reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 8 - BREAST AND CERVICAL CANCER PREVENTION AND TREATMENT ACT SERVICES › Section 10:72-8.6 - Redetermination of eligibility

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A
				redetermination of medical eligibility shall be made every six months, and
				shall be based upon the need for continuing treatment for breast or cervical
				cancer, as determined by the individual's treating physician. Continuing
				treatment shall not include routine monitoring services. The treating physician
				shall complete a form provided for the purpose of certifying the continuing
				need for treatment and shall send the form to the county board of social
				services in the beneficiary's county of residence.
(b) The individual beneficiary shall provide,
				or shall assist in providing, information as requested by the county board of
				social services in order to determine continuing medical eligibility. Medical
				eligibility will be evaluated every six months.
(c) The county board of social services will
				assess non-financial eligibility factors every 12 months.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 9 - NJ WORKABILITY › Section 10:72-9.1 - Purpose, scope and applicability

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of
				this subchapter is to establish requirements to implement the NJ WorkAbility
				program in accordance with
				30:4D-1 et seq., as amended by
				P.L.
				2000, c. 116, and in
				accordance with the Federal Ticket to Work and Work Incentives Improvement Act,
				Public Law
				106-170 (113 Stat. 1860), and
				42 U.S.C. §
										1396a(a)(10)(A)(ii)(XV). The
				purpose of the NJ WorkAbility program is to provide an opportunity for disabled
				individuals who are employed to purchase Medicaid coverage when their earnings
				would otherwise disqualify them for Medicaid.
(b) The rules apply to employed,
				permanently-disabled individuals residing in New Jersey who are between the
				ages of 16 and 64 whose countable earned incomes are below 250 percent, and
				countable unearned incomes below 100 percent, of the Federal poverty level for
				an individual or a couple. These individuals may apply to purchase Medicaid
				coverage (Medicaid buy-in) from the State of New Jersey, and shall pay for such
				coverage based on the standards contained in this subchapter.
(c) Unless specifically excepted, all other
				requirements of this chapter shall apply to the NJ WorkAbility
				program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 9 - NJ WORKABILITY › Section 10:72-9.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this subchapter,
				  shall have the following meanings, unless the context clearly indicates
				  otherwise.
"Applicant" means any person who has made application for
				  purposes of becoming a "qualified applicant."
"Commissioner" means the Commissioner of the Department of
				  Human Services.
"Countable income" means both earned and unearned income
				  after disregards are taken in accordance with this subchapter.
"Department" means the Department of Human Services.
"Director" means the Director of the Division of Medical
				  Assistance and Health Services.
"Division" means the Division of Medical Assistance and
				  Health Services.
"Medicaid" means the New Jersey Medical Assistance and Health
				  Services program.
"Medical assistance" means payments made on behalf of
				  beneficiaries to providers for medical care and services.
"Provider" means any person, public or private institution,
				  agency or business concern approved by the Division in accordance with N.J.A.C.
				  10:49, lawfully providing medical care, services, goods and supplies which are
				  specified in this subchapter and holding, where applicable, a current valid
				  license to provide such services or to dispense such goods or supplies.
"Qualified applicant" means a person who is a resident of
				  this State who meets the requirements contained in this subchapter.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 9 - NJ WORKABILITY › Section 10:72-9.3 - Non-financial eligibility for NJ WorkAbility

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Permanently
				disabled employed individuals who are 16 years of age or over, but under 65
				years of age, shall be eligible to participate in the NJ WorkAbility
				program.
(b) Either the Social
				Security Administration or the Division's Disability Review Team may make the
				determination of permanent disability.
(c) The test of disability shall be identical
				to the SSI/SSDI disability test, except that employment activity, earnings and
				substantial gainful activity shall not be considered in determining whether the
				individual meets the definition of disability.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 9 - NJ WORKABILITY › Section 10:72-9.4 - Income eligibility for NJ WorkAbility

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The earned
				income of a qualified applicant, after disregards, shall not exceed 250 percent
				of the Federal poverty level for a family unit of one or two, as
				applicable.
(b) The unearned income
				of a qualified applicant, after disregards, shall not exceed 100 percent of the
				Federal poverty level for a family unit of one or two, as applicable.
(c) Countable income for NJ WorkAbility
				individuals shall be determined in accordance with the income rules found at
				N.J.A.C. 10:71-5. All rules at N.J.A.C. 10:71-5 shall apply, with the following
				exceptions:
1. The disregard of cost-of-living
				increases in Social Security benefits provided for in
				10:71-5.3(a)7  x
				and xi shall not apply.
2. The
				deeming of the income of an alien's sponsor as provided for at
				10:71-5.7 shall not
				apply.
3. Wages paid by the U.S.
				Census Bureau for temporary employment related to Census 2000 activities shall
				not be counted as income.
4. Social
				Security Disability benefits and Railroad Disability benefits received by the
				individual on his or her own account shall not be counted as income.
5. Nonrecurring lump sum income received by
				the household unit of a disabled individual shall be counted as income in the
				month received and any portion retained shall be counted as a resource in
				subsequent months.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 9 - NJ WORKABILITY › Section 10:72-9.5 - Resource eligibility for NJ WorkAbility

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Qualified
				applicants for NJ WorkAbility shall meet resources eligibility standards as
				defined in N.J.A.C. 10:71-4 in order to be eligible for benefits under this
				chapter.
(b) In the determination
				of countable resources,
				10:71-4.2 shall apply.
(c) Eligibility shall not exist in any month
				in which the countable resources of a NJ WorkAbility person exceeds the limits
				of $ 20,000 for an individual and $ 30,000 for a couple.
(d) The spouse-to-spouse and parent-to-child
				deeming of resources found at
				10:71-4.6 shall apply to
				eligibility for NJ WorkAbility. In the deeming of resources from one parent to
				a child, the countable parental resources in excess of the Medicaid Only
				resource limit for an individual shall be deemed to the blind or disabled
				child. When the resources of two parents shall be deemed to a child, the
				countable parental resources in excess of the Medicaid Only resource limit for
				a couple shall be deemed to the child.
(e) In addition to those resources excluded
				under 10:71-4.4, funds in an IRA, 401K
				or other retirement accounts shall also be excluded.
(f) The provisions at
				10:71-4.6(f) 
				requiring the deeming of resources of an alien's sponsor shall not
				apply.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 9 - NJ WORKABILITY › Section 10:72-9.6 - Premium payments

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An eligible
				individual with countable income in excess of 150 percent of the Federal
				poverty level shall pay a premium of $ 25.00 per month to the
				Division.
(b) An eligible couple
				with countable income in excess of 150 percent of the Federal poverty level
				shall pay a premium of $ 50.00 per month to the Division.
(c) Premium payments required shall be
				submitted each month to:
Division of Medical Assistance and Health Services
NJ WorkAbility--Premiums
PO Box 712, Mail Code #27
Trenton, New Jersey 08625-0712
(d) Participants shall be billed in advance
				of the coverage month. Failure to submit the full contribution shall result in
				termination of coverage for the month following the coverage month where the
				premium has not been received by the NJ WorkAbility program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 9 - NJ WORKABILITY › Section 10:72-9.7 - Services available through the NJ WorkAbility program

Current through Register Vol. 56, No. 14, July 15, 2024
Services available through the NJ WorkAbility program shall
				  be provided by the Division through its existing contracts with health
				  maintenance organizations and fee-for-service providers.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 9 - NJ WORKABILITY › Section 10:72-9.8 - Application process

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Applications
				shall be obtained from, and returned to, the county board of social services in
				the applicant's county of residence.
(b) Information can be obtained from the
				Division of Disability Services by calling toll free 1-888-285-3036 or at the
				address below.
Division on Disability Services
DHS-Capital Place I
PO Box 700, 1st Floor
Trenton, NJ 08625-0700
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 10:73-1.1 - Chapter purpose and organization

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This chapter
				outlines information about targeted case management services provided by
				approved New Jersey Medicaid/NJ FamilyCare program providers.
(b)N.J.A.C. 10:73-2 describes the Case
				Management Program/Mental Health for Adults, providing a description of the
				individuals for whom the services are targeted; the case management services
				covered; the requirements and responsibilities of the agencies that will
				provide the services, including agency staff; and the procedures required to
				provide services and the reimbursement for the provision of those
				services.
(c) N.J.A.C.
				10:73-3describes the Care Management Organization services component provided
				under the Department of Children and Families' Children's System of Care
				(CSOC). The subchapter describes the target population to be served; services
				provided; and the requirements and responsibilities of the provider, including,
				but not limited to, the organizational structure, staffing, procedures,
				reporting requirements, monitoring, evaluation, and reimbursement
				requirements.
(d) N.J.A.C.
				10:73-4describes Youth Case Management services provided by the Division of
				Medical Assistance and Health Services under the auspices of the Department of
				Children and Families' Children's System of Care (CSOC), and provides a
				description of what is included in the services; the requirements and
				responsibilities of the providers rendering the services; beneficiary
				eligibility; and the reimbursement for the provision of those
				services.
(e)N.J.A.C. 10:73-5
				provides a listing of the Centers for Medicare & Medicaid Services
				Healthcare Common Procedure Coding System (HCPCS) Procedure Codes.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 2 - ADULT CASE MANAGEMENT PROGRAM/MENTAL HEALTH (CMP/MH) › Section 10:73-2.1 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this subchapter,
				  shall have the following meanings, unless the context indicates
				  otherwise:
"Adult" means any individual over age 21, or an individual
				  over age 18 who did not receive services from the Department of Children and
				  Families' child-serving systems, including, but not limited to, the Children's
				  System of Care, prior to their 18th birthday.
"Clinical case management" means the provision of
				  face-to-face individualized clinical support services to adult Medicaid/NJ
				  FamilyCare beneficiaries, in accordance with
				  10:73-2.11, for a beneficiary who
				  needs consistent contact to ensure that the beneficiary remains:
1. Engaged with the case manager;
2. Stable in his or her individual situation; and
3. Linked to needed services.
"Ongoing support services" means the provision of
				  face-to-face individualized clinical support services for a beneficiary who
				  needs such contact, as determined in accordance with
				  10:73-2.4(a)5.
"Risk category" means the three levels of clinical case
				  management involvement, based upon assessed risk of hospitalization, functional
				  level and willingness and/or ability to access needed services. The three risk
				  categories are: high-risk, or intensive case management; at-risk, or supportive
				  case management; and low-risk, or maintenance level case management.
"Service provider monitoring" means the process of routine
				  follow-up by a case manager or by the Division of Mental Health and Addiction
				  Services with the beneficiary's service providers to assess whether services
				  have been provided as planned and whether such services meet the beneficiary's
				  needs, in accordance with
				  N.J.A.C.
				  10:73-2.4(a)4.
"Targeted case management" under Case Management
				  Program/Mental Health (CMP/MH) means the provision of services targeted to
				  adults with serious mental illness who are at high risk of hospitalization or
				  deterioration in their functioning and who require an assertive community
				  outreach service to meet their needs. Targeted case management services
				  include, but are not limited to: assessment, service planning, services
				  linkage, ongoing monitoring, ongoing clinical support and advocacy.
"Unit of service," for the purposes of this subchapter, means
				  a continuous face-to-face contact with an enrolled beneficiary, or on behalf of
				  an enrolled beneficiary, which lasts 15 minutes, not including travel
				  time.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 2 - ADULT CASE MANAGEMENT PROGRAM/MENTAL HEALTH (CMP/MH) › Section 10:73-2.2 - Adult Case Management Program/Mental Health (CMP/MH); general

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				CMP/MH is under the auspices of the Division of Mental Health and Addiction
				Services (DMHAS) and is administered jointly with the Division of Medical
				Assistance and Health Services, in accordance with N.J.A.C. 10:37, the DMHAS
				Community Mental Health Services rules, N.J.A.C. 10:49, and this chapter. The
				CMP/MH is a program that provides case management services to seriously
				mentally ill adult Medicaid/NJ FamilyCare beneficiaries who do not accept, or
				engage in, community mental health programs and/or who have multiple service
				needs and require extensive coordination.
(b) Case management services shall not be
				available to beneficiaries of the Medically Needy Program, except pregnant
				women, or to beneficiaries served in the Department's Home and Community Based
				Services Waiver Program, Community Resources for People with Disabilities
				Waiver Program, DDD Waiver, Traumatic Brain Injury Waiver or the Home Care
				Expansion Program.
1. For information on how
				to identify a Medicaid/NJ FamilyCare beneficiary, refer to N.J.A.C. 10:49-2,
				Administration.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 2 - ADULT CASE MANAGEMENT PROGRAM/MENTAL HEALTH (CMP/MH) › Section 10:73-2.3 - Individuals targeted to receive adult CMP/MH services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Clinical case
				management services under CMP/MH are targeted to adults with serious mental
				illness who are at high risk of hospitalization or deterioration in their
				functioning and who require an assertive community outreach service to meet
				their needs. This targeted group is composed of individuals who meet at least
				two of the following criteria:
1. Have
				repeated admissions to inpatient services. Priority will be given to persons
				with two or more admissions to inpatient psychiatric services within a 12-month
				period, or two or more uses of emergency/screening services within a 30-day
				time period;
2. Participate in
				mental health services, but are not receiving additional services which meet
				the individual's multiple needs, and who require extensive service coordination
				(for example, individuals who are dually diagnosed as mentally ill and chemical
				abusing);
3. Have a recent history
				of being a danger to self or others within a time period of three
				months;
4. Have a history of
				resistance or non-compliance in use of medication, resulting in a pattern of
				decompensation and rehospitalization;
5. Are in another service system and in need
				of assessment and possible treatment prior to linkage to case management (for
				example, residential, drug and alcohol programs, or shelters for the
				homeless);
6. Reside with family,
				in boarding homes, or other residential settings and are not receiving needed
				mental health services;
7. Recently
				were discharged from a State or county psychiatric hospital or a general
				acute-care hospital psychiatric inpatient unit and are in need of linkage
				services to ensure continuity of care with other mental health services;
				and/or
8. Have a recent history of
				a hospitalization as a result of mental illness and dangerousness to self or
				others.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 2 - ADULT CASE MANAGEMENT PROGRAM/MENTAL HEALTH (CMP/MH) › Section 10:73-2.5 - Provider enrollment requirements for providers participating in adult CMP/MH

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This section lists the specific
				provisions relevant to a provider who wishes to apply and be approved as a
				provider of CMP/MH services.
				10:73-2.6 provides information
				about service responsibilities of the CMP/MH provider and
				10:73-2.7 describes the
				responsibilities of staff members of a CMP/MH provider agency.
(b) Any agency providing CMP/MH services
				shall first be certified by the Division of Mental Health and Addiction
				Services (DMHAS), shall be under contract as an approved clinical case
				management provider and shall be individually approved as a Medicaid/NJ
				FamilyCare provider by the New Jersey Medicaid/NJ FamilyCare program.
(c) Case management providers under CMP/MH
				shall comply with Medicaid/NJ FamilyCare program rules regarding provider
				participation (see
				N.J.A.C.
				10:49-3.1). Provider entities shall be mental
				health provider organizations that contract with the New Jersey Division of
				Mental Health and Addiction Services in accordance with the Community Mental
				Health Services Act rules, N.J.A.C. 10:37, to provide clinical case management
				services.
(d) Upon notification
				from DMHAS of the completion of the certification of, and contract with, a
				CMP/MH provider, the New Jersey Medicaid/NJ FamilyCare program will forward the
				appropriate provider enrollment forms to the provider. (See
				N.J.A.C.
				10:49-3.1, Eligible providers)
(e) The CMP/MH provider will receive written
				notification of approval or disapproval from the Division of Medical Assistance
				and Health Services.
1. If approved, the
				CMP/MH provider will be assigned a provider number by the Medicaid/NJ
				FamilyCare fiscal agent; and
2. The
				New Jersey Medicaid/NJ FamilyCare program will furnish a provider manual (which
				includes this chapter, other relevant chapters including N.J.A.C. 10:49 and
				additional non-regulatory material).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 2 - ADULT CASE MANAGEMENT PROGRAM/MENTAL HEALTH (CMP/MH) › Section 10:73-2.6 - Service responsibilities of the adult CMP/MH provider

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The CMP/MH
				provider rendering services to adults shall:
1. Provide ongoing support to enrolled CMP/MH
				beneficiaries, in their own environment, who are at risk of hospitalization or
				deterioration in function, to enable them to function in the community and to
				enable them to access other mental health services whenever possible;
2. Provide or arrange for a clinical offsite
				service capability to enrolled CMP/MH beneficiaries seven days a
				week;
3. Provide community-based
				engagement activities, coordination, and integration for enrolled CMP/MH
				beneficiaries;
4. Provide ongoing,
				individualized clinical support and monitoring to maintain stability until the
				beneficiary participates effectively in other needed services; and
5. Seek and accept referrals within provider
				capacity of beneficiaries from emergency/screening services, local inpatient
				units and other structured sites, such as homeless shelters or jails, and other
				referral sites as identified at the local level.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 2 - ADULT CASE MANAGEMENT PROGRAM/MENTAL HEALTH (CMP/MH) › Section 10:73-2.9 - Basis of payment for adult CMP/MH services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Reimbursement
				for services covered under the CMP/MH in accordance with this subchapter shall
				be determined by the Commissioner of the Department of Human Services. The
				provider of CMP/MH services shall be compensated on a fee-for-service basis.
				Reimbursement will be based upon HCPCS Codes as specified in N.J.A.C. 10:73-5.
				The provider shall submit a claim form and shall identify the services
				performed by the use of procedure codes based on the Centers for Medicare &
				Medicaid Services Healthcare Common Procedure Coding System (HCPCS).
(b) A beneficiary who receives case
				management services shall be entitled to receive other approved mental health
				services that are rendered by authorized providers.
(c) Each provider shall charge for all
				services to all beneficiaries, except as provided by legislation, except that
				no charge shall be made directly to the Medicaid/NJ Family Care
				beneficiary.
(d) In no event shall
				the charge to the New Jersey Medicaid/NJ FamilyCare program exceed the charge
				by the provider for identical services to other groups or individuals in the
				community.
1. Payment for CMP/MH services
				shall not duplicate payments made to public agencies or private entities under
				other program authorities for this same purpose, including, but not limited to,
				the Home and Community Based Service Waiver programs. Payment for CMP/MH
				services shall not duplicate payment for case management services which are an
				integral part of another provider service.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 2 - ADULT CASE MANAGEMENT PROGRAM/MENTAL HEALTH (CMP/MH) › Section 10:73-2.11 - Clinical case management services under adult CMP/MH

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Clinical
				case management services shall include, but shall not be limited to,
				assessment, individualized service planning, services linkage, ongoing clinical
				support and advocacy (see
				10:73-2.4(a) 
				).
(b) There are three levels (risk
				categories) of clinical case management involvement based upon assessed risk of
				hospitalization, functional level, and willingness and/or ability to access
				needed services as defined by DMHAS. The three risk categories are: high risk,
				or intensive case management; at risk, or supportive case management; and low
				risk, or maintenance level case management.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 2 - ADULT CASE MANAGEMENT PROGRAM/MENTAL HEALTH (CMP/MH) › Section 10:73-2.13 - Recordkeeping for adult CMP/MH services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Case
				management providers shall keep such individual records as are necessary to
				fully disclose the kind and extent of services provided and shall assure that
				such information is available to the DMAHS or DMHAS or their agents, upon
				request.
(b) The CMP/MH provider
				shall maintain the following data in support of all payment claims as required
				by the rules:
1. The name of the
				beneficiary;
2. The name of the
				provider agency and the name and the title of the individual providing
				service;
3. The dates of
				service;
4. The units of
				service;
5. The length of time of
				all face-to-face contact (excluding travel to or from beneficiary
				contact);
6. The name of
				individual(s) with whom face-to-face contact was maintained on behalf of
				beneficiary; and
7. A summary of
				services provided.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES › Section 10:73-3.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter sets forth the manner in
				which care management organization (CMO) services shall be provided to eligible
				Medicaid/NJ FamilyCare beneficiaries and children, youth and young adults
				receiving services under the Children's System of Care (CSOC), and shall apply
				to all CMO services provided under Title XIX and Title XXI of the Social
				Security Act,
				42 U.S.C.
				§§
										1396 and
				1397,
				or State-funded only programs.
(b)
				Care management organization services are administered under the auspices of
				the Department of Human Services (DHS) and its Division of Medical Assistance
				and Health Services (DMAHS) and the Department of Children and Families'
				Children's System of Care.
(c) All
				services shall be provided and administered in accordance with all DHS, DCF,
				CSOC, and DMAHS rules and contract obligations and all other applicable State
				and Federal laws, rules, and regulations including, but not limited to,
				N.J.A.C. 10:3 and 10:49 and this chapter.
(d) If a conflict arises between contract
				requirements and any existing provider rules, the terms set forth in the DHS or
				DCF contract shall prevail.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES › Section 10:73-3.3 - Provider enrollment and participation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Prior to
				enrollment as a Medicaid/NJ FamilyCare provider, any agency applying to render
				Medicaid/NJ FamilyCare CMO services shall first be under contract with the New
				Jersey Department of Human Services as an approved CMO provider. Such contract
				shall be in full effect and shall not be currently suspended, terminated or in
				default.
(b) In order to
				participate as a provider of CMO services, all providers shall apply to, and be
				approved by, the New Jersey Medicaid/NJ FamilyCare fee-for-service program as a
				CMO provider, in accordance with N.J.A.C. 10:49-3 and this subchapter.
1. Applicants may obtain the Medicaid
				"Provider Application" (FD-20), the Medicaid "Provider Agreement" (FD-62), and
				the CMS 1513 form at
www.njmmis.com
, or
				from:
Gainwell Technologies
Provider Enrollment
PO Box 4804
Trenton, NJ 08650-4804
2. All applicants shall complete and submit
				the forms to: Department of Children and Families
PO Box 717
Trenton, NJ 08625-0717
Attn: Director, Division of Child Behavioral Health
				  Services
3. The Director,
				Children's System of Care, will review the contract status of the applicant and
				will forward the application, if approved, to the Medicaid/NJ FamilyCare
				program for further processing.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES › Section 10:73-3.4 - CMO responsibilities and services; general overview

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Under
				contract to the Department of Children and Families and working as a systems
				partner with CSOC, each CMO provider shall:
1. Provide initial and continuing case
				management services to children and families referred to them by the Department
				of Children and Families or other designated agent of the Department of
				Children and Families.
i. Initial CMO
				services provided shall include, but shall not be limited to:
(1) Enrollment of the child, youth or young
				adult into CMO services; and
(2)
				Development of an interim plan to stabilize the child, youth or young adult and
				address the immediate concerns of the child, youth or young adult and his or
				her family/caregiver.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES › Section 10:73-3.5 - Eligibility and referral for CMO services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A
				child, youth, or young adult may be eligible for CMO services if:
1. He or she meets the requirements of this
				subchapter and is:
i. Enrolled in Medicaid/NJ
				FamilyCare as described at N.J.A.C. 10:49-2, and not enrolled in: :
(1) The Medically Needy Program, except that
				pregnant women in that program may be eligible;
(2) The Home and Community Based Services
				Waiver Program;
(3) The DDD Waiver
				Program;
(4) The Traumatic Brain
				Injury Waiver Program;
(5) The
				Community Resources for People with Disabilities Waiver Program; or
(6) The Home Care Expansion Program;
				or
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES › Section 10:73-3.6 - Discharge from CMO services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A child, youth,
				or young adult shall be discharged from CMO services if:
1. The child, youth, or young adult's CSOC
				assessment, ISP, and other relevant information indicate that the child, youth,
				or young adult no longer needs CMO services; or
2. The child, youth or young adult or his or
				her parent or caregiver refuse CMO services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES › Section 10:73-3.7 - Processing eligibility applications

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All CMO
				providers shall:
1. Complete a presumptive
				eligibility (PE) application for each child, youth and young adult who is not
				otherwise covered under Medicaid/NJ FamilyCare at the time of the referral to
				the CMO, if the PE process has not already been initiated by another
				entity;
2. Submit all PE
				applications to DMAHS;
3. Assure
				that provider case management staff and other appropriate staff complete DMAHS
				PE training;
4. Assist the child,
				youth or young adult and/or his or her family in collecting the documentation
				required to complete and submit a Medicaid/NJ FamilyCare application within 30
				days of enrollment, if this process has not already been initiated by another
				entity;
5. As family circumstances
				indicate, review eligibility factors for each beneficiary and assist the
				beneficiary and/or his or her family in applying for any and all benefits for
				which they may be eligible, including, but not limited to, Medicaid/NJ
				FamilyCare; and
6. Assist the
				beneficiary and/or his or her family in maintaining eligibility for Medicaid/NJ
				FamilyCare and other benefits.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES › Section 10:73-3.8 - Enrollment of the beneficiary into CMO services and the initial ISP

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The CMO shall
				initiate enrollment of the child, youth or young adult upon receipt of the
				referral from the Department of Children and Families or its designated agent
				and shall complete the electronic case record within seven calendar days of
				receipt of the referral.
(b) The
				CMO shall begin the initial ISP by contacting the family and holding a
				face-to-face meeting with the child, youth or young adult, and the family or
				other caregiver within 72 hours of the referral from the CSA, the Department of
				Children and Families or the DCF-designated agent.
(c) The CMO shall refer the child, youth, or
				young adult and his or her family or other caregiver(s) to the family support
				organization (FSO) within the CMO service area for family-to-family support
				services during this time period.
(d) The initial ISP developed by the CMO
				shall include an interim plan to stabilize the child, youth or young adult and
				his or her family or other caregiver(s) and address immediate concerns,
				including, but not limited to:
1. Preliminary
				crisis management plans to address any crisis situations that may occur prior
				to the completion of the comprehensive ISP;
2. Child and community safety;
3. Clinical need; and
4. Caregiver needs.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES › Section 10:73-3.9 - Child/Family Team; members and responsibilities

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				To complete the comprehensive ISP, the CMO shall develop a Child/Family Team,
				in conjunction with the family member or caregiver, which shall consist of, at
				a minimum, the following members:
1. A CMO
				care manager;
2. The child, youth
				or young adult and the parent or other caregiver;
3. Any interested person the family wishes to
				include as a member of the team, including, but not limited to, clergy members,
				family friends, and any other informal support resource;
4. A representative from the FSO, if desired
				by the family;
5. A clinical staff
				member who is directly involved in the treatment of the child, youth or young
				adult that the ISP is being developed for, if desired by the family;
6. Representation from outside agencies the
				child, youth or young adult is involved with, including, but not limited to,
				current providers of services, parole/probation officers, and/or educators that
				the child, youth or young adult and his or her family/caregiver agree to
				include on the team; and
7. The CP
				& P caseworker assigned to the child, if the child is receiving child
				protection or permanency services from CP &P.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES › Section 10:73-3.10 - Comprehensive ISP; general

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The ISP shall
				include a copy of the DHS or DCF confidentiality agreement form signed by all
				participants to adhere to all rules and procedures governing beneficiary
				confidentiality.
(b) The ISP shall
				be comprehensive in nature, strength based, and developed in partnership with
				the child, youth, young adult and the family or other caregivers.
(c) The ISP shall be based on the
				comprehensive assessments completed as indicated by the presenting problems,
				needs and strengths of the child, youth or young adult and his or her
				family/caregiver.
(d) The ISP shall
				identify the services to be provided and shall ensure that the services are
				provided to the child, youth, or young adult in the least restrictive manner
				possible.
(e) The ISP shall consist
				of outcome based, short term, interim, and long term goals to address each area
				of unmet need with measurable goals and time frames, specific individual roles
				and responsibilities, a crisis/emergency response plan and a schedule for
				ongoing review and assessment.
(f)
				The ISP shall, at a minimum, address areas of unmet need in all areas of the
				following life domains, as indicated by the multi-system assessment process,
				including, but not limited to:
1. Child
				safety;
2. Child risk;
3. Clinical needs;
4. Non-clinical needs, if deemed therapeutic
				and approved by the Child/Family Team;
5. Permanency planning; and
6. Community safety issues.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES › Section 10:73-3.11 - Comprehensive ISP; contents

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				comprehensive ISP shall contain the following components:
1. Documentation of the participation of
				providers and local community partners and the integration of available and
				appropriate services and resources;
2. Documentation of the responsibilities,
				objectives, and requirements of child welfare, mental health, juvenile justice,
				the courts, and other service systems, as applicable;
3. Documentation of the coordination of
				system partner mandates and responsibilities with the assessment
				plan;
4. Documentation of the
				involvement of FSOs, if desired by the family;
5. A plan for permanency, clinical care, and
				child and community safety (CP & P maintains the primary responsibility for
				permanency and child safety for the CP & P child);
6. A community based crisis management plan,
				which includes emergency response capability to respond in person to deliver
				in-home or off-site crisis support as warranted, and coordination of crisis
				response services, if intervention is needed beyond care manager
				response;
7. A plan to develop and
				purchase those items and/or services necessary to support the individual's
				needs as determined by the team and included in the ISP;
8. Documentation of the coordination of
				applicable services with the physical health insurer;
9. Measurable goals and the criteria to be
				met to obtain those goals;
10. A
				plan for transitioning the child, youth or young adult and the family/caregiver
				from CMO services to a community based, natural support network of services;
i. For children, youth or young adults who
				are transitioning from CMO services into youth case management (YCM) services,
				the initial 90 days of YCM services and other services specified in the ISP
				will be authorized as part of the transition plan. Additional authorizations
				shall be requested by the YCM agency, if needed. (See
				10:73-4.9.)
11. A plan to maintain enrollment for the
				child, youth or young adult receiving the CMO services on a "no eject/no
				reject" basis until the defined outcomes and discharge criteria specified in
				the ISP are met; and
12. The
				signatures of the CMO care manager, the parent/caregiver and the child, youth
				or young adult receiving the services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES › Section 10:73-3.12 - Amendments to the ISP

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The CMO shall
				review and update the ISP at least every three months, and more often if
				needed. The care manager shall work with the Child/Family Team to facilitate
				this process.
(b) As part of the
				reviewed and amended ISPs, the Child/Family Team may need to change the
				composition of the team, based on the family requests, or to reflect changing
				circumstances and revised treatment goals.
(c) Reviewed and amended ISPs shall reflect
				the review of existing services provided for effectiveness and shall include a
				determination of whether changes to the ISP are indicated based on the
				provision of current services and their effectiveness.
(d) The CMO care manager shall have the
				following responsibilities to the rest of the team for the subsequent or
				amended ISPs:
1. Continue to engage the
				child, youth or young adult and his or her family as active participants in the
				assessment, planning and service delivery process;
2. Continue to serve as the facilitator of
				the Child/Family Team;
3. Continue
				to ensure that subsequent ISP meetings are convenient to the family;
				and
4. Ensure that subsequent ISPs
				are developed as a collaborative effort of all Child/Family team members. The
				care manager shall:
i. Ensure that the
				written plan, and any subsequent amendments to the plan, are approved by each
				team member, including the family and the child, at the subsequent Child/Family
				Team meetings and placed in the child's file;
ii. Assure the subsequent reviewed and
				amended ISPs are signed, at a minimum, by the CMO care manager, the
				parent/caregiver, the child, as age appropriate, and submitted to the CSA
				within seven calendar days of the Child/Family Team meeting; and
iii. Forward the completed and approved
				revised ISP to each team member.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES › Section 10:73-3.13 - Transition/discharge planning; general

Current through Register Vol. 56, No. 14, July 15, 2024
Transition/discharge planning for children, youth and young
				  adults receiving CMO services shall be considered within the context of the
				  ongoing ISP process and shall guide the team process from the time of the
				  referral.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES › Section 10:73-3.14 - Transition planning

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				Child/Family team shall develop a transition plan if one or more of the
				following criteria are met:
1. The goals of
				the individual service plan (ISP) have been substantially achieved;
2. The Child/Family Team determines that the
				child, youth or young adult no longer requires the intensive level of care
				management provided by the CMO;
3.
				The Child/Family Team determines that the child, youth or young adult is ready
				to be transitioned to adult services; or
4. The family requests transition. Family
				requests for transition shall be in written form and shall be made by the
				parent or legal guardian of the child, youth or young adult.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES › Section 10:73-3.15 - Discharge planning

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Child/Family Team shall develop a
				discharge plan if one or more of the following criteria are met:
1. Active attempts to engage the
				family/guardian to participate in the CMO process, for a two-month period, have
				not been successful;
2. The family
				has moved out of the geographic area with no intent to return;
3. The child, youth, or young adult is
				missing and, after active searching by the CMO, the child, youth, or young
				adult continues to be missing and has had no contact with the CMO for more than
				two months. In actively searching for the child, youth, or young adult, the CMO
				shall request the assistance of the family support organization (FSO), the
				family and all other parties appropriate for the particular child, youth, or
				young adult, including, but not limited to, individuals and entities known to
				have contact with the child, youth, or young adult, such as the local or State
				police, Department of Human Services police, probation officers, and other law
				enforcement entities.
i. Active attempts to
				locate and engage the child, youth, or young adult and his or her
				family/guardian with the requested assistance of the FSO shall include, but not
				be limited to:
(1) Documented attempts to
				reach the family by telephone on a weekly basis;
(2) Monthly certified letters with copies to
				the referring agent and/or CP & P and/or the Family Court, as appropriate;
				and
(3) Scheduled and unscheduled
				visits to the child, youth or young adult's and/or family's or guardian's place
				of residence;
ii. The
				CMO shall document all efforts to locate the child, youth or young adult;
				and/or
4. The family
				requests discharge. Family requests for discharge shall be in written form and
				shall be made by the parent or legal guardian of the child, youth or young
				adult.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES › Section 10:73-3.16 - CMO Pre-transition/pre-discharge responsibilities

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Upon determination that a transition/discharge from CMO services is
				appropriate, the CMO shall assure that:
1. A
				comprehensive transition/discharge ISP shall be developed by the Child/Family
				Team, and documented by the CMO. The transition/discharge ISP shall include:
i. The recommended date for
				transition/discharge;
ii. A
				recommendation for any needed additional care management services;
iii. For children, youth or young adults who
				will be transitioning into other case management services, 30 days notice and
				participation of a representative of the appropriate case management entity in
				the Child/Family Team meeting where the transition/discharge ISP is
				developed;
iv. Identification of
				responsible parties for all goals and objectives;
v. Confirmation of linkages to community
				organization, both formal and informal, and assurance that any services not
				currently in place for the child, youth or young adult are in place prior to
				the date of transition/discharge;
vi. Discussion at the Child/Family Team
				meeting of the availability of services provided by the FSO. The care manager
				shall ensure that the family is provided with the FSO information appropriate
				for the family's geographic location and shall document the receipt of the
				information in the child, youth or young adult's record; and
vii. If CP & P and/or Family
				Court/Probation will be involved after the transition/discharge, a CSA/CP &
				P/YCM/Family Court/Probation interface process shall be established, which
				shall include identification of designated individuals in each specific agency
				or entity.