reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 163 - MEDICAL NECESSITY REVIEW TOOL FOR SUBSTANCE USE DISORDERS › Subchapter 1 - GENERAL PROVISIONS › Section 10:163-1.2 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
This chapter applies to State-regulated health insurance
				  carriers, the State Health Benefits Program, and the School Employees' Health
				  Benefits Program. In accordance with
				  P.L.
				  2017, c. 28, this
				  chapter does not apply to benefit plans established by the Department of Human
				  Services, benefits to those persons who are eligible for medical assistance
				  under P.L. 1968, c. 413 (N.J.S.A.
				  30:4D-1 et seq.), the "Family Health Care
				  Coverage Act,"
				  P.L.
				  2005, c. 156
				  (N.J.S.A.
				  30:4J-8 et seq.), or any other program
				  administered by the Division of Medical Assistance and Health Services in the
				  Department of Human Services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 163 - MEDICAL NECESSITY REVIEW TOOL FOR SUBSTANCE USE DISORDERS › Subchapter 1 - GENERAL PROVISIONS › Section 10:163-1.3 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, as used in this chapter, shall
				  have the following meaning, unless the context clearly indicates
				  otherwise.
"American Society of Addiction Medicine criteria" or "ASAM
				  criteria" means the clinical guidelines for purposes of the assessment,
				  treatment, placement, and transfer/discharge of individuals with substance use
				  disorders. These ASAM criteria are contained in The ASAM Criteria: Treatment
				  Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, 3rd
				  ed., Carson City, NV: The Change Companies, 2013, which is incorporated herein
				  by reference, as amended and supplemented.
"Department" means the Department of Human Services, unless
				  otherwise specified.
"Division" means the Division of Mental Health and Addiction
				  Services and is the single State agency responsible for the oversight of a
				  range of community addiction services in the State of New Jersey.
"Level of Care Index" or "LOCI" means the standardized
				  practice tool, which is incorporated herein by reference, as amended and
				  supplemented, that is used to implement and document the ASAM criteria for
				  treatment planning and placement of patients with substance use disorders. The
				  LOCI is published by The Change Companies,
www.changecompanies.net
.
"Substance use disorder" means the classification as defined
				  in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
				  (DSM-5), which is incorporated herein by reference, as amended and supplemented
				  and includes substance use withdrawal.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 163 - MEDICAL NECESSITY REVIEW TOOL FOR SUBSTANCE USE DISORDERS › Subchapter 2 - CLINICAL GUIDELINES AND REVIEW TOOL FOR MEDICAL NECESSITY REVIEW OF TREATMENT OF SUBSTANCE USE DISORDERS › Section 10:163-2.1 - Clinical guidelines and review tool

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The evidenced-based and peer-reviewed
				clinical practice guidelines appropriate to review the medical necessity for
				treatment of substance use disorders is the ASAM criteria.
(b) The evidence-based and peer-reviewed
				clinical review tool for purposes of reviewing medical necessity for the
				treatment of substance use disorders is the LOCI or any similar tool with
				fidelity to the ASAM criteria.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164 - ADULT DAY HEALTH SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 10:164-1.1 - Purpose and scope; participant eligibility

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Adult Day Health Services Program is
				concerned with the fulfillment of the health needs of eligible individuals who
				could benefit from a health services alternative to total institutionalization.
				Adult Day Health Services is a program that provides medically necessary
				services in an ambulatory care setting to individuals who are nonresidents of
				the facility, and who, due to their physical and/or cognitive impairment,
				require such services supportive to their community living.
(b) To be eligible for services through the
				Adult Day Health Services Program, an individual must satisfy the clinical
				eligibility and prior authorization requirements at
				N.J.A.C.
				10:164-1.5 and either:
1. Have been determined to be eligible for
				Medicaid; or
2. Be enrolled in the
				Community Care Program for the Elderly and Disabled, the Caregiver Assistance
				Program, the Adult Family Care Program, Community Resources for People with
				Disabilities, the AIDS Community Care Alternatives Program, the Traumatic Brain
				Injury Program, the Home Care Expansion Program or the Jersey Assistance for
				Community Caregiving Program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164 - ADULT DAY HEALTH SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 10:164-1.4 - Required services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) As a
				condition of per diem reimbursement in accordance with
				N.J.A.C.
				10:164-1.6, ADHS facilities shall provide the
				following to adult beneficiaries:
1. The
				services required as a condition of licensure at N.J.A.C. 8:43F;
2. The service(s) each adult beneficiary
				requires to be clinically eligible pursuant to
				N.J.A.C.
				10:164-1.5(f); and
3. A minimum of five hours of services per
				day, excluding transportation time between the ADHS facility and the adult
				beneficiary's home, not to exceed five days per week.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164 - ADULT DAY HEALTH SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 10:164-1.5 - Clinical eligibility and prior authorization for adult day health services

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Clinical eligibility for adult day health services shall be contingent upon
				receipt of prior authorization from the Department on the basis of:
1. The results of an assessment of the
				individual using an instrument prescribed by the Department and the eligibility
				criteria specified at (f) below. The prescribed assessment instrument is
				designed to collect standardized information on a broad range of domains
				critical to caring for individuals in the community, including items related to
				cognition; communication/hearing; vision; mood and behavior; social
				functioning; informal support services; physical functioning; continence;
				disease diagnoses; health conditions; preventive health measures;
				nutrition/hydration; dental status; skin condition; environment/home safety;
				service utilization; medications; and socio-demographic/background information;
				and
2. The Department's evaluation
				and consideration of information received from either the facility RN, the
				individual and/or the individual's legally authorized representative, personal
				physician or other healthcare professional who has current and relevant
				knowledge of the individual, the individual's medical or psychosocial needs and
				the individual's ADL or cognitive deficits. Such information may be considered
				by the Department along with the results of the assessment performed in (a)1
				above and the eligibility criteria in (f) below as the basis for determining
				clinical eligibility for adult day health services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164 - ADULT DAY HEALTH SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 10:164-1.6 - Basis of payment

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				facility providing adult day health services shall agree to accept the
				reimbursement rates established by the Department as the total reimbursement
				for services provided to eligible Medicaid beneficiaries and to eligible
				beneficiaries enrolled in the HCEP or in the JACC.
1. In a nursing facility-based program, the
				adult day health services per diem rate is 45 percent of that nursing
				facility's per diem rate.
2. In
				freestanding facilities, the adult day health services per diem rate is based
				on an average of the rates paid to nursing facility adult day health services
				providers in effect as of July 1 each year.
3. For hospital-affiliated facilities, the
				adult day health services rate is a negotiated per diem rate, which shall not
				exceed the maximum adult day health services per diem rate paid to nursing
				facility-based providers.
4. The
				reimbursement rate set for any Medicaid beneficiary or any JACC or HCEP
				beneficiary in an adult day health services facility shall not exceed the rate
				charged by the facility to individuals who are not enrolled in the Medicaid,
				JACC or HCEP programs.
5. The per
				diem reimbursement shall cover the cost of all services required as a condition
				of licensure at N.J.A.C. 8:43F, except as noted below:
i. Physical therapy, occupational therapy and
				speech-language pathology services shall not be included in the per diem rate
				reimbursed for adult day health services. These therapies, when provided by the
				facility, shall be billed separately using the Health Insurance Claim Form,
				CMS-1500 established by CMS, incorporated herein by reference as amended and
				supplemented, available upon request from the US Government Printing Office at
				(202) 512-1800, or third-party insurance form, as applicable.
ii. It is only in the role of attending
				physician that the medical consultant may bill the New Jersey Medicaid Program
				on the Health Insurance Claim Form, CMS-1500, for services provided to a
				Medicaid beneficiary. The medical consultant shall not bill the New Jersey
				Medicaid Program separately for any service performed for any Medicaid
				beneficiary in an adult day health services facility while serving solely in
				his or her capacity as medical consultant.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164 - ADULT DAY HEALTH SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 10:164-1.7 - Voluntary transfer between ADHS facilities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An adult beneficiary who chooses to
				request to transfer from one ADHS facility to another ADHS facility shall
				submit a transfer request, in accordance with (b) below, to:
1. The facility to which the beneficiary
				chooses to request to transfer; or
2. The beneficiary's case or care manager if
				the beneficiary is a participant of any program listed at
				N.J.A.C.
				10:164-1.1(b)  that requires
				case or care management.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164 - ADULT DAY HEALTH SERVICES › Subchapter 2 - BILLING CODES › Section 10:164-2.1 - Introduction

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The New Jersey
				Medicaid Program adopted the Centers for Medicare and Medicaid Services (CMS)
				Healthcare Common Procedure Coding System (HCPCS). The HCPCS codes as listed in
				this subchapter are relevant to certain Medicaid and HCEP adult day health
				services. A separate billing code is used by the fiscal agent for the JACC
				program.
(b) These codes shall be
				used when requesting reimbursement for certain adult day health
				services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164 - ADULT DAY HEALTH SERVICES › Subchapter 2 - BILLING CODES › Section 10:164-2.2 - Billing codes

Current through Register Vol. 56, No. 14, July 15, 2024
(a) HCPCS codes
				for adult day health services are as follows:
HCPCS
Code
Description
Z0300
Initial visit, speech-language
							 pathology services
Z0310
Initial comprehensive speech-language
							 pathology evaluation
Z0270
Initial visit, physical therapy
92507
Speech-language pathology services
97799
Physical therapy
W9002
Adult day health services visit
Z1860
Adult day health services visit for the
							 AIDS Community Care
Alternatives Program (ACCAP)
(b)
				The billing code for services provided to JACC participants is as follows:
J9002
Adult day health services visit for
							 JACC participants.
(c)
				Fees for adult day health services facilities are pre-approved by the
				Department, based on the reimbursement methodology described in
				N.J.A.C.
				10:164-1.6, with each facility's fees
				established in accordance with the setting in which the adult day health
				services are provided.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164 - ADULT DAY HEALTH SERVICES › Appendix C

Current through Register Vol. 56, No. 14, July 15, 2024
OUTLINE FOR WRITTEN NARRATIVE STATEMENT ON
							 PROPOSED ADULT DAY HEALTH SERVICES FACILITY
1.
Describe the proposed therapeutic milieu through
							 which the proposed Adult Day Health Services Facility would provide medical and
							 ancillary health services to support the ability of clients to remain in the
							 community and to age well in place.
2.
Describe the physical facilities to be used for the
							 proposed Adult Day Health Services Facility (diagram acceptable).
3.
Describe the proposed Adult Day Health Services
							 Facility, including hours of operation, services to be provided, in-house
							 and/or by arrangement, and the staff members who would be implementing the
							 program.
4.
Provide staff position descriptions and state the
							 qualifications of personnel selected for each position.
5.
State the total number of participants the proposed
							 Adult Day Health Services Facility would serve and the anticipated daily
							 population.
6.
Submit a projection of anticipated costs the proposed
							 Adult Day Health Services Facility would incur. State the period of the
							 projection and provide the basis of cost allocation, if applicable.
7.
State whether the proposed Adult Day Health Services
							 Facility would be supported by a funding source other than Title XIX, such as
							 Title XX and/or Title III.
8.
State whether the proposed Adult Health Services
							 Facility would be a new facility or an expansion of an existing
							 facility.
9.
Provide additional comments relevant to the
							 application for approval of the proposed Adult Day Health Services Facility
							 under the New Jersey Medicaid Program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164 - ADULT DAY HEALTH SERVICES › Appendix E

Current through Register Vol. 56, No. 14, July 15, 2024
AGENCY NOTE:
The Fiscal Agent Billing Supplement
				is appended as a part of this chapter/manual but is not reproduced in the New
				Jersey Administrative Code. When revisions are made to the Fiscal Agent Billing
				Supplement, replacement pages will be distributed to providers and copies will
				be filed with the Office of Administrative Law. For a copy of the Fiscal Agent
				Billing Supplement, write to:
Unisys Corporation
PO Box 4801
Trenton, NJ 08650-4801
or contact:
Office of Administrative Law
Quakerbridge Plaza, Building 9
PO Box 049
Trenton, NJ 08625-0049
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164A - ADULT DAY SERVICES PROGRAM FOR PERSONS WITH ALZHEIMER'S DISEASE OR RELATED DISORDERS › Subchapter 1 - GENERAL PROVISIONS › Section 10:164A-1.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
Pursuant to
				  N.J.S.A.
				  26:2M-9 et seq., the Department of Human
				  Services intends the Adult Day Services Program for Persons with Alzheimer's
				  Disease or Related Disorders to provide relief and support to family caregivers
				  of a person with Alzheimer's disease or a related disorder through the
				  provision of subsidized adult day services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164A - ADULT DAY SERVICES PROGRAM FOR PERSONS WITH ALZHEIMER'S DISEASE OR RELATED DISORDERS › Subchapter 1 - GENERAL PROVISIONS › Section 10:164A-1.2 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
The rules in this chapter are applicable to social adult day
				  agencies and adult day health services facilities licensed by the Department
				  that are operating under a Letter of Agreement with this Department. Adult day
				  health services facilities must also abide by standards outlined in N.J.A.C.
				  8:43F.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164A - ADULT DAY SERVICES PROGRAM FOR PERSONS WITH ALZHEIMER'S DISEASE OR RELATED DISORDERS › Subchapter 1 - GENERAL PROVISIONS › Section 10:164A-1.3 - Target population; prioritizing target individuals

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The target population is limited to those
				individuals who have a diagnosis of Alzheimer's disease or a related
				dementia.
(b) Priority shall be
				given to those individuals in moderate to severe ranges of
				disability.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164A - ADULT DAY SERVICES PROGRAM FOR PERSONS WITH ALZHEIMER'S DISEASE OR RELATED DISORDERS › Subchapter 2 - ADMINISTRATIVE ORGANIZATION › Section 10:164A-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 State government which has control over the administration of the Adult Day
				  Services Program for Persons with Alzheimer's Disease or Related Disorders.
				  Under the terms of
				  N.J.S.A.
				  26:2M-9 et seq., the Department is
				  responsible for the general policies governing administration of the Adult Day
				  Services Program for Persons with Alzheimer's Disease or Related Disorders, for
				  effecting the issuance of rules and procedures in accordance with the
				  Administrative Procedure Act (N.J.S.A. 52:14B-1 et
				  seq.) for implementing the statutory provisions and for Statewide coordination
				  of the program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164A - ADULT DAY SERVICES PROGRAM FOR PERSONS WITH ALZHEIMER'S DISEASE OR RELATED DISORDERS › Subchapter 3 - APPLICATION PROCESS AND RESPONSIBILITIES OF AGENCIES › Section 10:164A-3.1 - General provisions

Current through Register Vol. 56, No. 14, July 15, 2024
An agency interested in participating in the program shall
				  provide supportive documentation describing its existing program and services
				  to persons with a form of dementia and their families. The application must
				  include the agency's cost proposal, statement of need, goals and objectives,
				  staffing, programming, revenue projection, census data and operating
				  budget.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164A - ADULT DAY SERVICES PROGRAM FOR PERSONS WITH ALZHEIMER'S DISEASE OR RELATED DISORDERS › Subchapter 3 - APPLICATION PROCESS AND RESPONSIBILITIES OF AGENCIES › Section 10:164A-3.3 - Responsibilities of participating agencies

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The agency shall determine the
				eligibility of all applicants for service under the Adult Day Services Program
				for Persons with Alzheimer's Disease or Related Disorders as defined by
				N.J.A.C. 10:164A-6.
(b) Once
				eligibility is determined, the agency shall submit completed Waiting List
				Application, Financial Profile, Client Funding Utilization and Demographic Data
				forms to the Department for authorization.
(c) The agency shall verify the income of
				each applicant applying for services under the Adult Day Services Program for
				Persons with Alzheimer's Disease or Related Disorders and determine the
				applicant's ability to contribute to the cost of the adult day services. This
				income verification shall be reviewed on an annual basis, or more frequently if
				circumstances change to ensure continued eligibility for services.
(d) The agency shall determine sources of
				payment for adult day services for each applicant and assess and collect all
				co-payments through retrospective billing.
(e) The agency shall submit monthly
				statistical and financial reports on adult day services provided and other
				information as requested by the Department.
(f) The agency shall maintain a minimum
				staff-client ratio of 1:5 for programming for clients with a form of
				dementia.
(g) New staff shall
				receive an orientation within 30 days of employment which, in addition to job
				responsibilities, includes:
1. Methods of
				dealing with the specific problems encountered in the care of people with
				Alzheimer's disease, such as communicating with clients, necessary safety
				measures and common behavior concerns; and
2. An overview of the progression of dementia
				and the different types of dementia.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164A - ADULT DAY SERVICES PROGRAM FOR PERSONS WITH ALZHEIMER'S DISEASE OR RELATED DISORDERS › Subchapter 5 - APPLICATION PROCESS FOR CLIENTS › Section 10:164A-5.1 - General provisions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				application process includes all activity related to a request for eligibility
				determination under the Adult Day Services Program for Persons with Alzheimer's
				Disease or Related Disorders. The process begins with the receipt of an
				application by an agency and continues in effect until there is an official
				disposition of the eligibility request from that agency.
(b) All applicants shall be notified within
				30 days after receipt of their application of their eligibility in the
				program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164A - ADULT DAY SERVICES PROGRAM FOR PERSONS WITH ALZHEIMER'S DISEASE OR RELATED DISORDERS › Subchapter 5 - APPLICATION PROCESS FOR CLIENTS › Section 10:164A-5.2 - Authorized agent

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Since most
				clients served shall be in moderate to severe stages of dementia and the
				applicant is most likely incompetent or incapable of filing an application on
				his or her own behalf, the agency shall recognize any of the following persons,
				listed in order of priority, as an authorized agent for the purpose of
				initiating such applications:
1. A legal
				guardian;
2. A close relative of
				the applicant by blood or marriage, such as parent, spouse, son, daughter,
				brother or sister; and
3. A friend
				of the applicant who is his or her caregiver but does not receive remuneration
				for the caregiving.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164A - ADULT DAY SERVICES PROGRAM FOR PERSONS WITH ALZHEIMER'S DISEASE OR RELATED DISORDERS › Subchapter 5 - APPLICATION PROCESS FOR CLIENTS › Section 10:164A-5.3 - Responsibilities in the application process

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The agency has the 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. Accept and process applications;
				and
3. Maintain files, including
				applications and supporting documents, for all applicants.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164A - ADULT DAY SERVICES PROGRAM FOR PERSONS WITH ALZHEIMER'S DISEASE OR RELATED DISORDERS › Subchapter 6 - ELIGIBILITY › Section 10:164A-6.1 - Eligibility standards

Current through Register Vol. 56, No. 14, July 15, 2024
(a) To be
				eligible for adult day services under the Adult Day Services Program for
				Persons with Alzheimer's Disease or Related Disorders, an applicant shall meet
				the following criteria at the time of application:
1. Have a diagnosis by a physician of
				Alzheimer's disease, or a related disorder such as multi-infarct dementia,
				Huntington's disease, Parkinson's disease with dementia, Creutzfeldt Jacob
				disease, or Pick's disease;
2. Be a
				resident of New Jersey;
3. Be
				routinely cared for by a family member or informal caregiver who does not
				receive financial remuneration for the care;
4. Reside in the community with a relative or
				informal caregiver;
5. Have liquid
				resources (as declared by that individual) that do not exceed $ 40,000. A
				couple's combined liquid resources shall not exceed $ 60,000; and
6. Have income that falls within the income
				limits established in
				N.J.A.C.
				10:164A-3.2(c).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164A - ADULT DAY SERVICES PROGRAM FOR PERSONS WITH ALZHEIMER'S DISEASE OR RELATED DISORDERS › Subchapter 6 - ELIGIBILITY › Section 10:164A-6.2 - Confidentiality and disclosure of information

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All personally identifiable information
				regarding applicants, clients or caregivers obtained or maintained under the
				Adult Day Services Program for Persons with Alzheimer's Disease or Related
				Disorders shall be confidential and shall not be released without the written
				consent of the authorized agent or caregiver.
(b) The prohibition against unauthorized
				disclosure in (a) above shall not be construed to prevent:
1. The release of statistical or summary data
				or information in which applicants or clients cannot be identified;
2. The release to the Attorney General, or
				other legal representative of the State, of information or files relating to
				the claim of any applicant, clients, or their authorized agent challenging the
				program's statutes, rules, or a determination made pursuant thereto, or against
				whom an action or proceeding for the recovery of incorrectly paid benefits has
				been instituted;
3. The release of
				information or files to the State Treasurer, the Commissioner of the Department
				of Human Services or other governmental agency, or to their duly authorized
				representatives, for an audit, review of expenditures or similar activity
				authorized by law; or
4. The
				release of information or files to any law enforcement authority charged with
				the investigation or prosecution of violations of the criminal laws of this
				State.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164A - ADULT DAY SERVICES PROGRAM FOR PERSONS WITH ALZHEIMER'S DISEASE OR RELATED DISORDERS › Subchapter 6 - ELIGIBILITY › Section 10:164A-6.3 - Primary and secondary payment

Current through Register Vol. 56, No. 14, July 15, 2024
If a client's adult day service costs are covered in whole or
				  in part by another State or Federal government program or insurance contract,
				  the government program or insurance carrier shall be the primary payer and the
				  Adult Day Services Program for Persons with Alzheimer's Disease or Related
				  Disorders shall be the secondary payer.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164A - ADULT DAY SERVICES PROGRAM FOR PERSONS WITH ALZHEIMER'S DISEASE OR RELATED DISORDERS › Subchapter 7 - APPEALS › Section 10:164A-7.1 - Appeals process

Current through Register Vol. 56, No. 14, July 15, 2024
An applicant who is denied participation in the program
				  because he or she does not qualify, or a client whose participation in the
				  program is terminated, has the right to request a hearing pursuant to the
				  Administrative Procedure Act,
				  N.J.S.A.
				  52:14B-1 et seq. and the Uniform
				  Administrative Procedure Rules, N.J.A.C. 1:1, within 30 days of receipt of
				  notice of an adverse action notice. Appeals shall be in writing and directed
				  to:
Director of the Office of Community Programs
New Jersey Department of Human Services
Division of Aging Services
PO Box 807
Trenton, NJ 08625-0807
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164B - STATEWIDE RESPITE CARE PROGRAM › Subchapter 1 - GENERAL PROVISIONS › Section 10:164B-1.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
Pursuant to
				  30:4F-7 et seq., the Department of
				  Human Services intends to use the Statewide Respite Care Program to provide
				  relief and support to family or other uncompensated caregivers from the demands
				  of the daily care of functionally impaired persons, including the frail
				  elderly.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164B - STATEWIDE RESPITE CARE PROGRAM › Subchapter 1 - GENERAL PROVISIONS › Section 10:164B-1.2 - Scope of service

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This chapter
				shall apply to all activities provided by and persons participating in the
				Statewide Respite Care Program, including, but not limited to, applicants,
				eligible persons, caregivers and sponsors.
(b) Pursuant to
				30:4F-7 et seq., the New Jersey
				Statewide Respite Care Program is limited to the provision of and payment for
				short-term, intermittent respite care for functionally impaired adults,
				including the frail elderly.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164B - STATEWIDE RESPITE CARE PROGRAM › Subchapter 1 - GENERAL PROVISIONS › Section 10:164B-1.3 - Target population; priority of services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The target
				population is limited to those individuals who are at risk of severe illness,
				fatigue or stress due to the demands of their basic, daily caregiving
				responsibilities for the eligible person.
(b) The sponsor agency shall give priority in
				receiving services to those situations where the eligible person is at risk of
				institutionalization due to the temporary incapacity of a caregiver.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164B - STATEWIDE RESPITE CARE PROGRAM › Subchapter 2 - ADMINISTRATIVE ORGANIZATION › Section 10:164B-2.1 - Department of Human Services

Current through Register Vol. 56, No. 14, July 15, 2024
The Department is the administrative unit of the State
				  government, which has control over the administration of the Statewide Respite
				  Care Program pursuant to
				  30:4F-7 et seq.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164B - STATEWIDE RESPITE CARE PROGRAM › Subchapter 2 - ADMINISTRATIVE ORGANIZATION › Section 10:164B-2.2 - County administration

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Advisory
				Council of the Area Agency on Aging in each county shall be responsible for
				choosing the sponsor agency in its respective county subject to confirmation by
				the Department.
1. The sponsor agency shall
				administer the Statewide Respite Care Program in that county and process
				applications for services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164B - STATEWIDE RESPITE CARE PROGRAM › Subchapter 3 - APPLICATION PROCESS › Section 10:164B-3.1 - General provisions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The application
				process includes all activity related to a request for eligibility
				determination under the Statewide Respite Care Program. The process begins with
				the receipt of an application by a sponsor agency and continues in effect until
				there is an official disposition of the eligibility request from that sponsor
				agency.
(b) All applications for
				eligibility determination shall be made to the sponsor agency in the county
				where the applicant resides. The sponsor agency shall make a determination of
				eligibility and perform appropriate assessments within 30 days after the
				receipt of an application.
(c) When
				the sponsor agency terminates, reduces or suspends respite services, the
				sponsor agency shall provide the eligible person or formerly eligible person,
				as applicable, written notification of the determination and/or the right to a
				hearing as set forth at N.J.A.C. 10:164B-8.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164B - STATEWIDE RESPITE CARE PROGRAM › Subchapter 3 - APPLICATION PROCESS › Section 10:164B-3.2 - Authorized agent

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Where the
				applicant is incapacitated or incapable of filing an application on his or her
				own behalf, the sponsor agency shall recognize any of the following persons,
				listed in order of priority, as an authorized agent for the purpose of
				initiating such application:
1. A legal
				guardian;
2. A close relative of
				the applicant 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 person
				of a public or private social service agency, of which the person is a client,
				who has been designated by the applicant to so act; or
5. A friend of the applicant.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164B - STATEWIDE RESPITE CARE PROGRAM › Subchapter 3 - APPLICATION PROCESS › Section 10:164B-3.3 - Responsibilities in the application process

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				sponsor agency has the 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. Accept and process applications;
				and
3. Maintain files including
				applications and supporting documents for all applicants.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164B - STATEWIDE RESPITE CARE PROGRAM › Subchapter 4 - ELIGIBILITY › Section 10:164B-4.1 - Eligibility standards

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For the purpose
				of the Statewide Respite Care Program, an eligible person shall meet the
				following eligibility standards:
1. An
				eligible person shall be 18 years of age or older; functionally impaired; cared
				for at home by a caregiver who is not remunerated for his or her services; and
				at risk of long-term institutional placement if his or her regular caregiver
				could not continue in that role;
2.
				The maximum income level shall be 300 percent of the Federal Supplemental
				Security Income standard for an individual living alone, in effect under
				section 1611(a)(1)(A) of the Social Security Act (
				42 U.S.C. §
											1382 ) (as increased pursuant to section 1617
				of the Act (
				42 U.S.C. §
											1382f )).
i. In the case of an individual and spouse,
				one of whom is an applicant for respite care, 50 percent of the couple's
				combined income shall be subject to this same income standard.
(1) Clients determined eligible prior to June
				1, 1998 will not lose their eligibility upon redetermination for reasons set
				forth at (a)2i above.
ii. In the case of an individual and spouse,
				both of whom are applicants for respite care, 50 percent of the couple's
				combined income shall be subject to this same income standard.
(1) Clients determined eligible prior to the
				June 1, 1998 will not lose their eligibility upon redetermination for reasons
				set forth at (a)2ii above;
3. An eligible person shall be a resident of
				the State of New Jersey;
4. An
				eligible person shall have liquid resources, as declared by that individual,
				that do not exceed $ 40,000.
i. In the case
				of an individual and a spouse who are both dependent on the caregiver, the
				couple's combined liquid resources shall not exceed $ 60,000; and
5. Notwithstanding the provisions
				of this subsection or any other provision of law to the contrary, no eligible
				veteran shall be determined ineligible for the Statewide Respite Care Program
				based on income or liquid resources if he or she does not exceed the financial
				limits set forth in
				N.J.S.A.
				30:4F-10.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164B - STATEWIDE RESPITE CARE PROGRAM › Subchapter 4 - ELIGIBILITY › Section 10:164B-4.2 - Confidentiality and disclosure of information

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All personally
				identifiable information regarding applicants, eligible persons or caregivers
				obtained or maintained under the Statewide Respite Care Program shall be
				confidential and shall not be released without the written consent of the
				applicant, eligible person, their authorized agent, or caregiver.
(b) The prohibition against unauthorized
				disclosure in (a) above shall not be construed to prevent:
1. The release of statistical or summary data
				or information in which applicants or eligible persons cannot be
				identified;
2. The release to the
				Attorney General, or other legal representative of the State, of information or
				files relating to the claim of any applicant, eligible person or their
				authorized agent challenging the program's statute, rules or a determination
				made pursuant thereto, or against whom an action or proceeding for the recovery
				of incorrectly paid benefits has been instituted;
3. The release of information or files to the
				State Treasurer, the Commissioner of the Department or other governmental
				agency or to their duly authorized representatives, for an audit, review of
				expenditures or similar activity authorized by law; or
4. The release of information or files to any
				law enforcement authority charged with the investigation or prosecution of
				violations of the criminal laws of this State.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164B - STATEWIDE RESPITE CARE PROGRAM › Subchapter 5 - SPONSORS AND PROVIDERS › Section 10:164B-5.1 - Qualifications and requirements of sponsors

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				Commissioner, based upon the recommendations from the Advisory Council of the
				Area Agency on Aging, shall designate one sponsor agency for the Statewide
				Respite Care Program in each county in New Jersey, subject to the following
				qualifications:
1. A sponsor agency shall be
				a public or private nonprofit agency and shall contract annually with the
				Department to administer the local respite program.
2. Each sponsor agency shall:
i. Demonstrate, through its contract with the
				Department, its ability to purchase respite services from provider agencies and
				individuals in the county; and
ii.
				Provide evidence of its capability to deliver the full range of respite
				services available in its county, as defined in
				10:164B-1.4.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164B - STATEWIDE RESPITE CARE PROGRAM › Subchapter 5 - SPONSORS AND PROVIDERS › Section 10:164B-5.2 - Qualifications and requirements for provider agencies

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Provider agencies shall be accountable to the sponsor agency for the provision
				of respite services and shall enter into contracts with the designated sponsor
				agency.
(b) Provider agencies shall
				have demonstrated prior experience in delivering services to families with
				elderly and/or disabled members.
(c) Provider agencies shall agree to provide
				services at the rates set by the Department.
(d) An individual desiring to provide
				services under the Statewide Respite Care Program shall enter into a
				sub-contract with the sponsor agency as a provider and be subject to all
				requirements of provider agencies.
(e) All providers and their employees,
				workers, agents, and subcontractors utilized for the Statewide Respite Care
				Program shall possess any and all licenses, certifications, registrations,
				accreditations, qualifications, permits, and/or approvals required by law as a
				precondition to conduct the particular business or render the particular
				service.
(f) The sponsor agency
				and/or the Department shall reserve the right to cease purchasing services from
				any provider agency when any breach of the rules contained in this chapter
				occurs, constituting grounds for contract cancellation upon reasonable
				notice.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164B - STATEWIDE RESPITE CARE PROGRAM › Subchapter 6 - COST LIMITATIONS AND CO-PAYMENT FEE SCALE › Section 10:164B-6.1 - Service and cost limitations for eligible persons

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each
				eligible person shall receive up to $ 4,500 of respite services in a calendar
				year.
1. The Department shall adjust the
				service level based on the funding available to the Department.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164B - STATEWIDE RESPITE CARE PROGRAM › Subchapter 6 - COST LIMITATIONS AND CO-PAYMENT FEE SCALE › Section 10:164B-6.2 - Sliding fee scale for co-payments

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Co-payment fees
				shall apply to eligible persons rendered respite care services in accordance
				with the co-payment fee scale set forth in (b) below.
1. In all cases the point at which
				cost-sharing shall be initiated will be based upon the most current
				Supplemental Security Income (SSI) guidelines in effect under section
				1611(c)(1)(A) of the Social Security Act,
				42 U.S.C. §
											1382, as increased pursuant to section 1617
				of the Act,
				42 U.S.C. §
											1382f.
2. The threshold beyond which an eligible
				person becomes ineligible for program services is 300 percent of the SSI
				guidelines.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164B - STATEWIDE RESPITE CARE PROGRAM › Subchapter 7 - REIMBURSEMENT AND PAYMENT › Section 10:164B-7.1 - Reimbursement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department shall determine
				reimbursement and payment levels for the respite services to be provided under
				the program.
(b) The rates for the
				various types of respite services are as follows:
Service
Reimbursement Amount
Adult Day Health Services
Medicaid Rate
Alternate Family Care
Negotiated Rate
Assisted Living
Negotiated Rate
Campership
$ 90.00 per day
Companion Services
$ 12.00 per hour/weekday
$ 13.00 per hour/weekend
Homemaker/Home Health Aide Services, Personal Care
						  Services, and Homemaker
$ 17.00 per hour/weekday
Services
$ 18.00 per hour/weekend/holiday
$ 120.00 per 12-hour block
$ 140.00 per 24-hour block
Hospital Inpatient Respite
Medicaid Rate
Nursing Facility Respite
Negotiated Rate
Private Duty Nursing
Medicaid Rate
Social Adult Day Care
$ 45.00 per day
Residential Health Care Facility Respite
$ 60.00 per day
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164B - STATEWIDE RESPITE CARE PROGRAM › Subchapter 7 - REIMBURSEMENT AND PAYMENT › Section 10:164B-7.2 - Primary and secondary payment

Current through Register Vol. 56, No. 14, July 15, 2024
If an eligible person's respite service costs are covered in
				  whole or in part by another State or Federal government program or insurance
				  contract, the government program or insurance carrier shall be the primary
				  payer and the Statewide Respite Care Program shall be the secondary
				  payer.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 164B - STATEWIDE RESPITE CARE PROGRAM › Subchapter 8 - APPEALS › Section 10:164B-8.1 - Appeals process

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An applicant
				who is denied participation in the program because he or she does not qualify
				as an eligible person has the right to request a hearing pursuant to the
				Administrative Procedure Act,
				52:14B-1 et seq., and the Uniform
				Administrative Procedure Rules, N.J.A.C. 1:1, within 30 days of receipt of the
				written determination.
(b) Appeals
				shall be directed to:
Department of Human Services
Division of Aging Services
Attn: Statewide Respite Care Program
PO Box 807
Trenton, New Jersey 08625-0807
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 165 - PLANNING AND SERVICE AREAS AND AREA AGENCIES ON AGING › Subchapter 1 - GENERAL PROVISIONS › Section 10:165-1.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This chapter
				sets forth the procedures for establishing planning and service areas within
				the State, and designating Area Agencies on Aging, consistent with the Older
				Americans Act of 1965, and amendments thereto,
				42 U.S.C. §§
										3001 et seq.
(b) This chapter sets forth the procedure for
				revocation of the designation of an Area Agency on Aging.
(c) This chapter sets forth the procedure for
				redefining the boundaries of the planning and service areas of the
				State.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 165 - PLANNING AND SERVICE AREAS AND AREA AGENCIES ON AGING › Subchapter 1 - GENERAL PROVISIONS › Section 10:165-1.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
"Area Agency on Aging" means a public or private nonprofit
				  agency designated by the State Division in accordance with this chapter and
				  45 C.F.R. §
										1321.17 to act as the central coordinating
				  and planning body for older adult services within a PSA.
"Area Plan" means the document completed by each Area Agency
				  on Aging and submitted to the State Division delineating the comprehensive and
				  coordinated system of service delivery to be provided for older adults in the
				  PSA through the allocation of Federal, State and local dollars.
"Assistant Secretary for Aging" means the Assistant Secretary
				  of the United States Administration on Aging, within the Department of Health
				  and Human Services.
"Planning and Service Area" or "PSA" means the geographic
				  unit designated by the State Division for the allocation of funds and the
				  delivery of services for older adults.
"Revoke" means to withdraw the designation as an Area Agency
				  on Aging from an existing agency.
"State Division" means the Division of Aging Services of the
				  New Jersey Department of Human Services.
"Unit of general purpose local government" means a political
				  subdivision of the State whose authority is general and not limited to only one
				  function or combination of related functions, or an Indian tribal
				  organization.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 165 - PLANNING AND SERVICE AREAS AND AREA AGENCIES ON AGING › Subchapter 1 - GENERAL PROVISIONS › Section 10:165-1.3 - Notice and public hearing requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The State Division shall provide no less
				than 60 days written notice of any intended action to define or redefine a PSA,
				or designate or revoke an Area Agency on Aging designation, except that this
				requirement shall not apply to PSAs and Area Agency on Aging designations
				established prior to September 7, 1999.
(b) The notice shall be published in the New
				Jersey Register and in the legal notices of the newspaper of largest
				circulation in the geographical area affected at the time of the notice, with
				copies sent to all Areas Agencies on Aging and units of general purpose local
				governments in the area affected.
(c) The notice shall include at least the
				following:
1. A summary of the intended
				action, including the geographic locations in which the impact of the intended
				action will be most substantial;
2. Whether the State Division is accepting
				applications with respect to the intended action, with instructions relevant to
				the submission of application(s), if any, including the final date for
				submission of the application, and how additional details, such as format
				requirements, may be obtained; and
3. The location, time, and date for a public
				hearing to be held by the State Division concerning the intended action, and
				instructions to be followed by those persons who desire to submit written
				and/or oral comments at the public hearing.