New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 73 - CASE MANAGEMENT SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 10:73-1.2 - 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 indicates
				  otherwise:
"Advocacy" means the ongoing process of assisting the
				  beneficiary in receiving, and maintaining receipt of, all services and benefits
				  to which he or she is entitled by working toward the removal of barriers to
				  receiving needed services and benefits.
"Assessment" means the ongoing process of identifying and
				  reviewing a beneficiary's strengths, deficits, and needs based upon input from
				  the beneficiary and significant others including, but not limited to, family
				  members and health professionals. The assessment process continues throughout
				  the entire length of service. The assessments are updated periodically based
				  upon availability of beneficiary information and the requirements of this
				  chapter.
"Beneficiary monitoring" means the ongoing review by the
				  provider of the beneficiary's status and needs.
"Case management services" means those services which will
				  assist a beneficiary of Medicaid/NJ FamilyCare or a child, youth, or young
				  adult receiving services from the Children's System of Care (CSOC) in gaining
				  access to needed medical, social, educational, and other services.
"Centers for Medicare & Medicaid Services (CMS)" means
				  the agency of the Federal Department of Health and Human Services which is
				  responsible for the administration of the Medicaid program and the State
				  Children's Health Insurance Program (SCHIP) in the United States.
"Child Protection and Permanency (CP & P)" means the
				  agency that is the organizational component within the New Jersey Department of
				  Children and Families that administers the Title IV-E program of the Social
				  Security Act, Federal Payments for Foster Care and Adoption Assistance, 42
				  U.S.C. §§ 670-679b.
"Children's System of Care (CSOC)" means the organizational
				  component within the Department of Children and Families that provides a
				  comprehensive approach to the provision of mental health and behavioral health
				  services to eligible children, youth, and young adults.
"Contract systems administrator (CSA)" means an
				  administrative organization contracted by, and serving as an agent of, the
				  State of New Jersey to provide utilization management, care coordination,
				  quality management and information management for the Department of Children
				  and Families' Children's System of Care (CSOC) in its management of the
				  Statewide system of care that provides mental and behavioral health services
				  and supports to eligible children, youth, and young adults.
"Contract systems administrator care coordination (CSACC)"
				  means management and coordination of the assessment process by the CSA for
				  children, youth and young adults with mental or behavioral healthcare
				  needs.
"Department of Children and Families (DCF)" means the
				  department of New Jersey government, created by
				  P.L.
				  2006, c. 47, that has
				  the goal of ensuring safety, permanency, and well-being for all children and
				  has direct responsibility for child welfare and other child and family
				  services, supported by strong inter-agency partnerships among other State
				  departments also responsible for family services. The new department includes
				  Child Protection and Permanency, the Children's System of Care (CSOC), the
				  Division of Prevention and Community Partnerships, and the New Jersey Child
				  Welfare Training Academy.
"DHS" means the New Jersey Department of Human
				  Services.
"Division of Mental Health and Addiction Services (DMAHS)"
				  means the organizational component of the New Jersey Department of Human
				  Services that is responsible for the administration of the State's mental
				  health programs, primarily for adults.
"Healthcare Common Procedure Coding System (HCPCS)" means a
				  nationwide coding system, established and maintained by CMS in accordance with
				  the Health Insurance Portability and Accountability Act of 1996,
				  P.L.
				  104-191. Level 1 codes are adapted from codes
				  published by the American Medical Association in the Common Procedural
				  Terminology (CPT) and are utilized primarily by physicians and independent
				  clinical laboratories. Level 2 codes are assigned by CMS for physician and
				  non-physician services which are not in the CPT.
"Juvenile Justice Commission (JJC)" means the agency in, but
				  not of, the Department of Law and Public Safety which is mandated by statute to
				  develop and operate both non-secure residential programs and secure facilities
				  for adolescent juvenile offenders sentenced to the Commission by the New Jersey
				  Superior Court, Family Part, and to provide parole supervision to juvenile
				  inmates released by the New Jersey Parole Board. (See N.J.S.A.
				  52:17B-17O)
"Service planning" means the process of organizing the
				  outcomes of the assessment in collaboration with the beneficiary, significant
				  others, potential service providers, and others as designated, to formulate a
				  written service plan that addresses the beneficiary's needs, planned services
				  to address these needs, and plans to motivate the beneficiary to utilize
				  services. The service planning process continues throughout the beneficiary's
				  entire length of stay with the case management entity.
"Service provider monitoring" means the process of routine
				  follow up with the beneficiary's service providers to assess provision and
				  coordination of all aspects of the services specified in the beneficiary's
				  service plan.
"Services linkage" means the referral to and enrollment with
				  other appropriate service providers for the purposes of addressing the needs
				  identified in the beneficiary's assessment, including facilitating linkages to
				  community resources or services included in the beneficiary's treatment
				  goals.
"Young adult" means, for purpose of eligibility for CSOC
				  services, an individual at least 18 years of age and under 21 years of age
				  who:
1. Prior to becoming 18 years of age, received services from
				  the child-serving system in New Jersey, including, but not limited to:
i. CSOC;
ii. CP & P;
iii. The Juvenile Justice Commission; or
iv. Any other child-serving State agency; and
2. Demonstrates a clinical need for the continuation of
				  services provided by the CSOC, as part of the transition into adult
				  services.