reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 4 - RESOURCES › Section 10:71-4.2 - Countable resources

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any resource
				which is not specifically excludable under the provisions of
				10:71-4.4 shall be considered a
				countable resource for the purpose of determining Medicaid Only eligibility.
1. No portion of a cash reward offered by the
				Division to an individual for providing information about fraud and/or abuse in
				any program administered in whole or in part by the Division shall be included
				in the computation of resources for financial eligibility purposes, if the
				resource is maintained in a separate account, in accordance with
				10:71-4.4(b).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 4 - RESOURCES › Section 10:71-4.4 - Excludable resources

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A resource
				which is classified as excludable shall not be considered either in the deeming
				of resources or in the determination of eligibility for participation in the
				Medicaid Only Program.
(b) The
				following resources shall be classified as excludable:
1. A house occupied by the individual as his
				or her place of principal residence, and the land appertaining thereto, shall
				be excluded:
i. Short temporary absences from
				home such as trips, visits, and hospitalizations do not affect this exclusion
				so long as the individual intends, and may reasonably be expected, to return
				home. An absence of more than six months is assumed to indicate that the home
				no longer serves as a principal residence. However, if the home is used by a
				spouse or there is evidence that the absence from the house is temporary, the
				home may continue to be excluded. With that exception, the CWA shall extend the
				period only with approval from the Division of Medical Assistance and Health
				Services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 4 - RESOURCES › Section 10:71-4.5 - Resource eligibility standards

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For eligibility
				in the Medicaid Only Program, total countable resources are subject to the
				following limits. (See
				10:71-4.1(b) 
				regarding definition of resources,
				10:71-4.2 regarding countable
				resources, and
				10:71-4.8 regarding resources of a
				couple when one member is applying for Medicaid for institutional services.)
1. Resource eligibility is determined as of
				the first moment of the first day of the month. Changes in the amount of
				countable resources subsequent to the first moment of the first day of the
				month shall not affect eligibility.
2. In the case of checking accounts, the
				balance as of the first moment of the first day of the month shall be reduced
				by the amount of any checks which have been drawn on the account but which have
				not yet cleared the financial institution.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 4 - RESOURCES › Section 10:71-4.6 - Deeming of resources

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When an
				applicant/beneficiary is an adult residing in the same household with his or
				her ineligible spouse or is a child residing in the same household with his or
				her parent(s) or spouse of parent, the resources of the ineligible spouse or
				parent(s) is considered in the determination of eligibility. The amount
				included as resources to the applicant/beneficiary, whether or not it is
				actually available, is termed deemed resources.
(b) Applicant/beneficiary living alone: If
				the applicant/beneficiary lives alone, only his or her countable resources
				shall be applied to the resource maximum for an individual.
(c) Applicant/beneficiary couple: In the case
				of an applicant/beneficiary couple, the total amount of the husband's and
				wife's combined countable resources shall be applied to the resource maximum
				for a couple. Such individuals will continue to have resources treated in this
				manner until they have been separated for one calendar month. At such time, the
				individuals will be considered to be living alone.
1. If one member of an eligible couple enters
				a Title XIX institution, only the resources of the institutionalized individual
				will be counted in the determination of his or her eligibility beginning with
				the date of admission except as provided in
				10:71-4.8.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 4 - RESOURCES › Section 10:71-4.8 - Institutional eligibility; resources of a couple

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In the
				determination of resource eligibility for an individual requiring long-term
				care, the county welfare agency shall establish the combined countable
				resources of a couple as of the first period of continuous institutionalization
				beginning on or after September 30, 1989. This determination shall be made upon
				request for a resource assessment in accordance with
				10:71-4.9 or at the time of
				application for Medicaid benefits. The total countable resources of the couple
				shall include all resources owned by either member of the couple individually
				or together. The county welfare agency shall establish a share of the resources
				to be attributed to the community spouse in accordance with this section. (No
				community spouse's share of resources may be established if the
				institutionalized individual's current continuous period of
				institutionalization began at any time before September 30, 1989.)
1. The community spouse's share of the
				couple's combined countable resources is based on the couple's countable
				resources as of the first moment of the first day of the month of the current
				period of institutionalization beginning on or after September 30, 1989 and
				shall not exceed $ 117,240, as indexed annually in accordance with
				42
				U.S.C. §
											1396r-5(g) and
				published as a notice in the New Jersey Register, and unless authorized in (a)4
				or 5 below. The community spouse's share of the couple's resources shall be the
				greater of:
i. $ 23,448, as indexed annually
				in accordance with
				42
				U.S.C. §
												1396r-5(g) and
				published as a notice in the New Jersey Register; or
ii. One half of the couple's combined
				countable resources.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 4 - RESOURCES › Section 10:71-4.9 - Resource assessment

Current through Register Vol. 56, No. 14, July 15, 2024
(a) At the
				beginning of the first continuous period of institutionalization (beginning on
				or after September 30, 1989), the institutionalized spouse or the community
				spouse (or a representative of either spouse) may request an assessment of the
				couple's total countable resources. The purpose of the assessment is to
				establish the community spouse's share of the couple's total countable
				resources (see
				10:71-4.8(a) 
				).
(b) The county welfare agency
				shall, upon a request for a resource assessment, advise the requesting parties
				of the documentation and verification necessary to make the assessment. When
				the necessary documentation and verification is not submitted to the county
				welfare agency in a timely manner, the requesting parties shall be advised that
				the resource assessment cannot be completed. Upon receipt of all relevant
				documentation of resources from the couple the county welfare agency shall
				establish the total countable resources of the couple. The county welfare
				agency shall notify both members of the couple of the total value assigned to
				their combined countable resources and the community spouse's share of those
				resources. A copy of the notice shall be retained at the county welfare agency.
1. The county shall complete the resource
				assessment and notify the requesting parties of its results within 45 calendar
				days of the request unless third-party verification has not been received by
				the county welfare agency or the requesting parties request a delay.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 4 - RESOURCES › Section 10:71-4.10 - Transfer of assets

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The provisions
				of this section shall apply, effective June 18, 2001, only to persons who are
				receiving an institutional level of services, including individuals who are
				receiving services under a 42 U.S.C. § 1915(c) home and community care
				waiver under Medicaid, or who are seeking that level of service, and who have
				transferred assets on or after August 11, 1993. An individual shall be
				ineligible for institutional level services through the Medicaid program if he
				or she (or his or her spouse) has disposed of assets at less than fair market
				value at any time during or after the 60-month period immediately before:
1. In the case of an individual who is
				already eligible for Medicaid benefits, the date the individual becomes an
				institutionalized individual; or
2.
				In the case of an individual not already eligible for Medicaid benefits, the
				date the individual applies for Medicaid as an institutionalized
				individual.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 4 - RESOURCES › Section 10:71-4.11 - Trusts

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For purposes of
				this subchapter, effective June 18, 2001, a trust is any legal instrument,
				device, or arrangement which is similar to a trust, in which a grantor
				transfers property to an individual or entity with fiduciary obligations
				(considered to be a trustee for purposes of this section). The grantor
				transfers the property with the intention that it be held, managed, or
				administered by the trustee for the benefit of the grantor or others. For the
				purposes of this chapter, a trust shall include, but not be limited to, escrow
				accounts, annuities, investment accounts, and other similar devices managed by
				an individual or entity with fiduciary obligations.
(b) The standards set forth in this section
				shall apply to trusts without regard to:
1.
				The purposes for which the trust is established;
2. Whether the trustee(s) has discretion or
				exercises such discretion under the trust;
3. Any restrictions on when or whether
				distribution can be made from the trust; or
4. Any restrictions on the use of
				distributions from the trust.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 5 - INCOME › Section 10:71-5.1 - Income; financial eligibility standards

Current through Register Vol. 56, No. 14, July 15, 2024
(a) As a condition
				of eligibility for the Medicaid Only Program, applicants must comply with the
				income standards set forth in this subchapter (see
				10:71-5.6 ).
(b) Income defined: For the purpose of this
				program, income shall be defined as receipt, by the individual, of any property
				or service which he or she can apply, either directly or by sale or conversion,
				to meet his or her basic needs for food or shelter. All income, whether in cash
				or in-kind, shall be considered in the determination of eligibility, unless
				such income is specifically exempt under the provisions of
				10:71-5.3.
1. Availability of income: In order to be
				considered in the determination of eligibility, income must be "available."
				Income shall be considered available to an individual when:
i. With the exception of income from
				self-employment, the individual actually receives the income;
ii. With the exception of income from
				self-employment, the income becomes payable but is not received by the
				individual due to his/her preference for voluntary deferment;
iii. Income has been deemed available to the
				applicant (see
				10:71-5.5 regarding the deeming of
				income);
iv. Net earnings from
				self-employment have been determined in accordance with
				10:71-5.4(a)2.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 5 - INCOME › Section 10:71-5.2 - Determination of countable income

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Countable
				income shall be determined by adding the applicant's nonexempt unearned income
				(less appropriate exclusions) to his/her earned income (less appropriate
				exclusions).
(b) Procedures
				regarding the determination of income eligibility shall be as follows:
1. Determination of initial income
				eligibility shall be based on all earned and unearned income which has or will
				be received during the month for which application is made, beginning with the
				first day of such month, except that quarterly, semiannual, or annual payments
				shall be prorated in accordance with (b)2 below. (See
				10:71-5.3(a)15 
				regarding exclusion of student earnings.)
2. The following shall apply to income
				received other than monthly:
i. Income
				received weekly shall be multiplied by 4.333 to determine the monthly amount;
				biweekly income shall be multiplied by 2.167. (If earned income is irregular,
				the initial determination shall be based on the average of the amounts received
				for any four weeks within the 10 week period which includes the five weeks
				immediately before and after the date of application.)
ii. When income received on a quarterly,
				semi-annual, or annual basis is of sufficient amount to affect the individual's
				eligibility, it shall be prorated as a monthly amount and entered on the
				Medicaid Eligibility Worksheet (Form PA-1E) accordingly. (See also
				10:71-5.4(a)11,
				regarding lump-sum payments.)
3. The period of income eligibility begins
				with the month in which application is made and continues until the scheduled
				redetermination, or until a change in status or income occurs which requires an
				earlier redetermination. (See
				10:71-8.1(a),
				regarding determination of continuing eligibility.)
4. At the time of application, the applicant
				shall identify any income which he or she receives periodically (less
				frequently than once a month) or anticipates receiving prior to the time of
				redetermination.
5. In situations
				where earned or unearned income is received irregularly or in irregular
				amounts, redetermination shall be made as frequently as necessary. The
				individual shall be advised of his or her responsibility to report significant
				changes in income. (See
				10:71-5.3(a)12 
				regarding exclusion of certain irregular income.)
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 5 - INCOME › Section 10:71-5.5 - Deeming of income

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When an applicant/beneficiary is an adult
				residing in the same household with his or her ineligible spouse or is a child
				residing in the same household with his or her parent(s) or spouse of the
				parent, the income of the ineligible spouse or parent(s) is considered in the
				determination of financial eligibility. The amount included as income to the
				applicant/beneficiary, whether or not it is actually available, is called
				deemed income and is computed as described in
				10:71-5.5(c), (d), (e) and
				(f).
1.
				Child: For the purpose of this section, a child is an individual who is not
				married and is under the age of 18 (see
				10:71-5.3(a)15  i
				regarding earnings of a child who is a student). Additionally, deeming of
				parental income to a blind or disabled child ceases when the child reaches age
				18.
2. Parent: A parent, for
				deeming purposes, is a natural or adoptive parent or stepparent living in the
				same household as an applicant/beneficiary child. However, death or divorce of
				the natural or adoptive parent terminates deeming responsibility of a
				stepparent.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 5 - INCOME › Section 10:71-5.7 - Post-eligibility treatment of income; institutionalized individuals

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The amounts
				specified in (b) through (h) below shall be deducted from the income of an
				institutionalized individual prior to the application of his or her income to
				the cost of the long-term care. These deductions apply only after the
				individual is determined eligible for Medicaid and shall not be deducted in the
				determination of income eligibility.
1.
				Should the total deductions authorized under this section exceed the
				institutionalized individual's income, no assistance is available from the
				Medicaid program to make up the deficit. In such circumstances, available funds
				shall first be used to provide the institutionalized individual with his or her
				personal needs allowance. Any remaining deductible income may be distributed to
				the community spouse or other family members as decided by the
				institutionalized individual, not to exceed the amount authorized under this
				section for any individual.
2. The
				deductions authorized in (c) through (e) below for the maintenance of the
				community spouse and other family members apply only so long as there is a
				community spouse as defined in (c) below. Deductions for the community spouse
				and other family members shall cease in the first full-calendar month after the
				community spouse dies, becomes divorced, or is institutionalized.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 5 - INCOME › Section 10:71-5.8 - Eligibility under life care and pay-as-you-go agreements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In a
				contractual agreement where the individual has transferred his available assets
				to the facility in exchange for full medical care in the institution, the
				institution has a legal responsibility to provide such care and Medicaid
				benefits are not payable for the institutional care. However, Medicaid
				eligibility may exist in the following circumstances (see also
				10:71-5.4(a)13 
				):
1. When it can be determined that no
				enforceable contract exists (for example, because the facility is financially
				unable to fulfill its responsibilities under the contract and all terms of the
				agreement are thus void), the facility has a legal obligation to refund to the
				individual any assets which remain from the amount assigned at the time the
				contract was signed. The individual may be eligible for Medicaid Only as long
				as all other eligibility criteria (including resources) are met.
2. When a contract is not actually rescinded
				and the individual retains his or her right under the terms of the contract
				but, where his or her contract rights for care in the facility are not fully
				met, Medicaid benefits may be available for those medical expenses not being
				met by this facility if the individual meets eligibility
				requirements.
3. When the
				contractual agreement for care in the facility does not include all of the
				medical care (for example, is limited to basic room and board), Medicaid
				benefits may be available for those medical expenses not covered by the
				contract as long as all eligibility criteria are met.
4. In those contractual situations above in
				which Medicaid eligibility may exist, the value of in-kind room and board is
				not considered income.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 5 - INCOME › Section 10:71-5.9 - Deeming from sponsor to alien

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For the
				purposes of determining eligibility for Medicaid Only for a legal alien
				(applying for the first time on or after October 1, 1980), the income and
				resources (see
				10:71-4.10 ) of any person who
				sponsored the alien's entry into the United States will be deemed to the alien.
				Such deeming applies for a period of three years from the month of the alien's
				entry into the United States. However, deeming shall not apply to any alien who
				is:
1. Admitted to the United States under
				the provisions of section 203(a)(7) of the Immigration and Nationality Act
				which were in effect prior to April 1, 1980;
2. Admitted to the United States under the
				provisions of section 207(c)(1) of such Act which became effective March 31,
				1980;
3. Paroled into the United
				States as a refugee under section 212(d)(5) of such Act;
4. Granted political asylum by the Attorney
				General;
5. Determined to be blind
				or disabled if such blindness or disability began after the date of admission
				into the United States for permanent residence; or
6. Sponsored by an institutional sponsor such
				as an employer or a church.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 6 - CASE RECORDS AND FILES › Section 10:71-6.1 - Purpose of case records

Current through Register Vol. 56, No. 14, July 15, 2024
The case record is a complete record in support of the CWA's
				  decisions and actions for each case.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 6 - CASE RECORDS AND FILES › Section 10:71-6.2 - Contents of the case record

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				items shall be included in the case record:
1. The narrative recording;
2. All medical reports and record of action
				from the MRT (appropriate cases);
3. All forms related to financial
				eligibility; and
4. All related
				correspondence, memoranda and documents except those which are required by law
				and regulation to be maintained in some other files.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 6 - CASE RECORDS AND FILES › Section 10:71-6.3 - Forms applicable to the Medicaid Only program

Current through Register Vol. 56, No. 14, July 15, 2024
Forms applicable to the Medicaid Only program (aged, blind
				  and disabled) are listed on page 1 of Appendix A; sample forms follow that
				  list.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 6 - CASE RECORDS AND FILES › Section 10:71-6.4 - Maintenance and custody of case records

Current through Register Vol. 56, No. 14, July 15, 2024
All case record material relevant to each family shall be
				  maintained under an appropriate registration number. All records shall be
				  appropriately indexed and filed.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 6 - CASE RECORDS AND FILES › Section 10:71-6.5 - Movement of case records

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No case record
				or official part of such record shall be removed from its designated filing
				cabinet without an identifying record of the person who has custody of
				it.
(b) No case record or official
				part shall be removed from the offices of the county welfare board except at
				the specific authorization of the director, deputy director or duly designated
				representative of the director.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 6 - CASE RECORDS AND FILES › Section 10:71-6.6 - Retention and destruction of records

Current through Register Vol. 56, No. 14, July 15, 2024
For the policy and procedure on retention and destruction of
				  case records see N.J.A.C. 10:69-7, Case Records and Files.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 7 - OTHER PAYMENTS › Section 10:71-7.1 - General provisions

Current through Register Vol. 56, No. 14, July 15, 2024
Medicaid Only beneficiaries, like Supplemental Security
				  Income (SSI) beneficiaries, are eligible to receive services and related
				  service payments for services identified at
				  10:71-7.2 and for payment of
				  burial and funeral expenses as authorized by
				  10:71-7.5. Such payments as deemed
				  necessary and appropriate by the county welfare agency shall be paid either
				  directly to the vendor of the service or by a check issued to the eligible
				  person.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 7 - OTHER PAYMENTS › Section 10:71-7.2 - Services and service payments

Current through Register Vol. 56, No. 14, July 15, 2024
Eligible applicants and beneficiaries as defined under the
				  State Plan for Title XX of the Social Security Act may receive the services and
				  related service payments specified in the State Plan. The Division of Youth and
				  Family Services is responsible for providing the county welfare agency with
				  policies and procedures regarding these service programs, including those
				  specified in
				  10:71-7.3.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 7 - OTHER PAYMENTS › Section 10:71-7.3 - Other service payments

Current through Register Vol. 56, No. 14, July 15, 2024
Eligible applicants and beneficiaries of Medicaid Only are
				  also eligible to receive certain service payments as authorized at
				  10:69-10.22(b) 
				  and 10.23. These include payments for expenses incident to homemaker service,
				  travel costs for health care, and childcare in certain situations.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 7 - OTHER PAYMENTS › Section 10:71-7.4 - Emergency assistance payments

Current through Register Vol. 56, No. 14, July 15, 2024
Eligible applicants and beneficiaries of Medicaid Only are
				  not eligible to receive emergency assistance as defined in
				  10:69-10.23.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 7 - OTHER PAYMENTS › Section 10:71-7.5 - Payment of burial and funeral expenses

Current through Register Vol. 56, No. 14, July 15, 2024
The county welfare agency is directed, under certain
				  situations, to provide payments for burial and funeral expenses on behalf of
				  Supplemental Security Income and adult "Medicaid Only" beneficiaries, as well
				  as former Old Age Assistance, Disability Assistance and Assistance for the
				  Blind beneficiaries. The procedure authorizing these payments is located at
				  N.J.A.C. 10:90-8.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 8 - RESPONSIBILITIES › Section 10:71-8.1 - Other agency responsibilities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Determination
				of continuing eligibility: The eligibility of each case shall be redetermined
				at least once every 12 months. This redetermination provides an opportunity to
				evaluate the total situation and enables the eligibility worker to ascertain
				whether the individual's eligibility has changed.
1. It shall be the agency's responsibility to
				review indications of ineligibility as they occur and to discontinue Medicaid
				Only eligibility when appropriate and without delay. The agency shall notify
				each applicant/beneficiary of any agency decision that relates to his or her
				eligibility status in accordance with the provisions of (d) below and
				8.3.
2. The individual, or his or
				her authorized representative, shall execute a formal written application, Form
				PA-1G, Application and Affidavit for Medical Assistance Only (Aged, Blind, or
				Disabled), for continuance of assistance at least once every 12
				months.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 8 - RESPONSIBILITIES › Section 10:71-8.2 - Redetermination of medical eligibility

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Redetermination
				of disability and blindness factors shall be done for every Medicaid Only
				beneficiary at intervals set by the Division of Medical Assistance and Health
				Services, Medical Review Team (MRT), except those beneficiaries who are
				currently receiving SSA Disability Insurance Benefits. The redetermination
				review date is designated on Form PA-8, Record of Action: Medical Eligibility
				Factor (see
				10:71-3.13(g) 
				).
(b) An individual who has been
				determined to be disabled or statutorily blind shall, if requested with
				reasonable notice, present himself or herself for and submit to examinations or
				tests, and shall submit medical and other evidence necessary for the purpose of
				determining whether he or she continues to be disabled or statutorily
				blind.
(c) In Medicaid Only cases,
				the CWA shall take into account the redetermination review date on Form PA-8 in
				scheduling both the annual review and interim visits. The CWA may adjust the
				date for case submittal to the Medical Review Team, to coincide as closely as
				is practical with either the annual review or with an interim visit, but such
				adjustment shall assure that the case will be submitted not more than two
				months earlier and in no event later than the date originally set on Form
				PA-8.
(d) The Medical Review Team
				will maintain a control file in order to ensure appropriate and timely
				reevaluation by the Medical Review Team. The Medical Review Team will notify
				the county welfare agency one month in advance of cases scheduled for such
				review by means of Form PA-655, Cases for Medical Review Team Reevaluation Due
				During the Month.
(e) The
				eligibility worker shall organize his or her caseload controls (notebooks,
				index, and other related materials or equipment) so that he or she will be
				alerted sufficiently in advance of redetermination review dates to enable him
				or her to obtain any specific medical information or reports requested on the
				last Form PA-8. The data and reports so submitted must be "current."
(f) When a case is to be submitted to the
				Medical Review Team for redetermination review, the eligibility worker shall
				prepare Form PA-6A, Interim Medical Social Report in detail. Form PA-6A shall
				be placed on top of all forms, reports and related data previously
				submitted.
(g) Medicaid coverage
				shall be continued, if financial and resource eligibility continues to exist,
				unless and until the CWA is advised by the Medical Review Team that the
				individual no longer meets the disability and blindness requirements or the
				individual withdraws voluntarily.
(h) Upon receipt of records from the Medical
				Review Team, the CWA shall follow the procedures as outlined in
				10:71-3.13(g).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 8 - RESPONSIBILITIES › Section 10:71-8.3 - Notice of county welfare agency decision

Current through Register Vol. 56, No. 14, July 15, 2024
The county welfare agency shall promptly notify, in writing,
				  the applicant for, or beneficiary of, Medicaid Only of any agency
				  decision.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 8 - RESPONSIBILITIES › Section 10:71-8.4 - Complaints and fair hearings

Current through Register Vol. 56, No. 14, July 15, 2024
(a) It is the right
				of every applicant for, or beneficiary of, Medicaid Only to be afforded the
				opportunity for a fair hearing in the manner established by the policies and
				procedures set forth in N.J.A.C. 10:49-10 and 10:69-6, regarding complaints and
				fair hearings (see N.J.A.C. 1:1). Complaints and fair hearings regarding
				Medicaid Only eligibility should be referred to:
Division of Medical Assistance and Health Services
Office of Legal and Regulatory Liaison
PO Box 712
Mail Code #3
Trenton, New Jersey 08625-0712
(b) In situations where an applicant or
				recipient is denied medical services to which he or she feels that he or she is
				entitled, a request for a hearing and a brief explanation of the situation
				should likewise be sent to the Office of Legal and Regulatory
				Liaison.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 8 - RESPONSIBILITIES › Section 10:71-8.5 - Fraudulent receipt of assistance

Current through Register Vol. 56, No. 14, July 15, 2024
To protect the assistance agency and the public against the
				  commission of fraud, the policies and procedures as defined in
				  10:69-9.15 through 9.20
				  (fraudulent receipt of assistance) shall apply to the Medicaid Only
				  program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 8 - RESPONSIBILITIES › Section 10:71-8.6 - Reporting criminal offenses to law enforcement authorities

Current through Register Vol. 56, No. 14, July 15, 2024
Investigation of new applications or investigations for
				  redetermination or eligibility may on occasion present indications to the CWA
				  that a crime may have been committed. In such a situation, the procedures
				  outlined in
				  10:69-9.19 through 9.20 (reporting
				  criminal offenses to law enforcement authorities) are to be followed.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 8 - RESPONSIBILITIES › Section 10:71-8.7 - Safeguarding information

Current through Register Vol. 56, No. 14, July 15, 2024
The Federal Social Security Act requires that a state must
				  provide safeguards which restrict the use or disclosure of information
				  concerning applicants and beneficiaries to purposes directly connected with the
				  administration of public assistance. Therefore, the policies and procedures
				  outlined in
				  10:69-9.8 through 9.10
				  (safeguarding information) apply to the Medicaid Only program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 8 - RESPONSIBILITIES › Section 10:71-8.8 - Nondiscrimination in public assistance programs

Current through Register Vol. 56, No. 14, July 15, 2024
Title VI of the Federal Civil Rights Act of 1964 ( Public
				  Law 88-352 ) and Section 504 of the Federal Rehabilitation Act of 1973 prohibit
				  discrimination on the ground of race, color, national origin or handicap in the
				  administration of a program for which Federal funds are received. Therefore,
				  the policies and procedures relating to those acts, as outlined in
				  10:69-9.12 through 9.14
				  (nondiscrimination) are to be strictly observed.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 9 - MEDICAL ASSISTANCE FOR THE AGED CONTINUATION › Section 10:71-9.1 - General statement

Current through Register Vol. 56, No. 14, July 15, 2024
The Medical Assistance for the Aged Continuation (MAAC)
				  provides payment for the costs of medical services for certain former
				  beneficiaries of the program of Medical Assistance for the Aged (MAA).
				  Eligibility is based on continued medical need and lack of eligibility for any
				  other program through which the cost of medical care is provided. Beneficiaries
				  receive the full spectrum of Medicaid services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 9 - MEDICAL ASSISTANCE FOR THE AGED CONTINUATION › Section 10:71-9.2 - Initial certification

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Certification
				begins for those persons and only for those persons who were in certified
				status in the MAA program at the close of business on June 30, 1982 and those
				persons that filed MAA applications on or before June 30, 1982 and whose
				eligibility was established in accordance with regulations and case
				circumstances in effect on that date. The initial certification period in MAAC
				consists of the remainder of the current MAA certification period (see
				10:71-9.4(a) 
				).
(b) Recertification: Eligible
				persons will be recertified by the CWA for such additional periods, usually for
				three months or as specified by DMAHS/MRT (see
				10:71-9.4 ).
(c) Extension of certification periods: The
				CWA will extend initial or subsequent certification periods in units of one
				month as may be necessary, pending receipt of a medical need determination from
				DMAHS/MRT and/or, if applicable, to comply with requirements for timely notice
				of adverse action (see
				10:71-8.3 ). Extensions shall not
				be made for any other reasons.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 9 - MEDICAL ASSISTANCE FOR THE AGED CONTINUATION › Section 10:71-9.3 - Termination

Current through Register Vol. 56, No. 14, July 15, 2024
Once terminated for any reason, including loss of medical
				  certifications, a case shall not be reopened under the provisions of this
				  subchapter.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 9 - MEDICAL ASSISTANCE FOR THE AGED CONTINUATION › Section 10:71-9.4 - Continuation of medical need

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Submittal of
				data to DMAHS/MRT: Thirty days prior to the end of each certification period,
				the CWA will forward to DMAHS/MRT photocopies of all forms and reports bearing
				on the individual's need for continued inpatient hospital services, skilled
				nursing home services or home health care services required by reason of an
				illness necessitating confinement at home for a prolonged period.
(b) Response by DMAHS/MRT: The DMAHS/MRT will
				review the submitted material and notify the CWA of its determination. The
				determination will specify whether continuation does or does not
				exist.
(c) CWA Action: Upon receipt
				of the DMAHS/MRT determination the CWA will, as appropriate, move to terminate
				or recertify the case for such periods as may be required to make the review
				month become the final month of the new certification period.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 9 - MEDICAL ASSISTANCE FOR THE AGED CONTINUATION › Section 10:71-9.5 - Eligibility for other programs

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Review: The CWA
				will review each MAAC case in accordance with (a)1 below for potential
				eligibility for other assistance programs through which the costs of medical
				care may be met. Those programs will not include General Assistance but will
				include such programs as SSI and Medicaid Only.
1. Review times: The CWA will conduct a
				review with respect to other program eligibility at time of initial
				certification, at the beginning of the review month, whenever any change in
				client income occurs and at the time of any change in standards of other
				appropriate programs.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 1 - INTRODUCTION › Section 10:72-1.1 - Program scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This chapter
				contains the criteria for Medicaid eligibility for certain pregnant women and
				infants not eligible under the provisions of N.J.A.C. 10:69, as well as,
				certain aged, blind and disabled persons not eligible under the provisions of
				N.J.A.C. 10:71.
1. Because the eligibility
				criteria established by the rules contained within this chapter are more
				liberal than those applicable under AFDC-related Medicaid and SSI-related
				Medicaid, pregnant women, infants, and aged, blind or disabled individuals
				losing Medicaid eligibility because of financial reasons should be evaluated
				under the provisions of this chapter for the possibility of continuing Medicaid
				eligibility.
2. Except for children
				between the ages of one and 19, persons financially ineligible for Medicaid
				under the provisions of N.J.A.C. 10:69 and 10:71 and who are income ineligible
				for Medicaid under the provisions of this chapter shall be evaluated for
				eligibility as Medically Needy under the provisions of N.J.A.C. 10:70.
i. Persons determined eligible for the
				Medically Needy Program may be also determined eligible as specified low-income
				Medicare beneficiaries.
3. Infants not eligible under the provisions
				of N.J.A.C. 10:69, 10:71 or 10:72 should be evaluated for NJ FamilyCare under
				the provisions of N.J.A.C. 10:79.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 1 - INTRODUCTION › Section 10:72-1.2 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of
				the rules contained within this chapter is to:
1. Set forth eligibility criteria for the
				Medicaid program; and
2. Specify
				the rights and responsibilities of program applicants and eligible
				persons.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 1 - INTRODUCTION › Section 10:72-1.3 - Administrative organization

Current through Register Vol. 56, No. 14, July 15, 2024
Financial eligibility for the Medicaid program is
				  administered by the county welfare agencies under the supervision of the
				  Division of Medical Assistance and Health Services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 1 - INTRODUCTION › Section 10:72-1.4 - Principles of administration

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				principles of administration apply in the Medicaid program.
1. Opportunity to make application: Any
				individual who believes he or she is eligible shall be afforded an opportunity
				to make application (or reapplication) for the Medicaid program without
				delay.
2. Primary source of
				information: Program applicants or eligible persons are the primary source of
				information concerning program eligibility. The county welfare agency shall,
				when necessary, in the process of determining eligibility, use secondary
				sources of information with the knowledge and consent of the applicant or
				eligible person.
3. Adherence to
				law and administrative policy: There shall be strict adherence to law and
				complete conformity with rules and administrative policy. Requirements other
				than those established by law or rule shall not be imposed as a condition of
				receiving assistance under the Medicaid program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 1 - INTRODUCTION › Section 10:72-1.5 - Confidentiality of information

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No member,
				officer, or employee of the county welfare agency shall produce or disclose any
				confidential information to any person except as authorized below.
1. Information considered confidential
				includes, but is not limited to, the following:
i. Names and addresses;
ii. Medical services provided;
iii. Social and economic conditions and
				circumstances;
iv. County welfare
				agency evaluation of personal information; and
v. Medical data, including diagnosis and past
				history of disease or disability.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 1 - INTRODUCTION › Section 10:72-1.6 - Materials distributed to Medicaid applicants or eligible persons

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All materials
				distributed to program applicants or eligible persons must:
1. Directly relate to the administration of
				the Medicaid program;
2. Have no
				political implications;
3. Contain
				names only of individuals directly connected with the administration of the
				Medicaid program; and
4. Identify
				those individuals only in their capacity with the State or the county welfare
				agency.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 1 - INTRODUCTION › Section 10:72-1.7 - Nondiscrimination

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Title VI of the
				Federal Civil Rights Act of 1964 ( P.L. 88-352 ) and section 504 of the
				Rehabilitation Act of 1973 ( 29 U.S.C. § 70b ) and the Americans with
				Disabilities Act, P.L.
				101-336, codified as
				42 U.S.C. §§
										12101 et seq., prohibits discrimination on
				the ground of race, color, national origin, or handicap in the administration
				of any program for which Federal funds are received. Strict compliance with the
				provisions of these Acts and any regulations based thereon is required as a
				condition to receive Federal funds for the assistance programs administered by
				the county welfare agencies. These principles apply to the Medicaid program in
				New Jersey.
1. The county welfare agency
				shall inform all staff members of their obligations in regard to the Civil
				Rights Act of 1964 and section 504 of the Rehabilitation Act of 1973.
2. All persons seeking medical assistance
				shall be informed of Title VI of the Civil Rights Act of 1964 and section 504
				of the Rehabilitation Act of 1973.
3. All persons seeking or receiving medical
				assistance shall be afforded an opportunity to file a complaint alleging
				discrimination on the ground of race, color, national origin, or handicap. Such
				complaints may be filed directly with the Regional Manager, U.S. Department of
				Health and Human Services, Office of Civil Rights, Federal Plaza, New York, New
				York 10007, or with the Director, Division of Medical Assistance and Health
				Services, PO Box 712, Trenton, New Jersey 08625-0712.
4. In any instance in which a complaint of
				alleged discrimination is filed with a State or county agency, the complaint
				shall be forwarded immediately to the Director, Division of Medical Assistance
				and Health Services. The Director, upon receipt of any such complaint, will
				take any such action he or she deems appropriate to the situation. This action
				may include, but is not limited to, the securing of reports from whatever
				sources have knowledge pertinent to the situation and referral to the Division
				of Civil Rights of the New Jersey Department of Law and Public Safety, for
				investigation, evaluation, and recommendation by that agency.
5. The county welfare agency shall afford
				full cooperation in the investigation of complaints of discrimination as may be
				requested by the Federal Department of Health and Human Services, the State
				Division of Medical Assistance and Health Services, or the State Division of
				Civil Rights.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 1 - INTRODUCTION › Section 10:72-1.8 - Assignment of medical support rights

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any person who
				applies for Medicaid, by virtue of the application for benefits, is deemed to
				have assigned to the Commissioner of the Department of Human Services any
				rights to support for the purpose of medical care as determined by a court or
				administrative order and any rights to payment for care from any third party.
				Program applicants and beneficiaries are required to cooperate in the
				identification of and the obtainment of any such rights.
1. The county welfare agency shall advise
				program applicants and beneficiaries of the terms of the assignment and the
				consequences thereto.