the provider
				requirements as specified under
				N.J.A.C.
				10:141-1.11(a).
(g) The Division will make payments based on
				individually negotiated rates, or on the basis of reasonable and customary
				charges.
(h) Failure to comply with
				the provisions of these rules could result in recovery of funds or preclude
				future payment for support.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 141 - TRAUMATIC BRAIN INJURY FUND › Subchapter 1 - GENERAL PROVISIONS; REQUIREMENTS › Section 10:141-1.12 - Ineligible supports and services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				list represents ineligible goods, services, and other items that will not be
				considered for assistance from the Fund:
1.
				Acute medical care or emergency medical treatment;
2. Motor vehicles or automobiles;
3. Recreational drugs, alcohol, or any
				illegal substances;
4. Costs
				associated with vacations or other entertainment or recreation
				expenses;
5. Any item or service
				that is unrelated to the diagnosis or the treatment of brain injury;
6. Entertainment equipment, such as TVs,
				VCRs, and gaming systems;
7. Food
				and meals, except on an emergent basis;
8. Services provided by relatives, except as
				provided for under
				N.J.A.C.
				10:141-1.11;
9. Services provided by individuals or
				agencies without appropriate licensure or certification;
10. Furniture or home furnishings, except as
				provided for under
				N.J.A.C.
				10:141-1.11;
11. Child care services furnished outside the
				applicant/beneficiary's home;
12.
				Legal services other than those provided for under
				N.J.A.C.
				10:141-1.11;
13. Any service or support available to the
				general public through a governmental program or agency, and for which there is
				no charge;
14. Items to be used as
				gifts, including cash;
15. Payment
				for normal expenses related to the operation or maintenance of a
				vehicle;
16. Payment for cable
				television and internet services;
17. Payment for services needed by a
				beneficiary's family;
18. Payment
				for insurance coverage other than medical or pharmaceutical
				insurance;
19. Veterinary care,
				except for credentialed service animals;
20. Consumable supplies associated with the
				use of a computer;
21. Co-pays and
				deductibles associated with insurance coverage;
22. Services requested to supplement other
				government or public programs;
23.
				Routine costs associated with moving or relocation;
24. Gym and health club
				memberships;
25. Services requested
				because a provider does not accept insurance, including Medicare, Medicaid,
				and/or other government health programs for which the applicant is otherwise
				entitled or eligible;
26. Hospice
				services or palliative care;
27.
				Massage therapy;
28. Therapies and
				treatments, other than those set forth in
				N.J.A.C.
				10:141-1.11;
29. Treatments and services that are deemed
				to be experimental and/or have not been approved by the United States Food and
				Drug Administration or other recognized regulatory body;
30. Personal care services that are
				determined to be custodial in nature;
31. Payment to providers outside the State of
				New Jersey;
32. Payment of health
				insurance premiums; and
33. Payment
				for desktop and laptop computers in circumstances other than defined in
				N.J.A.C.
				10:141-1.11(a)30.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 141 - TRAUMATIC BRAIN INJURY FUND › Subchapter 1 - GENERAL PROVISIONS; REQUIREMENTS › Section 10:141-1.13 - Emergency services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Fund shall utilize the following
				procedure where emergency services are requested under the Fund.
1. Emergency services shall be considered in
				circumstances where there is a request to the Fund that cannot be heard
				according to the provisions of
				10:141-1.7.
2. Emergency services shall be authorized at
				the discretion of the Division Director and shall be invoked when a delay in
				the provision of services would cause a direct threat to the health and safety
				of the applicant. Emergency services shall include, but not be limited to:
i. Pharmaceuticals;
ii. Mental health services;
iii. One-time payment of housing security
				deposit, one-time payment of rent or mortgage in circumstances of unforeseen
				homelessness, to facilitate physical access or to facilitate institutional
				discharge. Beneficiaries must demonstrate the ability to maintain
				self-sufficiency after Fund assistance has been provided; and
iv. Respite or home health services on a
				time-limited basis.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 141 - TRAUMATIC BRAIN INJURY FUND › Subchapter 1 - GENERAL PROVISIONS; REQUIREMENTS › Section 10:141-1.14 - Revenue and reporting of expenditures

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In accordance
				with 30:6F-7, the Division of
				Disability Services in the Department of Human Services shall prepare an annual
				report on the status of the Fund. The report shall include the following
				information:
1. The number of
				beneficiaries;
2. The average
				expenditure per beneficiary; and
3.
				The average income and expenditures of persons or families who received
				financial assistance from the Fund.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 1 - GENERAL PROVISIONS › Section 10:142-1.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In accord with
				the mission of the Department of Human Services and pursuant to provisions
				under the Centers for Medicare and Medicaid Services (CMS) 1915(j) Waiver
				authority participants are offered a monthly allowance in place of traditional
				agency Personal Care Assistant (PCA) services under
N.J.A.C.
				10:60-3.1
to direct and manage their
				own PCA services. The Personal Preference Program is designed to:
1. Provide eligible Medicaid beneficiaries an
				option to self-direct their own personal care services;
2. Offer participants a greater opportunity
				for choice and control over how to best meet their individual personal care
				needs;
3. Empower participants by
				giving them the opportunity to control their own services by deciding by whom,
				when, and how their services would be delivered; and
4. Offer the participants buying power to get
				the most out of their program benefits.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 1 - GENERAL PROVISIONS › Section 10:142-1.2 - Scope and nature

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Personal
				Preference Program shall serve as an alternative delivery mechanism for
				eligible Medicaid PCA services.
(b)
				Participants in the program shall be given both employer and budget authority
				to hire their own care providers within the scope of this chapter and
				compensate the care provider(s) using financial resources that would have been
				paid to a provider agency within the scope of the traditional PCA delivery
				model.
(c) Participants in the
				program may utilize a portion of the benefit to purchase goods and services
				that are clearly related to meeting personal care needs. Approved purchase of
				goods and services are described at N.J.A.C. 10:142-4.3(a), and items that are
				prohibited under the program are described at N.J.A.C. 10:142-4.4(a).
(d) Participants will be educated in how to
				develop and generate a back-up plan independently.
(e) Participants shall be afforded an
				assessment and determination of needs that is similar in nature and value to
				that available under the traditional agency PCA model as described at
				N.J.A.C.
				10:60-3.9.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 1 - GENERAL PROVISIONS › Section 10:142-1.3 - Participant rights

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Participants
				are afforded the following rights under the Personal Preference Program:
1. To create a cash management plan and make
				required changes to meet their own personal needs within the program guidelines
				for using the budget;
2. To have
				the expectation of privacy and confidentiality, and to be treated with dignity
				and respect;
3. To make decisions
				about their own care;
4. To decide
				how to use a budget within program constraints, or to have someone of choice
				help with decisions about the program;
5. To exercise choice of individuals for
				hiring as employees, including family members, to provide needed services,
				subject to limitations set forth at N.J.A.C. 10:142-2.3;
6. To disenroll from the program, at any
				time, and return to the traditional Medicaid PCA program under N.J.A.C. 10:60-3
				without penalty or loss of benefits currently received;
7. To change his or her representative, as
				appropriate, at any time;
8. To be
				represented at meetings pertaining to the program by a representative of their
				own choosing, including a friend, relative, advocate, or attorney;
				and
9. To register a complaint with
				the State program office for any reason, on any matter related to the
				program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 1 - GENERAL PROVISIONS › Section 10:142-1.5 - Administration of the Personal Preference Program

Current through Register Vol. 56, No. 14, July 15, 2024
The Personal Preference Program (PPP) shall be administered
				  by the Department of Human Services, Division of Disability Services. The
				  Division shall perform all contracting responsibilities related to the
				  administration of the program and employ staff to oversee the day to day
				  operations of the program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 2 - ELIGIBILITY AND PARTICIPANT RESPONSIBILITIES › Section 10:142-2.1 - Eligibility requirements for the Personal Preference Program

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For the
				purposes of enrollment and continued participation in the Personal Preference
				Program, an eligible individual must meet the following standards:
1. An eligible applicant or participant shall
				be a resident of the State of New Jersey and must reside within the geographic
				boundaries thereof in order to qualify for services. Residency shall be
				determined by physical domicile in the State of New Jersey. Exceptions to this
				rule include participants who are enrolled in a college/university on a
				full-time basis in- or out-of-State subject to the following:
i. Participant students must be present at
				their New Jersey address to participate in home visits and nursing
				reassessments, in accordance with N.J.A.C. 10:142-2.2(a)13.
ii. Participant students must provide
				documentation of progress towards completion of a planned educational goal,
				such as a degree, certification, accreditation, etc.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 2 - ELIGIBILITY AND PARTICIPANT RESPONSIBILITIES › Section 10:142-2.3 - Employee requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Workers are eligible to be employed by participants under the program subject
				to the following criteria:
1. At least 18
				years of age or, of age to obtain legal working papers and able to work in the
				State of New Jersey in accordance with
				N.J.S.A.
				34:2-21.1 through
				34:2-21.64; and
2. Considered domestic household employees as
				defined by the Internal Revenue Service at
I.R.C. §§
				31
.3306(c)(2)-1(a)(2) and shall adhere to all criteria associated with
				that designation.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 3 - SCREENING AND APPLICATION › Section 10:142-3.1 - Screening and application process for PCA participants enrolled in NJ FamilyCare/Medicaid managed care

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Individuals who are enrolled in NJ FamilyCare/Medicaid MCO and are interested
				in participant-directed services shall make application directly to their
				respective MCO.
(b) Upon receipt of
				a request to self-direct PCA services, the MCO shall screen the participant to
				determine if he or she meets program criteria and shall use the State's
				prescribed screening and application forms.
(c) If it is determined that the applicant
				meets the program criteria as described in this section, the MCO will authorize
				the participant for participant-directed services and refer the applicant to
				the Division for further action.
(d) The Division shall refer applicants to
				the counseling agency to continue the enrollment process according to contract
				provisions established between the Division and the VF/EA counseling
				entity.
(e) The counseling agency
				consultant shall establish the applicant as the employer of record and complete
				the enrollment process.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 3 - SCREENING AND APPLICATION › Section 10:142-3.2 - Screening and application process for PCA participants enrolled in Medicaid fee-for-services

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				For both Medicaid eligible fee-for-service participants receiving PCA services
				through a traditional provider agency, and for new applicants who are
				interested in applying for the Personal Preference Program, an application must
				be made directly to the Division of Disability Services.
1. If the participant is currently receiving
				traditional agency delivered PCA services, the Division will obtain the most
				recent PCA assessment and authorization of PCA service hours from the home care
				provider agency.
2. For new
				applicants opting for participant-directed services, the Division will arrange
				for a PCA assessment by a DDS staff nurse in accordance with
N.J.A.C.
				10:60-3.1
.
3. If the PCA assessment process under (a)1
				and 2 above determines that a new applicant does not meet the eligibility
				criteria for PCA services, the Division shall issue a letter denying PCA (and,
				therefore, PPP) services. In the event an applicant disagrees with the
				decision, he or she will be afforded appeal rights under N.J.A.C. 10:142-9.1
				and 9.3.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 3 - SCREENING AND APPLICATION › Section 10:142-3.3 - Authorized representative standards, roles, and responsibilities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An authorized
				representative shall be interviewed and approved by the consultant. Individuals
				with a record of violent felony(ies) or allegations of abuse to vulnerable
				populations shall not be permitted to serve as an authorized representative
				under the program.
(b) The approved
				authorized representative shall assume full responsibilities of the participant
				as described in N.J.A.C. 10:142-2.2(a).
(c) The participant shall be permitted to use
				only one representative at a time to assist with managing services. The
				participant may change his or her representative at any time, using the
				following procedures:
1. A request for change
				in representative shall be made to the Division, for review and confirmation of
				agreement of the individual to serve as the new representative. The Division
				shall render a final decision on the participant's request.
2. Upon obtaining approval, the Division
				shall inform the MCO care manager and VF/EA consultant of the change in
				representative.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 3 - SCREENING AND APPLICATION › Section 10:142-3.4 - Consultant role and responsibilities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The consultant assists program
				participants in understanding and effectively using the cash and counseling
				approach.
(b) The consultant shall
				be responsible for specific duties and responsibilities as prescribed under
				contract between the Department of Human Services and the VF/EA.
(c) The consultant shall monitor for abuse or
				neglect of participants, and immediately report to the Division in writing of
				any situation of suspected abuse and neglect, and submit a written report on
				the incident within two business days. Consultants shall simultaneously report
				abuse and neglect to the designated State protective agency in accordance with
				legislative and regulatory requirements under N.J.A.C. 10:142-10.1.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 3 - SCREENING AND APPLICATION › Section 10:142-3.5 - Confidentiality and disclosure of information

Current through Register Vol. 56, No. 14, July 15, 2024
All identifiable personal health information regarding
				  program applicants or participants that is obtained or maintained under this
				  program shall be confidential and shall not be released without the written
				  consent of the applicant or participant or their authorized agent pursuant to
N.J.A.C. 10:49-9.7
. If,
				  because of an emergency situation, time does not permit obtaining consent
				  before release, the program shall notify the participant, his or her family, or
				  authorized representative, immediately after releasing the
				  information.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 4 - CASH GRANT AND CASH MANAGEMENT PLAN › Section 10:142-4.1 - Budget determination

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				budget shall be used for services, supports, and goods to ensure the
				participant is able to complete the activities of daily living consistent with
				the participant's individual needs.
(b) The budget shall be determined by cashing
				out the participant's PCA benefit based on the current authorization of hours
				per the current PCA assessment and present rate of reimbursement for PCA
				services performed on a monthly basis. An identified percentage of the total
				cashed out benefit is deducted for the cost of administrative services
				performed by the VF/EA as described in N.J.A.C. 10:142-7.1 to be determined by
				the State program office.
(c) The
				funds derived from the calculation in (b) above shall be maintained in a
				designated account by the VF/EA, to be used towards issuing payroll checks to
				employees hired by the participant, and payment for purchase of necessary
				equipment, supplies, and services upon receipt of timesheets and
				invoices/bills, in accordance with N.J.A.C. 10:142-4.3.
(d) The monthly budget shall form the initial
				basis for completion of the cash management plan (CMP) described in N.J.A.C.
				10:142-4.5.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 4 - CASH GRANT AND CASH MANAGEMENT PLAN › Section 10:142-4.2 - Impact of budget allocation on governmental benefits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The budget allocation obtained by the
				participant, as described in N.J.A.C. 10:142-4.1(a) and (b), shall not be
				counted as income or as a resource for determining his or her benefits for
				Supplemental Security Income (SSI) or Supplemental Nutritional Assistance
				Program (SNAP) (formerly known as food stamps), housing eligibility for
				individuals receiving rental assistance, or who reside in subsidized
				housing.
(b) The budget allocation
				as described in N.J.A.C. 10:142-4.1(a) and (b) may be counted as income or as
				an asset for participants applying for a post-secondary education loan program
				eligibility during enrollment under the program.
(c) Participants are responsible for
				consulting appropriate loan officers affiliated with benefits offered, to
				determine the outcome of eligibility for post-secondary educational loans,
				while receiving a budget allocation while enrolled in the program.
(d) In situations in which a participant
				hires a spouse or household member, as an employee to perform services under
				the program, any income derived by the spouse as an employee shall be counted
				as household income, and as such, may affect eligibility for benefits under
				Supplemental Security Income (SSI), Supplemental Nutritional Assistance Program
				(SNAP) (formerly known as food stamps), or for rental assistance. The
				participant is responsible for consulting with the appropriate social service
				or rental assistance agency to determine the impact of hiring a spouse or
				relative would have on eligibility for other governmental benefits.
(e) The budget amount shall count as income
				in accordance with N.J.A.C. 10:142-2.3(c).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 4 - CASH GRANT AND CASH MANAGEMENT PLAN › Section 10:142-4.3 - Standards for use of the budget

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				The budget may be used for participant-directed goods and services, to
				eliminate or diminish the need for personal care, and promote independence
				related to ensuring completion of activities of daily living with respect to
				each participant's individual needs including, but not limited to:
1. Hiring and paying workers with an hourly
				rate of pay;
2. Purchasing home
				care services from an accredited agency to supplement or back up self-hired
				workers;
3. Transportation services
				for participant and/or employees, to assist with activities of daily living and
				errands;
4. Household-related
				appliances and electronic equipment/devices;
5. Technology for safety and independence not
				otherwise covered by Medicaid;
6.
				Purchase and installation of environmental modifications;
7. Purchase and installation of vehicular
				modifications related to accessibility, including repairs to vehicle
				modifications and related equipment;
8. Purchasing health insurance for a
				worker;
9. Costs of training and
				education for a worker;
10.
				Purchasing a background check on workers;
11. Purchasing services (laundry or cleaning
				services, errands, and meal preparation) with Division approval to supplement
				personal care services on a time limited basis for the benefit of the
				participant;
12. Adult day care for
				the benefit of the participant only; and
13. Respite care to relieve unpaid
				caregivers.