reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 3 - INTERIM ASSISTANCE CASE PROCESSING › Section 8:133-3.4 - Responsibilities of the Discharge and/or Financial Unit

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Discharge or
				Financial Unit or equivalent shall:
1. Receive and
				process referrals for community placement and financial assistance;
2. Render eligibility decisions for Interim
				Assistance based on information received from the Social Security
				Administration;
3. Assemble the
				necessary information and documents for SSI applications, forward this material to
				the Social Security Administration, and monitor the SSI application process,
				including follow-up with Social Security on any applications pending for more than
				six months;
4. Obtain placements in
				suitable and approved residential settings, including, but not limited to,
				out-of-State facilities licensed by other states if located in an area served by New
				Jersey Medicaid providers and obtain signed Contracts for Interim Assistance
				(Appendix C) from congregate care providers or from a responsible family member, as
				appropriate for placements in a family residence;
5. Assist clients in negotiating community
				financial systems;
6. Provide follow-up
				contacts to ensure that the Personal Needs Allowance and maintenance payments are
				being regularly received and properly utilized;
7. Assist clients interested in appealing their
				denial by referring them to an agency for legal representation;
8. Notify the business manager to terminate
				Interim Assistance payments when eligibility or ineligibility for SSI benefits is
				established.
9. Notify the Social
				Security Administration of any change in the client's living arrangement, such as a
				return to the hospital or an elopement from the home; and
10. Notify the social services staff that the
				retroactive check is received and Interim Assistance has been terminated.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 3 - INTERIM ASSISTANCE CASE PROCESSING › Section 8:133-3.5 - The Office of Fiscal and Management Operations of the Division of Mental Health Services

Current through Register Vol. 56, No. 14, July 15, 2024
The role of the Office of Fiscal and Management Operations of the
				  Division of Mental Health Services shall be to receive copies of form FS-9, Business
				  Manager's Statement to Interim Assistance Recipient (Appendix H) or form FS-9A,
				  Business Manager's Statement to SSI Applicant (Appendix M) and completed form
				  SSA-L8125, State's Accountability Report, from the hospital business managers,
				  assure that SSI benefits were disbursed in accordance with Social Security
				  Administration regulations and add this information to the record.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 3 - INTERIM ASSISTANCE CASE PROCESSING › Section 8:133-3.7 - Action by the Social Security Administration

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Social Security
				Administration should:
1. Receive signed form
				MH-30's;
2. Evaluate SSI
				applications;
3. Direct retroactive SSI
				checks to the appropriate hospital in accordance with the Interim Assistance
				agreement;
4. Notify the Financial
				Entitlement Unit of approvals and denials of SSI applications;
5. Notify clients and/or representative payees of
				decisions reached;
6. Notify clients
				and/or representative payees that initial SSI retroactive checks shall be forwarded
				to the hospital; and
7. Hear client
				appeals regarding the amount of SSI payments and other adverse (financial and
				medical) actions.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 3 - INTERIM ASSISTANCE CASE PROCESSING › Section 8:133-3.8 - Responsibilities of the congregate housing provider

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When a client is
				placed in a congregate living residence, the congregate housing provider shall sign
				a contract for Interim Assistance agreeing to:
1.
				Accept the client for placement;
2.
				Furnish the client with food, if normally available at the facility, lodging, and
				necessary incidentals;
3. Accept an
				agreed-upon per diem as compensation by the seventh day of the month in which
				services are rendered;
4. Contact the
				hospital and designated emergency screening service in the event the client needs
				emergency medical or psychiatric care. The provider shall furnish details as to the
				patient's condition and shall abide by such directions as are given. In the event of
				a serious medical or psychiatric emergency, the provider shall arrange for immediate
				care and then notify the hospital and emergency screening service;
5. Provide the placing hospital with 30 calendar
				days' written notice of his of her intent to terminate the contract
				agreement;
6. Notify the hospital should
				the provider become aware that the client directly received the initial retroactive
				SSI check;
7. Refund to the hospital any
				Interim Assistance or other payments received which represent duplicate compensation
				to the provider for the time period beginning with the placement and ending with
				receipt of the initial SSI check; and
8.
				Notify the hospital immediately in the event the client terminates residence at the
				home.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 4 - INTERIM ASSISTANCE PAYMENT PROCEDURES › Section 8:133-4.1 - Authorization of payments

Current through Register Vol. 56, No. 14, July 15, 2024
Interim Assistance payments require the authorization of the
				  Financial Coordinator or his or her designee.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 4 - INTERIM ASSISTANCE PAYMENT PROCEDURES › Section 8:133-4.2 - Exempt resources

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Client cash
				resources, including Federal annuity awards, funds set aside for funeral and burial
				expense or identified special needs, and liened resources up to the amount due for
				care and maintenance shall be considered exempt (up to the SSI resource cap) in
				Interim Assistance eligibility determination.
(b) Rental assistance either from a Federal or
				State-funded program (including DMHS) is excluded as available income prompting a
				reduction in Interim Assistance payments where such resources do not deem a
				recipient ineligible for SSI. This exclusion applies only to clients in independent
				living situations (for example, client's own home or apartment where clients have a
				lease and are responsible for expenses such as the rent, utilities, food,
				furnishings, maintenance, etc.)
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 5 - MEDICAID COVERAGE FOR INTERIM ASSISTANCE CLIENTS › Section 8:133-5.1 - Medicaid coverage

Current through Register Vol. 56, No. 14, July 15, 2024
An Interim Assistance client shall be eligible for Medicaid
				  coverage until his or her SSI application is adjudicated or he or she is
				  reinstitutionalized.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 5 - MEDICAID COVERAGE FOR INTERIM ASSISTANCE CLIENTS › Section 8:133-5.2 - Procedures

Current through Register Vol. 56, No. 14, July 15, 2024
(a) To ensure Medicaid
				coverage for an Interim Assistance client, the following procedures shall be
				followed:
1. The individual completing the
				hospital daily population movement report shall list an Interim Assistance client as
				released to "Other".
2. The Financial
				Entitlement Unit or equivalent shall notify the Division of Medical Assistance and
				Health Services or designee of each impending client placement in the Interim
				Assistance Program. This notification shall precede the client's release to the
				greatest extent possible to provide for case processing by the Division of Medical
				Assistance and Health Services.
3. The
				Division of Medical Assistance and Health Services will establish community Medicaid
				coverage for the Interim Assistance client and promptly notify the hospital staff or
				designee of the appropriate Medicaid identification number for the client's use in
				obtaining covered medical services while receiving Interim Assistance
				benefits.
4. Form FD-412, Health
				Benefits Identification Card -- Emergency Services Letter, (Appendix K) shall be
				completed by the designated hospital representative on the date of placement, as
				needed. The permanent Health Benefits Identification Card will be received by the
				Interim Assistance recipient within approximately three to five business days of the
				establishment of community Medicaid; and
5. The client, family or housing provider may use
				the Form FD-412 Health Benefits Identification Card -- Emergency Services Letter, to
				obtain covered medical care, including pharmaceuticals, for the client until receipt
				of the permanent Health Benefits Identification Card.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 5 - MEDICAID COVERAGE FOR INTERIM ASSISTANCE CLIENTS › Section 8:133-5.3 - Termination of institutional Medicaid coverage

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The client's
				institutional Medicaid coverage will be terminated as of the last day of the
				calendar month in which he or she is placed in the Interim Assistance
				Program.
(b) Upon notification by the
				Financial Eligibility unit of the client's approval for SSI benefits, the hospital
				shall list the client as "Discharged" on the daily population movement
				report.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 6 - APPEAL PROCEDURES › Section 8:133-6.1 - Right to appeal

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An Interim
				Assistance client shall have the right to appeal an adverse eligibility decision in
				the following situations:
1. The client has been
				denied Interim Assistance by the Financial Entitlement Unit and he or she has filed
				an application for SSI benefits; or
2.
				The client has been found eligible for Interim Assistance but has subsequently been
				terminated from the Interim Assistance program for reasons other than the receipt of
				SSI benefits.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 6 - APPEAL PROCEDURES › Section 8:133-6.2 - Notice of decision and right of appeal

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Financial
				Entitlement Unit shall, within five working days of an adverse eligibility decision,
				notify the client in writing of such decision and shall furnish him or her with a
				summary statement giving the factual and/or legal basis upon which such decision was
				based.
(b) The client shall also, at the
				same time, be advised in writing of his or her right to appeal an adverse
				eligibility decision and of the procedure to be followed in filing an
				appeal.
(c) When a client has a legally
				appointed guardian, the written notification of adverse eligibility decision, the
				summary statement and the notice of right to appeal shall also be provided to the
				guardian.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 6 - APPEAL PROCEDURES › Section 8:133-6.3 - Procedure for filing appeal

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The client or his or
				her representative may provide either written or oral notice to the Financial
				Coordinator of the Discharge or Financial Entitlement Office, of his or her
				intention to appeal an adverse eligibility decision.
(b) Such notice must be provided to the Financial
				Coordinator within 20 calendar days of the date of mailing of the adverse
				eligibility decision and summary statement to the client.
(c) The Financial Coordinator shall, within three
				working days of receipt of the client's notice of intention to appeal, provide the
				client with written acknowledgement of such receipt.
(d) A request for appeal received after the time
				period specified shall be denied unless an unusual situation, such as client
				illness, exists. In such a case an additional 10 calendar days may be allowed by the
				Financial Coordinator for providing notice of intention to appeal.
(e) The placement worker, team social worker,
				and/or community caseworker shall assist the client in providing the Financial
				Coordinator with notice of his or her intention to appeal.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 6 - APPEAL PROCEDURES › Section 8:133-6.4 - Scheduling of Financial Entitlement Unit's review-rights of client

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A review shall be
				scheduled by the Financial Entitlement Unit within 10 calendar days of receipt of
				the client's notice of intention to appeal.
(b) The client shall have the right to be
				represented at the review by a person of his/her choice.
(c) The client and his or her representative shall
				have the right to inspect, prior to and at the review, all Financial Entitlement
				Unit generated documents. The client and his or her representative shall be made
				aware of other documents contained in the Financial Entitlement Unit's file. These
				shall be made available to the client and his or her representative upon the receipt
				by the Financial Entitlement Unit of proper authorization from the originating
				person or agency.
(d) The client shall
				have the right to present any and all evidence which will support his or her claim
				and to question any evidence upon which the denial or termination of Interim
				Assistance was based.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 6 - APPEAL PROCEDURES › Section 8:133-6.5 - Financial Entitlement Unit's review

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The review shall be
				conducted by an employee at the supervisory level or above designated as a reviewing
				officer, other than the person who made the original eligibility determination. Such
				reviewing officer shall be thoroughly familiar with the requirements of the Interim
				Assistance program and relevant Social Security Administration
				regulations.
(b) The review shall be
				conducted in an informal manner and shall be limited to the development of facts
				relating to the appeal.
(c) Only those
				persons whose presence or testimony are essential, that is, persons presenting
				testimony and persons appearing under
				10:38-6.4(b), shall be
				permitted to attend the review.
(d) The
				reviewing officer shall determine eligibility for Interim Assistance solely upon the
				documents and testimony submitted to him or her at the time of the review.
(e) The reviewing officer may, during the review,
				grant a continuance to the client if it appears in good faith that pertinent
				additional evidence establishing eligibility cannot be provided at that time. In any
				case, no continuance shall exceed 10 calendar days.
(f) If neither the client nor his or her
				representative appears at the scheduled review, after having received proper
				notification of such review, the client's appeal shall be considered to have been
				abandoned and the appeal shall be denied, unless the reviewing officer is provided
				with prior notice by the client or his or her representative of his or her inability
				to attend due to unavoidable circumstances. Postponement may be granted by the
				reviewing officer for a period not to exceed 10 calendar days from the originally
				scheduled review date.
(g) If a mutually
				satisfactory agreement between the client and the Financial Entitlement Unit is
				reached prior to the time of the review, the review may be cancelled by the
				reviewing officer, or discontinued if begun, at the client's request in
				writing.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 6 - APPEAL PROCEDURES › Section 8:133-6.6 - Results of the Financial Entitlement Unit's review

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If the reviewing
				officer concludes after hearing all the evidence that the client is eligible for
				Interim Assistance, he or she shall within five calendar days of the review notify
				the client and his or her representative to that effect. The reviewing officer shall
				also advise the Financial Entitlement Unit's staff person who made the original
				eligibility determination that Interim Assistance must be provided to the client
				effective the date of his or her placement in a community setting.
(b) If the reviewing officer concludes after
				hearing all the evidence that the client is ineligible for Interim Assistance, he or
				she shall within five calendar days of the review notify the client, his or her
				representative and the Financial Entitlement Unit of the decision. The reviewing
				officer shall advise the client and his or her representative of the client's right
				to have the decision reviewed at the Division level.
(c) Based on the evidence presented the reviewing
				officer shall prepare a written report of his or her findings summarizing what
				transpired at the review. Copies of this report shall be provided to the client, his
				or her representative, the Financial Entitlement Unit, the Chief Executive Officer
				of the hospital, and to the Assistant Director, Office of Fiscal and Management
				Operations, within five calendar days of the review.
(d) The review and resulting decision by the
				reviewing officer shall be treated and recognized as the initial administrative
				decision of the client's claim for Interim Assistance.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 6 - APPEAL PROCEDURES › Section 8:133-6.7 - Effect of determination by the Social Security Administration

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If prior to the
				review date the Social Security Administration determines that the client is
				eligible for SSI benefits, then the client, if he or she meets all eligibility
				requirements, shall be eligible for Interim Assistance from the date of his or her
				placement in a community setting until he or she begins to receive SSI
				benefits.
(b) If, prior to the review
				date the Social Security Administration determines that the client is ineligible for
				SSI benefits, then the client's sole recourse shall be through the Social Security
				Administration and his or her Interim Assistance appeal shall be denied.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 6 - APPEAL PROCEDURES › Section 8:133-6.8 - Divisional review

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The client shall
				have the right to a divisional review of the Financial Entitlement Unit's reviewing
				officer's decision.
(b) A divisional
				review must be requested in writing within 10 calendar days of issuance of the
				Financial Entitlement Unit's reviewing officer's decision. It must be submitted to
				the Assistant Director, Office of Fiscal and Management Operations, Division of
				Mental Health Services.
(c) In an
				unusual situation, for example, client illness, the Assistant Director, Office of
				Fiscal and Management Operations, may grant an extension of time not to exceed 10
				calendar days for submitting a request for divisional review.
(d) The Financial Entitlement Unit shall assist
				the client in requesting a divisional review.
(e) The Financial Entitlement Unit shall be
				responsible for advising the client regarding the availability of legal
				representation through the Community Health Law Project or local legal services
				corporation, as appropriate, and shall assist the client in communicating his or her
				desire for such representation.
(f) The
				client, and/or representative, shall be permitted to submit comments on the review,
				as well as additional evidence to substantiate his or her claim, to the Assistant
				Director, Office of Fiscal and Management Operations. Such comments and/or evidence
				must be submitted within 15 calendar days of the issuance of the Financial
				Entitlement Unit's reviewing officer's decision.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 6 - APPEAL PROCEDURES › Section 8:133-6.9 - Results of divisional review

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Assistant
				Director, Office of Fiscal and Management Operations, or his or her designee, shall
				review the Financial Entitlement Unit's reviewing officer's decision and shall
				affirm or reject such decision.
(b) The
				Assistant Director, Office of Fiscal and Management Operations, shall within 10
				calendar days of receipt of the client's request for review notify the client, his
				or her representative and the Financial Entitlement Unit of the results of the
				divisional review.
(c) If the Financial
				Entitlement Unit's reviewing officer's decision is affirmed, such decision shall be
				treated and recognized as the final divisional determination of the client's claim
				for Interim Assistance. The client, his or her representative and the Financial
				Entitlement Unit shall be so advised.
(d) The client shall have the right to request a
				hearing before an Administrative Law Judge if he/she is dissatisfied with the
				Assistant Director's decision. Such request must be submitted to the Assistant
				Director within 10 calendar days of issuance of the Assistant Director's decision.
				Upon receipt of such request, the Assistant Director shall immediately refer the
				matter to the Office of Administrative Law for a hearing before an Administrative
				Law Judge, in accordance with the Administrative Procedure Act at
				52:14B-1 et seq. and the Uniform
				Administrative Procedure Rules at N.J.A.C. 1:1.
(e) If the Financial Entitlement Unit's reviewing
				officer's decision is rejected the client shall be declared eligible for Interim
				Assistance benefits from the date of his or her community placement. The client, his
				or her representative and the Financial Entitlement Unit shall be so
				advised.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 6 - APPEAL PROCEDURES › Section 8:133-6.10 - Appeal to the hospital manager of computation of net payment

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An Interim
				Assistance client shall have the right to appeal to the hospital business manager
				the amount of the net payment from his or her retroactive SSI check (after deduction
				of the total Interim Assistance paid out for the client's benefit) and the
				procedures used to compute that net payment.
(b) Within five working days of receipt of the
				retroactive SSI check by the hospital, the business manager or designee shall
				provide the client with a statement detailing the manner in which the net payment
				was computed. The client shall also be provided with a written statement regarding
				his or her right to appeal such computation.
(c) The client shall within 20 calendar days of
				mailing of the above statement be required to serve written or oral notice upon the
				hospital business manager of his or her dissatisfaction with the computation and of
				his or her intention to appeal.
(d) The
				Financial Entitlement Unit shall assist the client in communicating to the hospital
				business manager his or her intention to appeal.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 6 - APPEAL PROCEDURES › Section 8:133-6.11 - Business manager's review

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospital
				business manager shall schedule a conference with the client within 10 calendar days
				of receipt of the client's request for a review.
(b) The business manager, or his or her designee,
				shall meet with the client as scheduled and explain to him or her the procedures
				used to compute the net payment from the client's retroactive SSI check.
(c) The business manager, or his or her designee,
				shall recheck computation of the amount of the net payment.
(d) The review shall be conducted in an informal
				manner and shall be limited to the procedures described in (b) and (c)
				above.
(e) The client shall have the
				right to be represented at the review by a person of his or her choice.
(f) The client shall have the right to present any
				and all evidence that would support his or her claim for a larger net
				payment.
(g) The business manager, or
				his or her designee, may require the attendance of the Financial Coordinator and/or
				placement social worker at the review for the purpose of assisting the client and
				the business manager in the full development of facts.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 6 - APPEAL PROCEDURES › Section 8:133-6.12 - Results of business manager's review

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The business manager
				shall advise the client and the client's representative of his or her decision in
				writing within five calendar days of the review. Copies of this notice shall also be
				provided to the Discharge or Financial Entitlement Unit, the Chief Executive Officer
				of the hospital, and the Assistant Director, Office of Fiscal and Management
				Operations.
(b) The business manager, or
				his or her designee, shall advise the client of his or her right to a divisional
				review.
(c) The business manager shall
				forward to the Assistant Director, Office of Fiscal and Management Operations,
				within three working days of the issuance of the notice to the client, a written
				summary report of the business manager's conference with the client.
(d) The business manager's review and resulting
				decision shall be treated and recognized as the initial administrative decision of
				the client's claim for a larger net payment.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 6 - APPEAL PROCEDURES › Section 8:133-6.13 - Divisional review

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The client shall
				have the right to a divisional review of the procedure used by the business manager
				in computing the client's net payment from his or her retroactive SSI
				check.
(b) A divisional review must be
				requested in writing within 10 calendar days of issuance of the business manager's
				decision and must be submitted to the Assistant Director, Office of Fiscal and
				Management Operations.
(c) The Discharge
				or Financial Entitlement Unit shall assist the client in requesting a divisional
				review.
(d) The Discharge or Financial
				Entitlement Unit shall be responsible for advising the client regarding the
				availability of legal representation through the Community Mental Health Law Project
				or local legal services corporation, as appropriate, and shall assist the client in
				communicating his or her desire for such representation.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 6 - APPEAL PROCEDURES › Section 8:133-6.14 - Results of divisional review

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Assistant
				Director, Office of Fiscal and Management Operations, or his or her designee, shall
				review the business manager's computation of the client's net payment and shall
				affirm or reject such computation.
(b)
				The Assistant Director, Office of Fiscal and Management Operations shall within 10
				calendar days of receipt of the client's request for a review notify the client, his
				or her representative, the business manager and the Financial Entitlement Unit of
				the results of the divisional review.
(c) If the business manager's computation is
				affirmed, such decision shall be treated and recognized as the final administrative
				decision of the client's claim for a larger net payment. The client, his or her
				representative, the business manager and the Discharge or Financial Entitlement Unit
				shall be so advised.
(d) The client
				shall have the right to request a further hearing before an Administrative Law judge
				if he or she is dissatisfied with the Assistant Director's decision. Such request
				must be submitted to the Assistant Director within 10 calendar days of issuance of
				the Assistant Director's decision. Upon receipt of such request, the Assistant
				Director shall immediately refer the matter to the Office of Administrative Law for
				scheduling of a hearing before an Administrative Law judge, pursuant to the
				Administrative Procedures Act,
				52:14B-1 et seq.
(e) If the business manager's computation is
				rejected the Assistant Director, Office of Fiscal and Management Operations, shall
				direct the business manager to issue a corrected payment to the client. Such payment
				shall be issued within five calendar days of issuance of the Assistant Director's
				decision.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 7 - CLIENT INCOME AND RESOURCE MONITORING › Section 8:133-7.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of the
				income and resource monitoring system described in this section is to:
1. Preclude the duplication of Personal Needs
				Allowance and maintenance payments to Interim Assistance clients; and
2. Provide the hospital business manager with
				standard procedures for effecting recoveries of Interim Assistance
				granted.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 7 - CLIENT INCOME AND RESOURCE MONITORING › Section 8:133-7.2 - Responsibilities of the hospital business manager

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospital
				business manager shall be responsible for recouping Interim Assistance payments
				made, first from the client's retroactive SSI check, then from the client's personal
				funds, when accessible, and finally from the client's other resources.
(b) The net balance of the client's Federal
				annuity funds controlled by the hospital shall be directed with SSA approval to the
				client upon his or her discharge.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 7 - CLIENT INCOME AND RESOURCE MONITORING › Section 8:133-7.3 - Chief Executive Officer as representative payee for client income

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When the Chief
				Executive Officer of the hospital is payee for the client's available income other
				than Interim Assistance, the hospital business manager may recoup Interim Assistance
				expenditures as client income payments are received and shall deposit recoveries in
				the Interim Assistance account on a monthly basis.
(b) The business manager shall notify the client
				in writing that recoveries may be made in this manner.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 7 - CLIENT INCOME AND RESOURCE MONITORING › Section 8:133-7.4 - Client or non-institutional agent as payee for available client income

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Business
				Manager's Financial Inquiry form (Appendix G) shall be mailed to the client, the
				housing provider or outside payee prior to the last week of each month that the
				client is eligible for and receives Interim Assistance payments. Unless the client
				is residing within his or her own family or home, a payment voucher for next month's
				payment shall be attached to the Financial Inquiry form sent to the housing
				provider.
(b) When the Financial Inquiry
				Form is returned to the hospital business manager showing additional available
				income, the business manager shall direct the client and/or payee in writing to make
				payments from the additional income directly to the housing provider in accordance
				with the Payee Agreement. Should the client or payee refuse to pay the provider
				directly, the business manager shall calculate and disburse the proper maintenance
				payment in accordance with
				10:38-4.3(e). The
				business manager shall further initiate the steps indicated in
				10:38-7.6 and 7.7.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 7 - CLIENT INCOME AND RESOURCE MONITORING › Section 8:133-7.5 - Client or non-institutional agent as payee for anticipated income

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When an Interim
				Assistance client or representative payee has not begun to receive anticipated other
				income payments, the Business Manager's Financial Inquiry form shall be mailed to
				the client or to the housing provider payee prior to the last week of each month
				that the client is eligible for and receives Interim Assistance payments. Unless the
				client is residing within his or her own family or home, a payment voucher for next
				month's payment shall be attached to the inquiry form sent to the housing
				provider.
(b) When the Financial Inquiry
				form indicating available income is returned to the business manager, he or she
				shall direct the client to make payments directly to the housing provider in
				accordance with the Payee Agreement.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 7 - CLIENT INCOME AND RESOURCE MONITORING › Section 8:133-7.6 - Refusal to honor payee agreement-client

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When an Interim
				Assistance client refuses to honor the Payee Agreement, the following procedures
				shall be followed:
1. The business manager shall
				notify the Financial Entitlement Unit of this fact;
2. A representative of the Financial Entitlement
				Unit or equivalent shall within five working days contact the client and review the
				Payee Agreement with him or her;
3. The
				business manager shall continue to make full Interim Assistance payments until the
				client's discharge if the client makes full reimbursement to the hospital;
				and
4. Interim Assistance shall be
				terminated immediately if the client continues to refuse to make
				reimbursement.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 7 - CLIENT INCOME AND RESOURCE MONITORING › Section 8:133-7.7 - Refusal to honor payee agreement-representative payee

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When a
				representative payee refuses to honor the Payee Agreement or questions any of its
				stipulations, the following procedures shall be followed:
1. The hospital business manager shall notify the
				Financial Coordinator of this fact;
2.
				The Financial Entitlement Unit shall within five working days contact the
				representative payee, clarify the situation and encourage him or her to comply with
				the Payee Agreement;
3. The Financial
				Entitlement Unit shall have the client initiate necessary procedures to have a new
				representative payee appointed if compliance with the terms of the Payee Agreement
				is not forthcoming;
4. Interim
				Assistance payments shall continue while payee reassignment is being effected;
				and
5. Interim Assistance shall be
				terminated immediately if the client fails or refuses to have a new representative
				payee appointed.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Subchapter 7 - CLIENT INCOME AND RESOURCE MONITORING › Section 8:133-7.8 - Termination of Interim Assistance

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When notified by the
				Financial Entitlement Unit or equivalent that the client's Interim Assistance has
				been terminated, the business manager shall:
1. If
				a client is his or her own payee, mail a form FS-9, Business Manager's Statement to
				Interim Assistance Recipient, or form FS-9A, Business Manager's Statement to SSI
				Applicant reflecting Interim Assistance payment made and recoveries effected, to the
				client within five working days of Interim Assistance termination together with a
				bill for any outstanding balance;
2. If
				the client has a representative payee, mail the form FS-9 or FS-9A to the client
				within five working days of Interim Assistance termination and send the payee a copy
				of the FS-9 or FS-9A along with a bill for any outstanding balance;
3. Refer to the Discharge or Financial Entitlement
				Unit, within 30 calendar days after mailing of the bill, instances of failure by the
				client and/or representative payee to make payment of any outstanding balance to the
				hospital;
4. The Discharge or Financial
				Entitlement Unit shall review the matter with the client and/or representative
				payee, as necessary, in an effort to effect reimbursement; and
5. If the client and/or representative payee
				continue to fail or refuse to make payment to the hospital of any outstanding
				balance, the Discharge or Financial Entitlement Unit or equivalent shall immediately
				refer the matter to the Division of Mental Health Services' attorney for possible
				legal action.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Appendix A

Current through Register Vol. 56, No. 14, July 15, 2024
INTERIM ASSISTANCE STATEMENT
I have been made aware of the Interim Assistance
						Program and its
requirements, and understand my rights and
						responsibilities as a recipient
of Interim Assistance.
I am _______ am not _______ interested in applying
						for Interim Assistance.
Signature: ____________________________
Witness: ____________________________
Date: _______________________________
Sample Form
Distribution:
Financial Coordinator (original)
Client
FORM MH-30
Hospital Social Worker
(Rev. 1/90)
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Appendix D

Current through Register Vol. 56, No. 14, July 15, 2024
STATEMENT OF BUSINESS MANAGER STATE PSYCHIATRIC HOSPITAL
......................................
......................................
(Hospital)
(Client Name)
......................................
......................................
(Business Manager)
(Client Social Security
						Number)
As Business Manager of the above-named State Psychiatric Hospital, I
				agree to authorize commitment of funds for Interim Assistance to, or on behalf of,
				the stated client. The client must be a bona fide SSI applicant for those goods and
				services required during the period while the application for SSI is being
				investigated.
The original copy of this completed form will be sent to the local
				Social Security Administration (SSA) District Office. One copy will go to the
				Discharge/Financial Coordinator or equivalent at the above noted hospital.
If an SSI check is received from the SSA on behalf of the applicant
				(client), I will arrange to deposit it into the client's patient trust account. I
				will arrange to pay to the hospitals Interim Assistance account an amount equal to
				the total recoverable assistance granted during this period. The hospital will pay
				to the applicant or representative payee the balance, if any, within five (5)
				business days from the date of receipt of the check by the above hospital. The
				payment will be accompanied by a completed copy of Form FS-9, explaining how the
				hospital computed the amount.
All accounts and records dealing with this activity shall be
				available for examination by duly authorized State and/or Federal
				representatives.
Under the Interim Assistance Placement procedure funded through the
				Division of Mental Health Services, recipients first check should go to the above
				hospital.
.........................
...................................................
(Date)
(Signature of Business Manager)
Distribution:
SSA/DO--Original
Business Manager
Discharge/Financial Coordinator
Form FS-10 (Revised 7/95)
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Appendix E

Current through Register Vol. 56, No. 14, July 15, 2024
APPENDIX E
PAYEE AGREEMENT
As used in this agreement, the term "Housing
						Provider" shall mean a congregate residence provider, a landlord, or a family
						member. In addition, this agreement shall apply to situations where the client lives
						independently.
I understand that I, as an Interim Assistance
						recipient, will have my community maintenance paid in full or in part by the
						Division of Mental Health Services until a determination of my SSI claim is made.
						The Division will also supplement my personal needs expenses, when necessary.
I also understand that income available to me or my
						representative payee while I am an Interim Assistance recipient, up to the normal
						monthly room and board rate, must be turned over to __________________________,
						toward
(Housing Provider)
payment of room and board expenditures.
I therefore agree:
1. To notify the Business Manager,
						____________________ Psychiatric Hospital, when income or resources from any source
						becomes available to me or my representative payee; and based on the Business
						Manager's direction, I agree to turn over all income or resources received by me
						(but not exceeding my monthly room and board rates) to the _______________________,
						until recurring SSI is available.
(Housing Provider)
2. That, if there are insufficient recoverable funds
						available from the initial SSI retroactive check for full reimbursement of Interim
						Assistance funds granted, the balance owing may be recovered by the hospital
						business office from other sources of funds available to me.
In the event that a representative payee selected by
						me fails to abide by the terms of this agreement, I will take the necessary steps to
						have a new representative payee appointed.
payment of room and board expenditures.
I therefore agree:
Witness: ___________________________________
Signature: ____________________
Address: ____________________
____________________
Date: _______________________
Sample Form
Distribution:
Business Manager (original)
Client
Representative Payee
Financial Coordinator
(Rev. 11/05)
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Appendix E1

Current through Register Vol. 56, No. 14, July 15, 2024
APPENDIX E1
REPRESENTATIVE PAYEE AGREEMENT
As used in this agreement, the term "Housing
						Provider" shall mean a congregate residence provider, a landlord, or a family
						member. In addition, this agreement shall apply to situations where the client lives
						independently
As payee or potential representative payee for an
						Interim Assistance recipient, I understand that the recipient will have his or her
						community maintenance paid in full or part by the Division of Mental Health Services
						until a determination of the SSI claim is made. The Division will also supplement
						the personal needs expenses, when necessary.
I understand that while the client is an Interim
						Assistance recipient, if I receive any client income up to the normal monthly room
						and board rate, I must forward it to ______________________.
(Housing Provider)
I therefore agree:
1. To notify the Business Manager,
						____________________ Psychiatric Hospital, when income or resources from any source
						becomes available to me or my representative payee; and based on the Business
						Manager's direction, I agree; to turn over all income or resources received by me
						(but not exceeding my monthly room and board rates) to the ___________________ until
						recurring SSI is available.
(Housing Provider)
2. That if there are insufficient funds available
						from the initial SSI retroactive check for full reimbursement of Interim Assistance
						funds granted, the balance owing may be recovered by the hospital business office
						from other sources of funds available to the client.
In the event that a representative payee selected by
						the client fails to abide by the terms of this agreement, the client or Division
						will take the necessary steps to have a new representative payee appointed.
I, ___________________________, agree to the terms
						stated above.
Witness: ___________________________________
Signature: ____________________
Address: ____________________
Date: ________________________
____________________
____________________
Sample Form
Distribution:
Business Manager (original)
Client
Representative Payee
Financial Coordinator
(Revised 11/05)
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 133 - INTERIM ASSISTANCE PROCEDURES MANUAL › Appendix G

Current through Register Vol. 56, No. 14, July 15, 2024
APPENDIX G
BUSINESS MANAGER'S FINANCIAL INQUIRY
Re: _________________________________
(Client)
Dear ________________________________:
(Interim Assistance Payee)
Please respond to the following questions and return
						to me within 5 days of receipt. Payment of room and board may be contingent upon
						completion of this form.
To the best of your knowledge, has the above named client
						received:
YES
NO
Supplemental Security Income Payment?
[ ]
[ ]
A Social Security benefit?
[ ]
[ ]
Any other type of benefit (specify)? ____________
[ ]
[ ]
A Community Medicaid card?
[ ]
[ ]
Rental Assistance Program* (State or Federal)?
[ ]
[ ]
If your answer is "yes" to any of these questions,
						please provide the following information:
Date Payment/Medicaid card was received:
						__________________
Type of Payment:
						__________________________________________
Amount of Check(s):
						_______________________________________
Check(s) Issued to (name):
						________________________________
* (Rental Assistance either from a Federal or
						State-funded program (including DMHS), is excluded as available income that would
						ordinarily replace IA funding. This exclusion is for clients in independent living
						situations (i.e. clients own home or apartment where clients have a lease and are
						responsible for expenses such as the rent, utilities, food, furnishings,
						maintenance, etc.) and where SSI eligibility would normally continue.)
___________________________
(Business Manager)
___________________________
(Interim Assistance Payee)
___________________________
(Client)
Sample Form
Distribution:
Interim Assistance Payee--Original
Client
Business Manager
(Rev. 11/05)
(Forms--BMFI)