New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 141 - TRAUMATIC BRAIN INJURY FUND › Subchapter 1 - GENERAL PROVISIONS; REQUIREMENTS › Section 10:141-1.11 - Eligible supports and services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				is a list of eligible supports and services that will be considered for
				sponsorship under the Fund:
1. Service
				coordination, defined as intensive assistance with resource coordination and
				advocacy. Only a credentialed care manager with experience in brain injury, who
				is employed by an agency, shall provide services;
2. Nursing services, defined as assessment
				and intervention related to professional nursing practice. A registered nurse
				or licensed practical nurse shall provide nursing services;
3. Neuropsychiatric/neuropsychological
				evaluation, defined as assessment of the beneficiary's deficits and strengths
				with recommendations for a treatment plan if necessary. A licensed psychiatrist
				or psychologist with knowledge of and experience with brain injury shall
				provide services;
4. Medication
				management, defined as monitoring of prescription medication, drug
				interactions, and modifications related to the brain injury. A licensed
				physician, nurse practitioner or clinic with experience in treating brain
				injury shall provide services;
5.
				Prescription medication, defined as the provision of medications to
				treat/manage the traumatic brain injury, as prescribed by a physician. A
				licensed pharmacist/pharmacy shall provide service;
6. Behavior management, defined as a
				time-limited program designed to assess and treat maladaptive or aggressive
				behavior, which is potentially destructive to the beneficiary or others. A
				licensed psychologist or psychiatrist, with experience in brain injury, shall
				provide service;
7. Substance abuse
				evaluation/treatment, defined as clinical intervention to resolve alcohol
				and/or drug problems experienced by the person with a traumatic brain injury. A
				certified alcohol and drug counselor with experience treating brain injury or a
				licensed alcohol/drug program shall provide services;
8. Counseling services, defined as individual
				or group intervention to resolve adjustment problems resulting from the brain
				injury. A licensed psychiatrist, psychologist, social worker or counselor shall
				provide services;
9. Cognitive
				rehabilitation therapy, defined as a time-limited intervention to improve
				memory, orientation, reasoning, appropriate verbal and behavioral responses. A
				professional who meets the certification standards for cognitive rehabilitation
				therapy as established by the Society for Cognitive Rehabilitation shall
				provide services;
10. Physical
				therapy, defined as a time-limited intervention to improve or maintain physical
				function, including muscle tone, gait and mobility. A licensed physical
				therapist or physical therapy assistant under supervision of a physical
				therapist shall provide services;
11. Occupational therapy, defined as a
				time-limited intervention to improve or maintain fine motor coordination and
				dexterity related upper body functions. Services shall be provided by a
				registered occupational therapist or a certified occupational therapy
				assistant;
12. Speech-language
				therapy, defined as a time-limited intervention to improve vocal and verbal
				skills, comprehension and expression, compensatory strategies or other
				treatments related to swallowing. A licensed speech-language pathologist or
				licensed speech therapist shall provide services;
13. Alternative therapy is defined as a
				heterogeneous set of practices or treatment modalities that are offered as an
				alternative or complementary adjunct to conventional medicine for the treatment
				of brain injury. Treatment modalities are time limited and must be approved by
				a national regulatory authority specifically for the treatment of brain injury.
				Evidence must be produced by the applicant/beneficiary of the efficacy and cost
				benefit of the particular therapy in treating brain injury. Providers of
				alternative therapy must be credentialed and recognized by an appropriate
				governing/regulatory body. Alternative therapy under the Fund shall be limited
				to:
i. Aqua therapy, which is a treatment
				where the patient is submersed in water to strengthen and to stretch muscles,
				ligaments and tendons and to build physical endurance;
ii. Biofeedback/neurofeedback, which is a
				non-invasive procedure that involves attaching sensors to the body. The sensors
				measure physical and cerebral response to internal and external stimuli. The
				patient can be trained to detect the subtleties of the body signals and learn
				new physiological responses;
iii.
				Chiropractic therapy, which is a therapy that emphasizes treatment of
				mechanical disorders of the musculoskeletal system, focusing on manual
				manipulation of joints, spine, and soft tissue;
iv. Hippotherapy, which is a physical,
				occupational and speech therapy treatment strategy that utilizes equine
				movement; and
v.
				Acupuncture/accupressure, which are Eastern holistic techniques that utilize
				needle sticks or pressure to manipulate body energy to relieve pain;
14. Structured day program,
				defined as a professionally managed program of meaningful group or individual
				activities provided during the day, in or out of home, with the purpose of
				developing or maintaining function and independence. A licensed community
				residential service provider agency, Commission for the Accreditation of
				Rehabilitation Facilities (CARF) accredited brain injury day program, or
				licensed medical day care center may provide services;
15. Life skills training, defined as teaching
				specific instrumental activities of daily living to increase independence and
				function. A professional with expertise in treating brain injury shall provide
				services;
16. Vocational services,
				defined as prevocational and extended vocational support to assist the
				beneficiary in obtaining and maintaining employment. A vocational professional
				with experience working with brain injury shall provide services;
17. Educational service, defined as
				assistance to the beneficiary obtaining educational services, including support
				while attending school or college and other activities related to education. A
				beneficiary shall provide the Fund with documents verifying eligibility for the
				educational program and shall demonstrate appropriate progress to be eligible
				for consideration of ongoing support. A credentialed professional shall provide
				services. Services are the provision of tutorial support designed to compensate
				for cognitive deficits associated with traumatic brain injury;
18. Respite care, defined as intermittent,
				temporary or short-term care to provide relief to or replace an absent or
				incapacitated unpaid caregiver. Services shall be provided in-home by a
				licensed or accredited home care agency or out-of-home by a licensed nursing
				facility, assisted living facility or community residential services
				program;
19. Medical care, defined
				as sub-acute treatment directly related to the traumatic brain injury. A
				licensed practitioner shall provide services;
20. Vision care, defined as eye care directly
				related to the traumatic brain injury. A licensed ophthalmologist or
				optometrist with experience in treating individuals with traumatic brain injury
				shall provide services. Payment for glasses or contact lenses will be limited
				to once every 12 months;
21. Dental
				care, defined as rehabilitative or restorative dentistry directly related to
				the treatment of dental injury related to the onset of, or care related to the
				traumatic brain injury. A licensed dentist shall provide services;
22. Protective legal services, defined as
				provision of guardianship services, preparation of a special needs trust and
				similar services related to the traumatic brain injury where these services are
				determined essential to the beneficiary's well being. Only attorneys who are
				members admitted to a state bar shall provide services;
23. Personal care, defined as assistance with
				eating, bathing, dressing, personal hygiene, activities of daily living, meal
				preparation and light housekeeping. A certified personal care assistant or home
				health aide shall provide services. Payments will be made only to licensed or
				accredited home care agencies, not individual contractors;
24. Companion care, defined as non-medical
				care, supervision, and socialization provided to the beneficiary to ensure
				safety and enhance quality of life. An individual experienced in working with
				brain injury may provide services, or a relative who is not a regular caregiver
				and does not reside in the residence of the applicant/beneficiary may provide
				services;
25. Parental support,
				defined as time-limited support required by a parent with a brain injury, when
				the parent is unable to perform with normal child rearing activities or defined
				as support for the parent when a child with a brain injury has behavioral and
				management problems. Only an adult with experience and training in brain injury
				and childcare shall provide this service. Support shall be centered on coaching
				and training the parent to perform parental care responsibilities
				independently. The parent must be present and involved in care when the service
				is rendered;
26. Household
				management, defined as support and assistance for a brain injured person in
				organizing the daily activities of managing a household, including shopping,
				meal preparation, housekeeping, bill paying and assistance with mail. This
				service may also include non-routine housekeeping required by the beneficiary
				to maintain a safe sanitary environment. An adult or provider agency with an
				understanding of brain injury shall provide services;
27. Financial management, defined as
				assistance with bill paying, banking and long-term financial planning when a
				knowledgeable family member or friend is not available. A financial
				professional or unrelated adult with experience and knowledge in financial
				management, depending on the complexity of the activity, shall provide
				services;
28.
				Transportation/vehicle modification, defined as payment for transportation
				services to provide access for the beneficiary to medical appointments,
				treatment facilities, or vocational programs. Activities under this service may
				include:
i. The modification of a vehicle
				specifically for the use/transport of the beneficiary if it is justified under
				the service plan as appropriate and cost effective. Certified licensed vendors
				must provide modifications to vehicles. If the vehicle is to be operated by the
				beneficiary, the beneficiary must have a valid driver's license, and
				demonstrate capacity to maintain insurance coverage. This benefit is limited to
				one vehicle per 12-month period;
ii. The purchase of services from a
				commercial transportation vendor including certified transportation services,
				such as ambulances, mobility assistance vehicles, or taxis. Payments may be
				made to the provider of the service or to the beneficiary/family upon
				presentation of the proof of purchase or service; and/or
iii. Reimbursement of the cost of travel for
				a beneficiary. The reimbursement shall not exceed the State's mileage rate as
				defined by the State Treasurer, the cost of any road tolls, and parking charges
				with valid receipts. This provision may be invoked by the Fund where
				beneficiaries demonstrate clear hardship in obtaining commercial
				transportation, or where individual travel reimbursement is in the best
				interest of the Fund;
29. Environmental modifications, defined as
				physical adaptation to the beneficiary's primary home necessary to ensure the
				health, welfare and safety of the beneficiary and/or to enable the beneficiary
				to function with greater independence. Modifications may include ramps and
				devices to assist with activities of daily living, room alterations or
				electrical and plumbing alterations to accommodate special equipment. This
				definition excludes adaptations or improvements to the home not directly
				related to the care of the beneficiary and excludes payment of expenses related
				to returning the environment to its original condition in accordance with
				Federal and State law. Services shall be provided by companies/businesses
				licensed to provide the intended modification. Three price quotations shall be
				required for any project with a cost over $ 1,500; and
30. Durable medical equipment and assistive
				technology. Durable medical equipment includes any equipment necessary to the
				beneficiary's health, safety, and function. Assistive technology is defined as
				any technological device that improves the functional independence of the
				beneficiary. Equipment and technology must be justified under the service plan
				as necessary, cost effective, and directly related to clinical rehabilitation.
				Social interaction and normal usage activities cannot be considered to justify
				a purchase of equipment or technology. The Fund shall, with clinical
				documentation of need, consider replacement of equipment after a period of 36
				months after the original purchase date. Age and functionality are insufficient
				reasons to request replacement of equipment. The Fund shall limit purchases to
				essential computer periphery. This benefit is limited to one hard drive per
				applicant. This definition excludes payment for routine repairs, upgrades, or
				service contracts. Such expenses shall remain the responsibility of the
				beneficiary. Suppliers must be certified equipment providers. Payments may be
				made to the provider of service or to the beneficiary/family upon presentation
				of proof of purchase. A certified durable medical equipment provider or
				technology provider shall provide this service. Replacement or repair of lost
				or damaged equipment by the Fund is not guaranteed and shall be evaluated on a
				case-by-case basis.