reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167C - PROVISION OF PHARMACEUTICAL SERVICES UNDER THE SENIOR GOLD PROGRAM › Subchapter 1 - REQUIREMENTS FOR PROVISION OF PHARMACEUTICAL SERVICES › Section 10:167C-1.23 - Eligible Senior Gold beneficiary

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An applicant
				shall be determined to be eligible for the Program only if physically present
				in New Jersey at the time of application and utilization, in accordance with
				the provisions of N.J.A.C. 10:167B.
1.
				Benefits shall not be payable for patients in nursing facilities, hospitals or
				special hospitals by the Program during any period recipients are covered for
				drug benefits by Medicaid, Medicare, Blue Cross and Blue Shield of New Jersey,
				Inc., or other insurance benefits or if such benefits are covered in the daily
				rate of the facility.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167C - PROVISION OF PHARMACEUTICAL SERVICES UNDER THE SENIOR GOLD PROGRAM › Subchapter 1 - REQUIREMENTS FOR PROVISION OF PHARMACEUTICAL SERVICES › Section 10:167C-1.24 - Senior Gold beneficiary identification

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pharmacies
				shall verify that the beneficiary is a Senior Gold covered person. This is done
				by checking the beneficiary's Senior Gold identification card or by calling the
				Recipient Eligibility Verification System (REVS) at 1-800-676-6562.
(b) The Program shall issue to all Senior
				Gold eligible beneficiaries a Validation Identification Card. The document
				shall contain the patient's name, Senior Gold identification number, effective
				date and expiration date.
(c) The
				beneficiary is eligible only for the period of time indicated on the
				identification card.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167C - PROVISION OF PHARMACEUTICAL SERVICES UNDER THE SENIOR GOLD PROGRAM › Subchapter 1 - REQUIREMENTS FOR PROVISION OF PHARMACEUTICAL SERVICES › Section 10:167C-1.25 - Point-of-sale (POS) claims adjudication system

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Senior Gold
				pharmacy claims may be submitted through a point-of-sale (POS) system and
				adjudicated by the State's fiscal agent on-line and in real-time. The POS
				system is an alternative to other methods of claim submission, including
				magnetic tape, diskette and paper claims. The pharmacist would be required to
				enter pharmacy claim detail data into a computer or POS device and transmit
				this data to the fiscal agent over a dedicated telephone line. Regardless of
				the method of claim submission, all claims will go through all New Jersey
				Medicaid Management Information System (NJMMIS) claims processing edits and the
				claims will be processed to determine their payment disposition (for example,
				paid or denied).
(b) In order for a
				Senior Gold approved pharmacy provider, in accordance with
				10:167C-1.3, to submit pharmacy
				claims through a POS system, the provider shall enter into an agreement with a
				POS intermediary or shall directly provide a similar telecommunications network
				approved by the New Jersey Division of Medical Assistance and Health Services
				(Division).
1. In order to become an approved
				POS intermediary or provider established network, a firm shall notify the
				Division at the following address:
Division of Medical Assistance and Health Services
Office of Information Systems
PO Box 712-Mail Code #4
Trenton, New Jersey 08625-0712
Telephone: (609) 588-2802
2. The Division shall send the interested
				party a summary of the program and instructions on how to submit an
				application.
3. The Division shall
				consider the following in evaluating an application:
i. The applicant's general approach and plans
				to meet the requirements of the POS project;
ii. The applicant's detailed approach and
				plans to meet the requirements of the POS project;
iii. The applicant's documented
				qualifications, expertise, and experience on similar projects;
iv. The applicant's proposed staff's
				documented qualifications, expertise, and experience on similar projects;
				and
v. The applicant's adherence to
				the requirements of CMS.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167C - PROVISION OF PHARMACEUTICAL SERVICES UNDER THE SENIOR GOLD PROGRAM › Subchapter 1 - REQUIREMENTS FOR PROVISION OF PHARMACEUTICAL SERVICES › Section 10:167C-1.26 - Prospective drug utilization review (PDUR) program

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Drug
				Utilization Review (DUR) Board was established by law on June 30, 1998 (
				P.L.
				1998, c. 41 ). A fully
				operational edit system began on December 1, 1999. The Division of Medical
				Assistance and Health Services of the Department of Human Services and the
				Department of Health have established a prospective drug utilization review
				(PDUR) program to assist pharmacy providers in monitoring drug utilization by
				Senior Gold beneficiaries. As a component of the Senior Gold POS claims
				adjudication system, the State's fiscal agent will review drug utilization
				based on claims submitted on-line and provide pharmacists with responses in
				real-time regarding utilization within PDUR standards as recommended by the DUR
				Board and approved by the Department. Similar responses related to electronic
				media claims (EMC) or paper claims processed by the New Jersey Medicaid
				Management Information System (NJMMIS) shall be received by pharmacies on the
				Remittance Advice statement.
1. PDUR
				standards developed by the DUR Board shall be based on official compendia and
				accepted medical literature and shall include, but not be limited to, those
				standards established by First Data Bank (FDB) as part of the FDB DUR
				information system. The FDB standards are incorporated herein by reference and
				may be obtained from First Data Bank, The Hearst Corp., 1111 Bayhill Drive, San
				Bruno, CA 94966.
2. PDUR standards
				shall be applied to all Senior Gold pharmacy claims, regardless of the mode of
				claim submission.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167C - PROVISION OF PHARMACEUTICAL SERVICES UNDER THE SENIOR GOLD PROGRAM › Subchapter 1 - REQUIREMENTS FOR PROVISION OF PHARMACEUTICAL SERVICES › Section 10:167C-1.27 - Medical exception process (MEP)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For pharmacy
				claims that exceed DUR Board standards, the Senior Gold program shall utilize
				the medical exception process (MEP) to allow the override of a claim denial,
				when medically necessary.
1. The MEP may be
				administered by a vendor on behalf of the Department.
2. All pharmacy claims shall be subject to
				the MEP regardless of claims media, except that claims from institutionalized
				beneficiaries shall be exempt from the PDUR and MEP until notice is issued
				otherwise.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167C - PROVISION OF PHARMACEUTICAL SERVICES UNDER THE SENIOR GOLD PROGRAM › Subchapter 1 - REQUIREMENTS FOR PROVISION OF PHARMACEUTICAL SERVICES › Section 10:167C-1.28 - Drug rebate program

Current through Register Vol. 56, No. 14, July 15, 2024
Reimbursement for legend drugs shall be limited to
				  manufacturers who have entered into a Senior Gold rebate agreement with the
				  Department of Human Services through the Division of Medical Assistance and
				  Health Services pursuant to
				  10:51-1.22.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 1 - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM › Section 10:167D-1.1 - Purpose and intent

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The intent of the Lifeline Credit Program
				is to provide a minimum supply of gas and electricity for heating, lighting,
				cooling, cooking, and other essential household usages, which have been
				determined to be necessities of life, to those residential utility customers
				whose level of income and age or disability status makes it difficult to meet
				the extraordinary and unprecedented energy costs which have been experienced in
				recent years.
(b) The intent of the
				Tenants' Lifeline Assistance Program is to afford assistance to residents who,
				by virtue of their level of income and age or disability status, would be
				eligible for the Lifeline Credit Program; but because their utility costs are
				included as part of the rental, they do not receive an individual utility bill,
				and are, therefore, ineligible for the Lifeline Credit Program, but who are
				nonetheless deserving of financial relief from burdensome energy
				costs.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 1 - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM › Section 10:167D-1.2 - Legal authority

Current through Register Vol. 56, No. 14, July 15, 2024
The New Jersey State budget for fiscal year 2004 transferred
				  the responsibility for funding the Lifeline Credit Program and the Tenants'
				  Lifeline Assistance Programs' benefits to the Board of Public Utilities (BPU).
				  Pursuant to a Memorandum of Understanding between the Department and BPU, the
				  Department shall continue to administer the Lifeline
				  Programs.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 1 - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM › Section 10:167D-1.4 - Lifeline Credit and Tenants Assistance payment

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				Lifeline Credit shall consist of a single amount established by law, which will
				be applied, on a yearly basis, to the electric and/or gas utility bills of an
				eligible residential customer. Only one credit per year is allowed per
				household, regardless of the number of eligible residential utility customers
				living in that household.
1. If the eligible
				individual is the residential utility customer of only one utility, the total
				Lifeline Credit shall be applied to the individual's utility account.
2. If the eligible individual is a
				residential electric utility customer and a residential gas utility customer,
				one-half of the total Lifeline Credit shall be applied to each one of the
				eligible individual's utility accounts.
3. When an eligible residential utility
				customer terminates service, the unused balance of the Lifeline Credit shall be
				dispersed accordingly.
i. Within 45 days of
				termination of service, the electric and/or gas utility shall apply the unused
				balance to the residential utility customer's account before any other credits
				or deposits are applied when determining the account balance due to or from the
				customer.
ii. When a residential
				utility customer changes his or her principal residence from a residential unit
				in the service territory of an electric and/or gas utility to an eligible
				residential unit within the service territory of another electric and/or gas
				utility and maintains utility service in his or her own name, the unused
				balance shall be transferred as a credit to the new account of the residential
				utility customer.
iii. In the event
				of the death of an eligible residential utility customer, the unused balance
				shall be transferred to a new account for the same residence if the new
				residential utility customer is a surviving member of the decedent's household
				and is eligible, in his or her own right, for Lifeline Credit
				benefits.
iv. The electric and/or
				gas utility shall return within 60 days of termination of service, any unused
				balance that cannot be transferred as stated in (a)3i, ii and iii above, to the
				Treasurer, State of New Jersey.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 2 - ADMINISTRATIVE ORGANIZATION › Section 10:167D-2.1 - Department of Human Services

Current through Register Vol. 56, No. 14, July 15, 2024
The Department of Human Services is the administrative unit
				  of the State government designated to administer the Lifeline Programs. As
				  provided in the "Lifeline Credit Program" and "Tenants' Lifeline Assistance
				  Program" acts, this Department is authorized to promulgate policies, rules,
				  regulations and procedures as may be deemed necessary to implement the
				  provisions of these acts.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 2 - ADMINISTRATIVE ORGANIZATION › Section 10:167D-2.2 - Lifeline Programs

Current through Register Vol. 56, No. 14, July 15, 2024
Lifeline Programs are administered by the Department, which
				  has the direct responsibility for processing applications and determining
				  eligibility for either program, reimbursing utility companies for credits
				  issued, recovering benefits improperly issued and authorizing the payment of
				  benefits.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 2 - ADMINISTRATIVE ORGANIZATION › Section 10:167D-2.3 - Agency controls

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commissioner shall establish
				operating policies to expedite the processing of applications and to assure the
				maximum possible compliance with the standards set forth in this
				manual.
(b) The Department has the
				responsibility for reviewing a sample of beneficiaries' case records to assure
				that eligibility determinations are consistent with State law and regulations.
				A quality control review of sample cases selected on a random basis shall
				include:
1. An analysis of the beneficiary's
				case record, including the application, maintained by the Department;
2. A personal interview with the
				beneficiary or the beneficiary's representative(s) to review eligibility
				information and documentation; and
3. Verification of eligibility factors
				through collateral contacts.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 2 - ADMINISTRATIVE ORGANIZATION › Section 10:167D-2.4 - Responsibilities of the utility companies

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each
				electric and gas utility shall inform each eligible residential utility
				customer of the Lifeline Credit Program when so directed by the
				Commissioner.
(b) Each electric and
				gas utility shall apply only one credit per utility account of an eligible
				residential utility customer.
(c)
				Each electric and gas utility shall recover any credits incorrectly made and
				return any such recoveries to the Treasurer, State of New Jersey, in accordance
				with the procedure set forth in
				10:167D-5.1(f)1.
(d) Each electric and gas utility shall
				return to the Treasurer, State of New Jersey, any unused balances.
(e) Each electric and gas utility shall
				maintain records of all credits made to residential utility
				customers.
(f) Each electric and
				gas utility shall transfer the Lifeline Credit balance due a residential
				utility customer to a new utility account if the residential utility customer
				moves his or her principal place of residence within that utility's service
				territory.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 2 - ADMINISTRATIVE ORGANIZATION › Section 10:167D-2.5 - Confidentiality and disclosure of information

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All
				personally identifiable information regarding applicants or beneficiaries
				obtained or maintained under the Lifeline Programs shall be confidential and
				shall not be released without the written consent of the applicant or
				beneficiary or their authorized agent.
(b) Disclosure of information without the
				consent of the applicant, beneficiary or their authorized agent shall be
				limited to purposes directly connected with the administration of the Lifeline
				Programs pursuant to State law and regulations.
(c) The prohibition of (a) above against
				unauthorized disclosure shall not be construed to prevent:
1. The release of statistical or summary data
				or information in which applicants or beneficiaries cannot be
				identified;
2. The release to the
				Attorney General or other legal representative of this State of information or
				files relating to the claim of any applicant, beneficiary or their authorized
				agent challenging the Lifeline Programs' statute, regulations or a
				determination made pursuant thereto, or against whom an action or proceeding
				for the recovery of incorrectly or illegally applied or issued benefits has
				been instituted;
3. The release of
				information to electric utilities, gas utilities, the Pharmaceutical Assistance
				to the Aged and Disabled Program, the Social Security Administration and the
				New Jersey Division of Family Development;
4. The release of information or files to the
				State Treasurer or other governmental agency or to their duly authorized
				representatives, for an audit, review of expenditures or similar activity
				authorized by law;
5. The release
				of information or files to any law enforcement authority of this State charged
				with the investigation or prosecution of violations of the criminal laws of
				this State;
6. The release of
				information to the Department of Health and participating licensed
				veterinarians for the purpose of verifying eligibility for benefits under the
				Animal Population Control Program; or
7. The release of information on files for
				the purpose of determining eligibility for the Universal Service Fund (USF)
				program and the Low Income Home Energy Assistance Program (LIHEAP) or for the
				distribution of USF or LIHEAP benefits.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 3 - APPLICATION PROCESS › Section 10:167D-3.1 - General provisions

Current through Register Vol. 56, No. 14, July 15, 2024
The application process includes all activity relating to a
				  request for an eligibility determination. The application process begins with
				  the receipt by the Department of an eligibility application and continues in
				  effect until there is an official disposition of the request by the
				  Department.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 3 - APPLICATION PROCESS › Section 10:167D-3.2 - Authorized agent

Current through Register Vol. 56, No. 14, July 15, 2024
(a)In those instances where the applicant is
				incompetent or incapable of filing an eligibility application on his or her own
				behalf, the Department shall recognize any of the following persons listed in
				order of priority, as an authorized agent for the purpose of initiating such
				application:
1. Power of attorney;
2. A close relative by blood or marriage;
				such as parent, spouse, son, daughter, brother or sister;
3. A representative payee designated by the
				Social Security Administration;
4.
				A staff member of a public or private social service agency, of which the
				person is a client, who has been designated by the client to so act;
5. A friend.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 3 - APPLICATION PROCESS › Section 10:167D-3.3 - Responsibilities in the application and renewal process

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Pursuant to statutory authority,
				N.J.S.A.
				48:2-29.31, the Department shall establish
				procedures on the application process consistent with law and supervise the
				operation with the policy and procedures so established.
(b) The Department, through a Memorandum of
				Understanding with BPU, has responsibility in the application process to:
1. Explain the purposes and eligibility
				requirements of the Lifeline Programs and indicate the applicant's rights and
				responsibilities under their provisions;
2. Process applications;
3. Certify to the Treasurer, State of New
				Jersey, the names of eligible tenants;
4. Notify the utility companies of eligible
				applicants and the amount of credit to be applied to their accounts;
				and
5. Maintain eligibility
				applications and supporting documents for audit purposes.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 4 - ELIGIBILITY › Section 10:167D-4.1 - Eligibility requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) To be eligible
				for the Lifeline Credit Program, an individual shall be a resident and the
				residential utility customer each year or the spouse of a residential utility
				customer and satisfy one of the following criteria:
1. Be a Pharmaceutical Assistance to the Aged
				and Disabled (PAAD) program beneficiary or determined to be eligible for PAAD
				benefits; or
2. Meet the residency,
				income, and age or disability requirements of the PAAD program but apply for
				Lifeline Credit Program only.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 4 - ELIGIBILITY › Section 10:167D-4.2 - Income standards

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any single permanent resident of New
				Jersey who is 65 years of age or older or who is between 18 and 65 and is
				receiving Social Security Title II disability benefits must have an annual
				income of less than $ 28,769 to be eligible for the Lifeline
				Programs.
(b) Any married permanent
				resident of New Jersey who is 65 years of age or older or who is between 18 and
				65 and is receiving Social Security Title II disability benefits, and his or
				her spouse, must have a combined annual income of less than $ 35,270 to be
				eligible for the Lifeline Programs.
1. An
				applicant and spouse shall be considered separated when each maintains a
				separate residence and the applicant does not have access to or receive support
				from the spouse's income.
i. Any support
				payment received by the applicant, for the sole benefit of the applicant, shall
				be considered as income for eligibility purposes.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 4 - ELIGIBILITY › Section 10:167D-4.3 - Residency requirement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Only residents
				of this State shall be eligible for the Lifeline Programs.
(b) The applicant must be able to
				substantiate residence upon request by the Department, and is required to
				submit copies of two documents showing evidence of current residence at the
				time of application. The following are examples of proof of residence:
1. Motor vehicle records, such as a valid
				driver's license;
2. Landlord's
				records and rent receipts;
3.
				Public utility records and receipts, such as an electric bill;
4. Personal property assessment
				records;
5. Records of professional
				people or businesses, such as doctors and department stores;
6. Post office records;
7. Records of social agencies, public or
				private; and
8. Employment
				records.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 4 - ELIGIBILITY › Section 10:167D-4.4 - Age

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The applicant who is 65 years of age or
				older must be able to document his or her age upon request of the Department.
				The applicant must submit a copy of one of the following acceptable proofs of
				age:
1. Birth certificate;
2. Baptismal certificate;
3. Bris certificate;
4. Social Security records verifying age,
				which can be obtained from the local Social Security office; or
5. Railroad Retirement letter, which can be
				obtained from the Railroad Retirement Board.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 4 - ELIGIBILITY › Section 10:167D-4.5 - Citizenship

Current through Register Vol. 56, No. 14, July 15, 2024
A person shall not be required to be a citizen of the United
				  States in order to be eligible for the Lifeline Programs.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 4 - ELIGIBILITY › Section 10:167D-4.6 - Disability

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The applicant who is between 18 and 65
				years of age and is receiving Social Security Title II disability benefits must
				be able to document his or her Social Security disability determination upon
				request of the Department. The applicant must submit a copy of one of the
				following documents:
1. Social Security Award
				Certification issued by the Social Security Administration within the last six
				months of application; or
2. A
				document issued by the Social Security Administration, which establishes
				Medicare eligibility and is dated within six months of the date of the
				application.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 4 - ELIGIBILITY › Section 10:167D-4.7 - Utility information

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A residential utility customer shall
				submit documentation of his or her utility account(s) to the Department before
				a Lifeline Credit will be applied to his or her account.
1. A residential utility customer shall
				submit a copy of his or her most recent electric and/or gas bill or statement.
				The utility statement must be made out in the applicant's or spouse's
				name.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 4 - ELIGIBILITY › Section 10:167D-4.8 - Eligibility applications

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department
				shall mail a Lifeline Programs application to all Medical Assistance to the
				Aged, Medicaid Only beneficiaries and New Jersey Care Special Medicaid Program
				beneficiaries, except for those residing in nursing facilities, who are
				eligible each year. There shall be only one application for those beneficiaries
				who apply for both PAAD and the Lifeline Programs.
(b) When an individual meets the residency,
				income, age, or disability requirements of the PAAD program and is not an SSI
				beneficiary and wishes to apply for the Lifeline Programs only, the individual
				shall complete the required application and return it to the
				Department.
(c) When necessary, the
				Department shall mail preprinted forms to those beneficiaries who met the
				qualifications for the Lifeline Programs only in the previous year and received
				benefits.
(d) When the Department
				receives the completed application form, the Department will determine whether
				the beneficiary is eligible for the Lifeline Programs and authorize credit or
				payment accordingly.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 4 - ELIGIBILITY › Section 10:167D-4.9 - Social Security Account Number

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each applicant
				must include his or her Social Security Account Number (SSAN) on the
				application form. The SSAN, a unique and verifiable number, is utilized to
				differentiate between persons with the same name. Married persons must also
				indicate the SSAN of their spouse.
(b) In the event that the applicant does not
				have a SSAN, a unique identifying number will be assigned by the Department.
				This number will be used to uniquely identify the beneficiary.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 4 - ELIGIBILITY › Section 10:167D-4.10 - Certification

Current through Register Vol. 56, No. 14, July 15, 2024
The applicant must certify that all answers to the questions
				  and items on the application form are true and accurate to the best of his or
				  her knowledge. This certification shall be dated, signed or marked by the
				  applicant and spouse, if married, and the preparer of the form, if other than
				  the applicant, before the application can be processed.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 4 - ELIGIBILITY › Section 10:167D-4.11 - Authorization

Current through Register Vol. 56, No. 14, July 15, 2024
(a) By signing or marking the certification
				and authorization statement on the application form, the applicant authorizes:
1. The Department to verify any information
				on the form by contacting the Social Security Administration, the Internal
				Revenue Service, the New Jersey Division of Taxation, employers and others as
				the need arises; and
2. Visitation
				and review by representatives of the Department.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 4 - ELIGIBILITY › Section 10:167D-4.12 - Eligibility period

Current through Register Vol. 56, No. 14, July 15, 2024
A Lifeline Credit shall be applied to the account(s) of a
				  residential utility customer and remain on the account until it is used or the
				  account is terminated. See
				  N.J.A.C.
				  10:167D-1.4.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 4 - ELIGIBILITY › Section 10:167D-4.13 - Appeal process

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When the Department determines that an
				applicant is ineligible for benefits, the applicant has the right to appeal the
				decision by submitting a written request for a fair hearing to the Lifeline
				Credit Program, Department of Human Services, PO Box 722, Trenton, NJ
				08625-0722, within 30 calendar days from the date of mailing of the notice of
				ineligibility. The document must clearly state the valid basis for such a
				request.
(b) The Department will
				forward the hearing request to the Office of Administrative Law, which will
				schedule the hearing and notify all parties of the date, time and location,
				pursuant to the New Jersey Administrative Procedure Act,
				N.J.S.A.
				52:14B-1 et seq.
(c) The petitioner will have the burden of
				demonstrating that the Department's determination deviates from the
				requirements and standards of the regulations and statute.
(d) When the petitioner requests a fair
				hearing, they shall clearly indicate the existence of a disputed question of
				fact or law arising from the requirements and standards of the rules and
				statutes of the Lifeline Programs. If the petitioner fails to establish a
				contested case, the Department shall deny the hearing request.
Appendix
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New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167D - LIFELINE CREDIT PROGRAM/TENANTS LIFELINE ASSISTANCE PROGRAM MANUAL › Subchapter 5 - RECOVERIES › Section 10:167D-5.1 - Benefits incorrectly paid

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department
				shall take all necessary action to recover the Tenants Assistance payments
				incorrectly or illegally made or the Lifeline Credit incorrectly or illegally
				applied, on behalf of an electric and/or gas utility customer, from the
				residential utility customer and any party or parties whose action or inaction
				resulted in the incorrect payment or from their respective estates, as the case
				may be. The action shall include, but is not limited to:
1. Requesting the Attorney General to
				commence civil actions;
2. Reducing
				subsequent benefits from the Lifeline Programs to which the beneficiary may be
				entitled;
3. Reducing New Jersey
				State income tax refunds to which the beneficiary may be entitled;
				and
4. Reducing New Jersey
				Homestead Rebates to which the beneficiary may be entitled.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 1 - GENERAL PROVISIONS › Section 10:167E-1.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this chapter, Hearing Aid
				Assistance to the Aged and Disabled (HAAAD), is to provide a payment of up to $
				100.00 in a calendar year in which a hearing aid is purchased to offset the
				cost of the hearing aid for individuals who meet the age or disability, income
				and residency requirements of the Pharmaceutical Assistance to the Aged and
				Disabled (PAAD) Program.
(b) This
				chapter has been developed as a statement of policy and procedures and is
				applicable only to eligibility for the HAAAD Program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 1 - GENERAL PROVISIONS › Section 10:167E-1.2 - Legal authority

Current through Register Vol. 56, No. 14, July 15, 2024
The New Jersey Program of Hearing Aid Assistance to the Aged
				  and Disabled (HAAAD) is established by Chapter 298, Laws of 1987 (N.J.S.A.
				  30:4D-36 et seq.), effective February 4,
				  1988.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 2 - DEFINITIONS › Section 10:167E-2.1 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this chapter,
				  shall have the following meanings, unless the context clearly indicates
				  otherwise.
"Annual income" means all income from whatever source
				  derived, actually received or anticipated.
"Applicant" means an individual who applies for HAAAD, either
				  personally or through an authorized agent.
"Beneficiary" means an individual who has been found eligible
				  for HAAAD benefits.
"Calendar year" means a year beginning January 1 and ending
				  December 31. "Calendar year" is the base period utilized to determine annual
				  income and HAAAD eligibility.
"Commissioner" means the Commissioner of the Department of
				  Human Services.
"Department" means the Department of Human Services.
"Resident" means a person legally domiciled within the State
				  of New Jersey for a period of 30 days immediately preceding the date of
				  application for inclusion in the HAAAD program. Mere seasonal or temporary
				  residence within the State, of whatever duration, does not constitute
				  domicile.
"Special needs trust" means a trust containing the assets of
				  a disabled individual that is established for the sole benefit of the
				  individual by a parent, grandparent, legal guardian or court prior to the time
				  the individual reaches the age of 65. (See
				  10:167E-2.2 for
				  provisions.)
"Viatical settlement" means the sale or cashing in of a life
				  insurance policy prior to the death of the insured, due to the fact that the
				  insured has experienced a catastrophic, life-threatening or chronic illness or
				  condition.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 3 - ADMINISTRATIVE ORGANIZATION › Section 10:167E-3.1 - Department of Human Services

Current through Register Vol. 56, No. 14, July 15, 2024
The Department of Human Services is the administrative unit
				  of the State government which has control over the administration of HAAAD.
				  Under the terms of the HAAAD law, the Department is responsible for the general
				  policies, governing administration of HAAAD, and for effecting the issuance of
				  rules and procedures in accordance with the Administrative Procedure Act,
				  52:14B-1 et seq., for implementing
				  the statutory provisions.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 3 - ADMINISTRATIVE ORGANIZATION › Section 10:167E-3.2 - Pharmaceutical Assistance to the Aged and Disabled

Current through Register Vol. 56, No. 14, July 15, 2024
Pharmaceutical Assistance to the Aged and Disabled (PAAD) is
				  the unit which has the direct responsibility for the processing of eligibility
				  applications and for authorizing payment of HAAAD benefits.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 3 - ADMINISTRATIVE ORGANIZATION › Section 10:167E-3.3 - Agency controls

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				Commissioner shall establish operating policies to expedite the processing of
				applications and to assure the maximum possible compliance with the standards
				set forth in this chapter.
(b) The
				Department of Human Services, Division of Medical Assistance and Health
				Services, has the responsibility for investigating beneficiaries in matters
				involving potential fraud and/or abuse.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 4 - APPLICATION PROCESS › Section 10:167E-4.1 - General provisions

Current through Register Vol. 56, No. 14, July 15, 2024
The application process includes all activity relating to a
				  request for eligibility determination. The application process begins with the
				  receipt by the Department of an eligibility application and continues in effect
				  until there is an official disposition of the request by the Department.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 4 - APPLICATION PROCESS › Section 10:167E-4.2 - Authorized agent

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In those instances where the applicant is
				incompetent or incapable of filing an eligibility application on his or her own
				behalf, the Department shall accept any one of the following, listed in the
				order of priority, as an authorized agent for the purpose of initiating such
				application:
1. Power of attorney;
2. A close relative by blood or marriage,
				that is, parent, spouse, son, daughter, brother, sister;
3. A representative payee designated by the
				Social Security Administration;
4.
				A staff member of a public or private social service agency, of which the
				person is a client, who has been designated by the agency to so act;
				or
5. A friend.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 4 - APPLICATION PROCESS › Section 10:167E-4.3 - Responsibilities in the application process

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				Department, through PAAD, establishes procedures on the application process
				consistent with law and supervises the operation with the policy and procedures
				so established.
(b) PAAD has
				responsibility in the application process to:
1. Explain the purposes and eligibility
				requirements of the program and indicate the applicant's rights and
				responsibilities under its provisions;
2. Process the PAAD and HAAAD
				applications;
3. Certify for the
				Treasurer, State of New Jersey, the names of eligible residents and authorize
				the payment of HAAAD benefits; and
4. Maintain eligibility applications and
				supporting documents for audit purposes.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 5 - ELIGIBILITY REQUIREMENTS › Section 10:167E-5.1 - Age

Current through Register Vol. 56, No. 14, July 15, 2024
(a) To be eligible for HAAAD, the applicant
				must be 65 years of age or older or must be between 18 and 65 and receiving
				Social Security Title II disability benefits. Individuals under age 65 who
				receive disability benefits on behalf of someone other than themselves are
				ineligible. The applicant shall be able to document his or her age upon request
				by the Department. The Department shall require that the applicant submit a
				photocopy of his or her birth certificate or other acceptable proof of age if
				over 65 years of age.
(b) The
				following are acceptable proofs of age:
1.
				Primary proof: The applicant is required to submit a photocopy of one of the
				following documents:
i. Birth
				certificate;
ii. Baptismal
				certificate;
iii. Bris
				certificate;
iv. Social Security
				records verifying age, which can be obtained from local Social Security office;
				or
v. Railroad retirement letter,
				which can be obtained from Railroad Retirement Board.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 5 - ELIGIBILITY REQUIREMENTS › Section 10:167E-5.2 - Income standards

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any single permanent resident of New
				Jersey who is 65 years of age or older or who is between 18 and 65 and is
				receiving Social Security Title II disability benefits must have an annual
				income of less than $ 28,769 to be eligible for HAAAD.
(b) Any married permanent resident of New
				Jersey who is 65 years of age or older or who is between 18 and 65 and is
				receiving Social Security Title II disability benefits, and his or her spouse,
				must have a combined annual income of less than $ 35,270 to be eligible for
				HAAAD.
1. An applicant and spouse shall be
				considered separated, and eligibility determined under the single income
				standard, when each maintains a separate residence and the applicant does not
				have access to the spouse's income.
i. Any
				support payment received by the applicant for the sole benefit of the applicant
				shall be considered as income for HAAAD eligibility purposes.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 5 - ELIGIBILITY REQUIREMENTS › Section 10:167E-5.3 - Citizenship and residence

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A person shall
				not be required to be a citizen of the United States in order to be eligible
				for HAAAD.
(b) Any resident of this
				State shall be eligible for HAAAD (see
				10:167E-2.1 ).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 5 - ELIGIBILITY REQUIREMENTS › Section 10:167E-5.4 - Recipient of other assistance and hearing aid coverage

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any person
				shall be ineligible for HAAAD if he or she is otherwise qualified for
				assistance for the New Jersey Title XIX (Medicaid) program.
(b) If an otherwise eligible person's hearing
				aid costs are covered in whole by any other State or Federal government program
				or insurance contract, the person is not eligible for hearing aid assistance
				under these rules. If an eligible person's hearing aid costs are covered in
				part by any other State or Federal government program or insurance contract,
				the person may be entitled to receive reduced hearing aid assistance. HAAAD
				will pay full client liability up to $ 100.00. The program will recover from
				the third party payor in cases where an applicant has partial coverage and
				total client out-of-pocket expense is less than $ 100.00.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 5 - ELIGIBILITY REQUIREMENTS › Section 10:167E-5.5 - Certification

Current through Register Vol. 56, No. 14, July 15, 2024
The applicant for HAAAD benefits must sign a certification
				  that all the answers to the questions and items on the application form are
				  true and accurate to the best of his or her knowledge.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 5 - ELIGIBILITY REQUIREMENTS › Section 10:167E-5.6 - Authorization

Current through Register Vol. 56, No. 14, July 15, 2024
By signing or marking the certification and authorization
				  statement on the application form, the applicant authorizes assignment of
				  benefits to the State of New Jersey if he or she or his or her spouse has any
				  other plan of assistance or insurance that covers, at least in part, the cost
				  of hearing aids.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 5 - ELIGIBILITY REQUIREMENTS › Section 10:167E-5.7 - Eligibility period

Current through Register Vol. 56, No. 14, July 15, 2024
A person eligible for HAAAD is entitled to receive a payment
				  of up to $ 100.00 in a calendar year. Only one benefit may be issued in the
				  period between January 1 and December 31 of any year.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 5 - ELIGIBILITY REQUIREMENTS › Section 10:167E-5.8 - Recoveries for benefits incorrectly paid

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department
				may take all necessary action to recover the cost of benefits incorrectly paid
				on behalf of a beneficiary.
1. The term
				"incorrect payment" includes, but is not limited to:
i. Payment made on behalf of a beneficiary
				whose hearing aid costs are wholly covered by another source;
ii. Payment made on behalf of a beneficiary
				who is no longer eligible, or has been incorrectly determined to be eligible to
				receive benefits; and
iii. Payment
				made as a result of fraud perpetrated by a beneficiary, his or her authorized
				agent and/or provider;
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 167E - HEARING AID ASSISTANCE TO THE AGED AND DISABLED › Subchapter 5 - ELIGIBILITY REQUIREMENTS › Section 10:167E-5.9 - Appeal process

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When PAAD determines that an applicant is
				ineligible for HAAAD benefits, the applicant has the right to appeal the
				decision by submitting a written request for a fair hearing to Pharmaceutical
				Assistance to the Aged and Disabled, Department of Human Services, PO Box 715,
				Trenton, New Jersey 08625-0715, within 30 calendar days from the date of
				mailing of the notice of ineligibility. The document must clearly state the
				valid basis for such a request.
(b)
				PAAD shall forward the hearing request to the Office of Administrative Law,
				which will schedule the hearing and notify all parties of the date, time, and
				location.
(c) The petitioner shall
				have the burden of demonstrating that PAAD's determination deviates from the
				requirements and standards of the regulations and statute.