reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 4 - CASH GRANT AND CASH MANAGEMENT PLAN › Section 10:142-4.4 - Non-permissible expense items

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				budget may not be used for goods and services that are not related to the
				activities of daily living including, but not limited to:
1. Goods and services covered by Medicaid or
				other public entitlement programs;
2. Goods and services provided to or
				supporting persons other than the individual participant;
3. Personal items not directly related to the
				participant's disability or individual personal care needs;
4. Room/board, rent, mortgage payments, and
				other normative living expenses;
5.
				Routine household expenses including utilities and regular
				maintenance;
6. Experimental
				goods/services;
7. Costs associated
				with travel (airfare, train, bus, rental cars, lodging, meals, etc.) for
				vacations or entertainment;
8.
				Food, vitamins, food or vitamin supplements, or medications;
9. Entertainment equipment and related
				supplies;
10. Recreational
				activities, exercise/fitness equipment, and/or memberships;
11. Household appliances not directly related
				to personal care needs;
12.
				Personal items (clothing and accessories) or social expenses (gambling,
				alcohol, recreational drugs, both legal and illegal);
13. Household furnishings, routine
				maintenance, and/or cleaning supplies;
14. Normative vehicle expenses, including
				routine maintenance, repairs, or insurance;
15. Landscape and yard work;
16. Salon services (manicures, pedicures,
				haircuts) and spa treatments (massages);
17. Computers for routine use only, and
				unrelated to accommodations due to a physical limitation or with
				speech;
18. Routine pet care or
				service animal expenses;
19.
				Environmental or vehicular modifications that are afforded under other
				available resources, or being procured under new residential construction, even
				if the new dwelling is designed to accommodate the personal care needs of a
				participant.
20. Services that are
				intended or provided for supervision and monitoring; or
21. Overtime, bonuses, or any type for
				remuneration other than salary as defined in the CMP.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 4 - CASH GRANT AND CASH MANAGEMENT PLAN › Section 10:142-4.5 - Cash management plan standards

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The cash management plan (CMP) shall
				indicate a pre-determined monthly cash allowance, which represents the amount
				available for use for hiring employees and purchasing services and/or goods as
				described in N.J.A.C. 10:142-4.3.
(b) The participant or representative shall
				decide which services, supports, and goods to purchase and document each item,
				with the corresponding expense(s), for inclusion in the development of the CMP.
				The plan shall indicate the monthly cost and frequency of each service, and
				rate of pay for all individual(s) or vendor(s) hired.
(c) The participant/representative will be
				granted budget authority to expend funds to meet personal care needs as
				identified within the plan and approved by the Division.
(d) The participant, or representative, is
				responsible for managing the CMP and requesting guidance from the consultant
				when changes need to be made.
(e)
				All CMPs shall be reviewed by and given final approval by the State program
				office. Payments for services based on an unapproved CMP, will be
				denied.
(f) All payments for
				services under the plan shall be made by the vendor fiscal employer agent
				(VF/EA), based upon approved items in the CMP and submission of required
				documentation. Any request to use funds to pay for unauthorized expenses shall
				be denied.
(g) The start date for
				initiating an approved CMP shall be effective on the 1st of the following
				month, to be determined by the State program office as follows:
1. The determination of CMP approval dates
				shall be in accordance with a schedule prepared by the State program office
				that includes information on required dates of receipt and corresponding
				effective dates.
2. The schedule
				shall be updated annually, at a minimum, in order to ensure appropriate
				implementation in a manner requested by the participant and to enable changes
				to be initiated and shared with participants and consultants, as
				requested.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 4 - CASH GRANT AND CASH MANAGEMENT PLAN › Section 10:142-4.6 - Penalties for overspending the cash management plan

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Participants/authorized representatives
				are responsible for ensuring that cash grant expenses are not in excess of the
				total allocation as determined under N.J.A.C. 10:142-4.1(a).
(b) The VF/EA staff shall monitor the
				participant's expenditures under the cash management plan and are responsible
				for informing the participant (and representative, as appropriate) and the
				Division of any overspending.
1. The VF/EA
				shall provide necessary information on the amount of funds overspent pursuant
				to (b) above.
2. The Division shall
				advise the participant and consultant of the need for a corrective action to
				modify the cash management plan to effectively reduce the monthly cash
				allocation to enable recoupment of the amount overspent.
3. Upon recoupment of the over-expenditure in
				(b)2 above, the participant will be permitted to modify the cash management
				plan to its original form, in accordance with cash allocation based upon the
				current PCA assessment.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 4 - CASH GRANT AND CASH MANAGEMENT PLAN › Section 10:142-4.7 - Cash management plan monitoring and modification

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The consultant shall periodically review
				and monitor service provisions with the participant to determine whether needs
				for personal care are being met through services identified in the cash
				management plan (CMP).
(b) The CMP
				may be revised as often as needed, at the request of the participant/authorized
				representative, if a participant decides to change the way he or she is using
				his or her funds to ensure that needs are being met, or based upon a
				reassessment determination pursuant to N.J.A.C. 10:142-6.2.
1. The participant shall be notified of the
				need to modify the CMP in order to effect a change in service hours and monthly
				budget allocation, resulting from a reassessment determination and subsequent
				change in services, and must submit the revised plan to the Division within 45
				days of the original notification or by the deadline required within the
				notification, whichever comes first, for final review and
				determination.
2. Until such time
				that a modified cash management plan is obtained and approved by the Division,
				the participant will continue to manage services in accordance with his or her
				last approved CMP.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 5 - APPLICATION DISPOSITION, ENROLLMENT, AND SERVICES › Section 10:142-5.1 - Application disposition

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				Division shall review the self-direction enrollment package and cash management
				plan, as submitted by the consultant, and affirm the establishment of the
				applicant as employer of record under the program.
(b) Division staff shall verify Medicaid
				eligibility as defined in N.J.A.C. 10:142-2.1.
(c) If the participant is determined as
				appropriate for participant directed services following review of the
				application described in (a) above, the Division shall:
1. Inform the respective MCO liaison (for
				participants enrolled in managed care) and VF/EA of the start date for program
				services;
2. Issue written or
				electronic correspondence informing the applicant of the start date and monthly
				budget amount pursuant to N.J.A.C. 10:142-4.1; and
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 5 - APPLICATION DISPOSITION, ENROLLMENT, AND SERVICES › Section 10:142-5.2 - Enrollment

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The start date
				for initiating services and using the CMP for new applicants shall be
				determined by the Division in accordance with N.J.A.C. 10:142-4.5(g).
(b) If the enrollment package as described in
				N.J.A.C. 10:142-5.1(a) is determined to be incomplete and/or contains errors,
				the Division will return the forms to the VF/EA for correction and
				resubmission. Participants may not be enrolled into the program until the
				application package is determined as completed in full by the
				Division.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 5 - APPLICATION DISPOSITION, ENROLLMENT, AND SERVICES › Section 10:142-5.3 - Service standards

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For the
				purposes of this program, the following service standards shall be met:
1. An individual approved for
				participant-directed services may use traditional provider agency services only
				when indicated as a private purchase arrangement under an approved cash
				management plan (CMP);
2. Program
				funds shall not be used for the performance or arrangement of skilled
				professional medical services;
3.
				Services under the program shall be suspended during a period of stay in a
				medical facility and resumed automatically upon discharge to the participant's
				residence, if the stay is not more than 30 days, otherwise, authorization from
				the MCO is required.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 6 - PARTICIPANT SELF-DIRECTION AND REASSESSMENT › Section 10:142-6.1 - Participant self-direction

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				Division shall retain sole authority in determining an individual's
				appropriateness for participant-directed services under the program.
(b) In the event of a change in the
				participant's condition, negatively impacting his or her continued ability to
				self-direct activities of daily living, that is detected by the MCO liaison
				care manager or program consultant, concerns must be provided to the Division
				along with supporting evidence to document the situation. The Division shall
				investigate all concerns and review information pursuant to this section, as
				well as from other sources, and shall render a determination regarding
				continuation of program eligibility, including the potential mitigation of
				circumstances.
(c) If the
				participant is determined to be incapable of participant-direction, the
				Division shall inform the participant in writing and notify the MCO liaison
				accordingly, so they can obtain traditional agency delivered PCA
				services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 6 - PARTICIPANT SELF-DIRECTION AND REASSESSMENT › Section 10:142-6.2 - Reassessment requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A
				personal care assistant nursing reassessment visit shall be conducted on a
				schedule determined by the Division of Medical Assistance and Health Services
				or at the discretion of the MCO or Division, as appropriate. A reassessment may
				be required in the event of a change in the participant's health condition or
				needs, support system, or the duration of a period of disenrollment from the
				program if those circumstances affect the need for personal care assistance.
				The following documents must be submitted in support of a request for
				reassessment:
1. Certification from a
				physician indicating a change in condition;
2. Verification indicating the loss of
				primary support; or
3. Participant
				request for reinstatement for program eligibility as described in N.J.A.C.
				10:142-8.3, where the reassessment approval period has expired.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 6 - PARTICIPANT SELF-DIRECTION AND REASSESSMENT › Section 10:142-6.3 - Change in scope, duration, and/or amount of services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The outcome of the reassessment pursuant
				to N.J.A.C. 10:142-6.2 shall determine the number of PCA hours needed to be
				used as the basis for determining the budget allocation under the program as
				described in N.J.A.C. 10:142-4.1.
(b) The reassessment package documents as
				described in N.J.A.C. 10:142-3.1(c) shall be reviewed by the Division,
				following completion of the reassessment by the MCOs for participants enrolled
				in managed care, or by Division staff for individuals enrolled in
				fee-for-services. The Division shall communicate the results of the
				reassessment to the participant, pursuant to contract provisions between the
				Department and MCOs.
(c) A change
				in the monthly cash allocation may not be initiated without an approved
				modified cash management plan (CMP). The Division shall inform the participant
				in writing of any need to modify the CMP pursuant to N.J.A.C. 10:142-4.7,
				resulting from the reassessment outcome and the subsequent change in the
				monthly cash allocation under (b) above.
(d) The Division will provide a time frame
				for completion and deadline for submission by participant of any modified CMP.
				Failure to complete a modified CMP by the requested date assigned by the State
				program office may result in disenrollment from the program due to
				non-compliance.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 7 - VENDOR FISCAL EMPLOYER AGENT (VF/EA) › Section 10:142-7.1 - Responsibilities of the VF/EA

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				VF/EA shall be an agency under contract with the Division that shall serve as a
				business agent as defined in Section 3504 of the IRS Code and Revenue Procedure
				70-6f, for all participants of the program.
(b) The VF/EA shall perform the following
				financial administration functions, at a minimum:
1. Assist participants to enroll as the
				"common-law" employer for program purposes and grant rights permitting budget
				authority and employer authority;
2. Assist participants in establishing and
				maintaining a bank account for the purpose of payroll distribution and program
				related expenses;
3. Develop and
				implement a system for documenting participant's cash allocation determination
				and tracking receipt and disbursement of funds and any remaining
				balances;
4. Perform bookkeeping
				services for participants;
5.
				Process forms as required by the Internal Revenue Service (IRS), the New Jersey
				Department of the Treasury, and/or the New Jersey Department of Labor and
				Workforce Development, to establish and maintain each program participant as a
				business entity;
6. Review and
				process required employment information for workers employed by program
				participants;
7. Withhold and pay
				all applicable business taxes for participants;
8. Withhold and pay all applicable employment
				taxes for workers employed by participants;
9. Review worker timesheets, to assure
				accuracy and compliance with the CMP;
10. Issue payments to vendors and service
				providers pursuant to the CMP;
11.
				Assist participants in obtaining and retaining workers' compensation coverage
				in accordance with State and Federal law, including prepayment prior to
				enrollment;
12. Prepare and issue
				reports as required by the IRS or New Jersey Department of Labor and Workforce
				Development, and share copies with participants (and representatives, as
				appropriate); and
13. Function as a
				payroll agent for workers employed by program participants, and perform the
				following tasks that include, but are not limited to:
i. Issuing paychecks to employees hired by
				consumers;
ii. Processing
				unemployment, New Jersey State Temporary Disability, and Family Medical Leave
				Act (FMLA) claims; and
iii. Issuing
				employment and wage verification letters.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 8 - DISENROLLMENT AND REINSTATEMENT › Section 10:142-8.1 - Voluntary disenrollment

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Voluntary disenrollment of service involves situations in which eligible
				individuals request and/or agree to the cessation of participant-directed
				services.
(b) Participants that
				voluntarily discontinue services and request disenrollment from the program may
				return to traditional PCA services through an approved Medicaid home care
				provider agency at any time in accordance with N.J.A.C.
				10:142-1.3(a)6.
(c) In the event of
				a request for a voluntary disenrollment of service by the participant, the
				following procedures shall be followed:
1. The
				Division shall inform the MCO of the disenrollment, for individuals enrolled in
				managed care, to enable transition to traditional PCA services, as requested by
				the participant.
2. Upon agreeing
				on a disenrollment date with the MCO as described in (c)1 above, the Division
				shall instruct the VF/EA to deactivate the participant-directed services
				account accordingly to avoid duplication of services, upon selection of a
				provider agency and the effective date of the transition.
3. The Division shall provide assistance for
				individuals enrolled in Medicaid fee-for-service with the transition to
				traditional services through an approved home care provider, at the request of
				the participant.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 8 - DISENROLLMENT AND REINSTATEMENT › Section 10:142-8.2 - Involuntary disenrollment

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Involuntary disenrollment shall be a result of non-compliance with program
				rules and procedures, or an inability to self-direct and manage program
				services, which may include, but are not limited to, the following
				circumstances:
1. Failure to submit
				information necessary to determine or reaffirm program eligibility;
2. Documented abuse or misuse of program
				services or employees as verified by the Division, with or without the
				provision of technical assistance and support from the consultant and/or
				financial management agent;
3.
				Failure of the participant to manage their own care needs, which results in
				placing the health or welfare of a participant or an employee at increased
				risk, as determined by the consultant, representative, vendor fiscal employer
				agent, or through substantiated allocations of abuse, neglect, or exploitation
				by Adult Protective Services (APS);
4. Duplication of program services through
				other service programs or funding sources as verified by the
				Division;
5. Verified, willful or
				knowing falsification of employee timesheets, vendor invoices, or other
				required program documents;
6.
				Participant is no longer eligible for Medicaid benefits;
7. Commission of other acts identified as
				program fraud or abuse of program services that have been
				substantiated;
8. Failure to notify
				a consultant of admission to a medical facility;
9. Failure to participate in mandated
				required home visits pursuant to N.J.A.C. 10:142-2.2(a)13;
10. Failure to submit timesheets and
				invoices/bills in accordance with prescribed time frames set forth by the
				VF/EA;
11. Documented non-response
				by the participant to attempts to make contact by the Division or agents
				thereof in the administration of the program;
12. Documented unwillingness to accept
				assignment of a mandated representative in accordance with requirements under
				N.J.A.C. 10:142-2.2(c) and 3.3(e);
13. Documented inability to comply with
				participant responsibilities as identified under N.J.A.C. 10:142-2.2;
				or
14. Failure to report changes in
				program contact information to the Division, or agents thereof, pursuant to
				N.J.A.C. 10:142-2.2(a)16.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 8 - DISENROLLMENT AND REINSTATEMENT › Section 10:142-8.3 - Reinstatement standards and procedures

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An individual who has been disenrolled
				pursuant to N.J.A.C. 10:142-8.1 or 8.2 may request a reinstatement to receive
				participant-directed services by contacting the State program office in
				writing, and completing the application process pursuant to N.J.A.C. 10:142-3.1
				and 3.2 with the assistance of the State Program Office.
(b) A reinstatement of program services may
				be granted, with permission from an MCO, where appropriate, if a valid PCA
				nursing reassessment is current and establishes a need for assistance with
				personal care, and the Division affirms the individual's continued ability to
				manage services independently or with the assistance of a representative, in
				accordance with requirements under N.J.A.C. 10:142-6.3.
(c) Upon submission of a request for
				reinstatement to the program, participants will be required to contact the
				VF/EA to determine if new employer registration forms are required, at the
				discretion of the VF/EA, to enable reactivation of the program
				account.
(d) Individuals may obtain
				traditional agency PCA services, in the event of any delay in reactivation of a
				participant-directed services account by the VF/EA, in accordance with
				requirements under N.J.A.C. 10:142-8.2(c)1 and 2.
(e) Participants involuntarily disenrolled as
				a result of substantiated Medicaid fraud or abuse, and confirmed by the New
				Jersey Office of the State Comptroller, Medicaid Fraud Division (MFD), may be
				reinstated onto participant-directed services at the discretion of the Division
				Director, subject to the following standards and procedures:
1. The participant shall be required to make
				financial restitution to the State of New Jersey prior to granting any
				reinstatement.
2. The participant
				shall agree in writing to a corrective action plan, set forth by the Division,
				and complete all required remedial action(s) as set forth in the plan, to
				return to good standing with program guidelines and retain eligibility. Failure
				of a participant to adhere to a mandatory correction plan shall result in a
				lifetime ban from the program, whereby all future reinstatement requests shall
				be automatically denied.
3. Any
				substantiated Medicaid fraud or abuse that has been referred to the New Jersey
				Office of Attorney General for possible criminal action may result in an
				automatic denial of any request for reinstatement and a lifetime ban from
				re-entry into the program, as determined by the Division Director.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 9 - ADMINISTRATIVE REVIEWS, ADVERSE AGENCY ACTIONS, AND FAIR HEARINGS › Section 10:142-9.1 - Request for administrative review

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Applicant/participant complaints, are
				defined as criticisms, protests, objections, concerns, or dissatisfaction
				related to any aspect of the Personal Preference Program.
(b) An applicant or participant may request
				an administrative review of any complaint(s), as described in (a) above, by
				contacting the Division in writing.
(c) Requests for an administrative review
				must state the question/issue to be resolved by a review made by letter and
				mailed to:
State Program Manager
Personal Preference Program
Division of Disability Services
PO Box 705
Trenton, New Jersey 08625-0705
(d) The State Program Administrator shall
				render a decision and respond in writing to all complaints within 30 days of
				receipt, and provide the applicant or participant the final decision on the
				matter in dispute.
(e) Applicants
				or participants who disagree with the decision of the administrative review,
				wherein the outcome results in an adverse agency action as described in
				N.J.A.C. 10:142-9.2, may request a fair hearing before an Administrative Law
				Judge pursuant to N.J.A.C. 10:142-9.3. Instructions for such requests shall be
				incorporated into the written response noted in (d) above.
(f) An exception to (e) above shall apply in
				situations in which a participant is involuntarily disenrolled due to
				non-compliance with program requirements as described in N.J.A.C.
				10:142-8.2(a)1 through 14. The determination on the administrative review
				described in (d) and (e) above shall be deemed as the final agency decision, in
				which a participant will not be entitled to a fair hearing under N.J.A.C.
				10:142-9.3, or any additional appeals regarding the matter in
				dispute.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 9 - ADMINISTRATIVE REVIEWS, ADVERSE AGENCY ACTIONS, AND FAIR HEARINGS › Section 10:142-9.2 - Adverse agency actions and appeal rights

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Determinations on denial of
				participant-directed services and/or involuntary disenrollment from the program
				shall be the responsibility of the Division, pursuant to N.J.A.C. 10:142-8.2,
				for all participants whether enrolled in managed care or in Medicaid
				fee-for-services.
1. Determinations involving
				a need for personal care services or level of benefits and award of services,
				involving reduction in hours, denial of benefits due to non-need, or denial of
				request for increased benefits, shall be the responsibility of the managed care
				organization (MCO) for participants enrolled in managed care.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 9 - ADMINISTRATIVE REVIEWS, ADVERSE AGENCY ACTIONS, AND FAIR HEARINGS › Section 10:142-9.3 - Fair hearings

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Fair
				hearings under this chapter shall be conducted pursuant to the Administrative
				Procedure Act,
N.J.S.A.
				52:14B-1
et seq., and
52:14F-1
et seq., and the Uniform Administrative Procedure
				Rules,
N.J.A.C. 1:1
.
(b) A fair hearing must be requested within
				20 days of receipt of the adverse agency decision by writing or faxing to:
Division of Medical Assistance and Health Services
Fair Hearings Unit
PO Box 712
Trenton, New Jersey 08625-0712
Fax: (609) 588-2435
(c) A fair hearing request will operate as a
				stay of any adverse agency action pending the outcome of the matter under
				appeal.
(d) Once a stay of the
				adverse agency action is applied, participant directed services shall not be
				suspended, reduced, or terminated prior to the completion of the fair hearing
				and the rendering of a final decision.
(e) An exception to (d) above shall be
				afforded when a change in the participant's situation occurs, affecting
				eligibility or award of services under the program, while the decision of the
				administrative review is still pending and the participant does not request an
				additional administrative review related to the subsequent adverse agency
				action.
(f) Upon completion of the
				fair hearing process, a final decision regarding the matter in dispute shall be
				rendered by the Director of the Division of Medical Assistance and Health
				Services.
(g) If the applicant or
				eligible consumer objects to the final decision made in accordance with (f)
				above, a notice of appeal may be filed by the applicant or eligible participant
				with the Appellate Division of the Superior Court of New Jersey. Such appeals
				shall be made within 45 days of the final decision date pursuant to
R.
				2:4-1(b)
.
(h) Further
				information about filing a notice of appeal may be obtained by calling or
				writing the Appellate Division of the Superior Court of New Jersey at:
Richard J. Hughes Justice Complex
PO Box 006
Trenton, New Jersey 08625-0006
(609) 292-4822
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 9 - ADMINISTRATIVE REVIEWS, ADVERSE AGENCY ACTIONS, AND FAIR HEARINGS › Section 10:142-9.4 - Outcome of fair hearings

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If
				the outcome of a fair hearing proceeding results in upholding the adverse
				action initiated by the MCO or State program agency, the following will take
				place:
1. The MCO shall issue a new service
				authorization to the Division to execute changes to the budget allocation. Upon
				receipt of such authorization, the Division shall inform the participant and
				VF/EA of the changes.
2.
				Modifications to the budget allocation and cash management plan shall be made
				effective in accordance with procedures under N.J.A.C. 10:142-4.7.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 142 - PERSONAL PREFERENCE PROGRAM › Subchapter 10 - MEDICAID FRAUD AND ABUSE › Section 10:142-10.1 - Medicaid fraud and abuse

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				Division, and agents thereof, responsible for the administration of the
				Personal Preference Program shall employ methods, including, but not limited
				to, offering training, issuing written materials, etc., to identify situations
				in which a case of fraud and/or abuse in the program may exist.
(b) Any suspected situation of a Medicaid
				fraud or abuse should be reported immediately to the Division.
(c) The Division shall refer to the Office of
				State Comptroller, Medicaid Fraud Division (MFD), any situation(s) in which
				there is valid reason to suspect that Medicaid fraud has or may have been
				committed in accordance with
N.J.A.C.
				10:49-9.12
.
(d) Willful or knowing acceptance of provider
				agency services by an applicant approved for participant-directed services,
				shall constitute fraud and may result in program disenrollment.
(e) Reporting may be performed by contacting
				the Medicaid Fraud and Abuse hotline at 1-888-937-2835 (toll free), or
				electronically by using the following website address:
http://www.nj.gov/comptroller/divisions/medicaid/complaint.html
.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 150 - ORGANIZATION OF THE DIVISION OF THE DEAF AND HARD OF HEARING › Subchapter 1 - SCOPE › Section 10:150-1.1 - Division history and purpose

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The New Jersey
				Division of the Deaf, established by law in 1977, began operations on May 15,
				1978 as a division of the New Jersey Department of Labor and Industry. On April
				28, 1989, the Division of the Deaf was transferred to the Department of Human
				Services from the Department of Labor as a result of a reorganization plan. The
				Division was renamed the Division of the Deaf and Hard of Hearing.
(b) The purpose of the Division of the Deaf
				and Hard of Hearing is to act as an advocate for New Jersey's deaf and hard of
				hearing citizens by promoting increased accessibility to programs, services,
				and information routinely available to the state's general population. Programs
				and services of the Division are administered by a Director who is appointed by
				the Commissioner, Department of Human Services.
(c) The Division's services may include, but
				are not limited to:
1. Information and
				Referral;
2. Deaf and Hard of
				Hearing Awareness Day;
3.
				Interpreter Referral Service.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 150 - ORGANIZATION OF THE DIVISION OF THE DEAF AND HARD OF HEARING › Subchapter 1 - SCOPE › Section 10:150-1.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this chapter,
				  shall have the following meanings:
"Deaf" means a hearing impairment of such severity that the
				  individual cannot understand speech through hearing alone, even with the use of
				  a hearing aid.
"Hard of hearing" means hearing impaired persons who are able
				  to utilize their residual hearing through amplification to such a degree that
				  they are able to carry on normal oral communication with a minimum of
				  difficulty.
"Text Telephone or TTY" means a device that permits people
				  with hearing and speech impairments to communicate using the standard telephone
				  system without the aid of an interpreter. It generally consists of a keyboard
				  and a display screen. "TTY" means text telephone and replaces TDD and
				  TT.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 150 - ORGANIZATION OF THE DIVISION OF THE DEAF AND HARD OF HEARING › Subchapter 2 - OPERATIONS AND SERVICES › Section 10:150-2.1 - Information and referral

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Division of
				the Deaf and Hard of Hearing is a clearinghouse for information on hearing loss
				in New Jersey. The Division distributes, upon request, information concerning
				assistive listening devices, telecommunication devices for the deaf, sign
				language, captioning, and other relevant topics.
(b) The Division serves as an advocate for
				deaf and hard of hearing persons seeking services from public and private
				agencies such as schools, courts, hospitals, employers and
				government.
(c) The Division makes
				available to the general public brochures and pamphlets which describe
				interpreting services, tips on communicating with the deaf, and information on
				how to use a TTY.
(d) The Division
				publishes the "Monthly Communicator" newsletter, which is distributed to deaf
				and hard of hearing individuals as well as professionals serving the deaf. The
				newsletter is a source of information for the deaf community involving
				cultural, social, educational and employment activities.
(e) The Division publishes the comprehensive
				publication entitled "Organizations Serving People With Hearing Loss in New
				Jersey."
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 150 - ORGANIZATION OF THE DIVISION OF THE DEAF AND HARD OF HEARING › Subchapter 2 - OPERATIONS AND SERVICES › Section 10:150-2.2 - Deaf and Hard of Hearing Awareness Day

Current through Register Vol. 56, No. 14, July 15, 2024
The Division of the Deaf and Hard of Hearing annually
				  sponsors Deaf and Hard of Hearing Awareness Day in New Jersey. The event was
				  initiated by the Division in 1984 to promote a better understanding by the
				  general public of the deaf and hard of hearing. Information on hearing loss is
				  available during the event. Also featured are performances by deaf and hard of
				  hearing performers.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 150 - ORGANIZATION OF THE DIVISION OF THE DEAF AND HARD OF HEARING › Subchapter 2 - OPERATIONS AND SERVICES › Section 10:150-2.3 - Interpreter Referral Service

Current through Register Vol. 56, No. 14, July 15, 2024
The Division operates an Interpreter Referral Service which
				  is staffed by coordinators who process requests for qualified sign language
				  interpreters. The coordinators will match the appropriate interpreter with the
				  specific needs of the client.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 150 - ORGANIZATION OF THE DIVISION OF THE DEAF AND HARD OF HEARING › Subchapter 3 - ADVISORY COUNCIL ON THE DEAF AND HARD OF HEARING › Section 10:150-3.1 - Advisory Council; membership

Current through Register Vol. 56, No. 14, July 15, 2024
Pursuant to
				  N.J.S.A.
				  34:1-69.1a, the New Jersey Division of the
				  Deaf and Hard of Hearing has an 18 member advisory council which supports and
				  guides the work of the Division. The members of the council are unsalaried.
				  Twelve public members are appointed by the Governor for staggered terms of
				  three years. Six representatives, one from each of the following, are ex
				  officio members: the Department of Education, Health , Human Services, Labor,
				  and the Commission on Higher Education, and the Marie Katzenbach School for the
				  Deaf. Committee chairs appointed cover the following areas: Education,
				  Community/Agency, Legislative, and Communications.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 155 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Subchapter 1 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Section 10:155-1.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of
				this subchapter is to implement the provisions of P.L. 1987, c. 370 and to:
1. Establish criteria for
				eligibility;
2. Establish a
				standard methodology for determining the amount of financial assistance to be
				allocated for services of a child's health providers and vendors for families
				in the State of New Jersey whose child experiences uncovered medical expenses
				for services required to treat or manage a catastrophic illness; and
3. Specify the procedures that shall be
				followed by the Catastrophic Illness in Children Relief Fund
				Commission.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 155 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Subchapter 1 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Section 10:155-1.3 - General requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to the
				Act, the Fund will provide assistance to families having a child with a
				catastrophic illness. To be eligible for the Fund's assistance, a child's
				verified medical expenses, incurred in any prior consecutive 12-month period in
				the seven years (84 months) prior to the date of application for assistance,
				must exceed the amount equal to 10 percent of the first $ 100,000 of verified
				annual income of a family plus 15 percent of the excess income over $ 100,000.
				The date of application is the date the application is postmarked and mailed,
				faxed, or electronically delivered to the State Office. See N.J.A.C. 10:155
				Appendix I, for example calculations of eligibility for Fund assistance for
				families with different income levels.
1. Ten
				percent shall be the screen used for families whose income is $ 100,000 or
				less.
2. Ten percent of the first
				$ 100,000 of annual income of a family plus 15 percent of the excess income
				over $ 100,000 shall be the screen used for families whose income is more than
				$ 100,000.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 155 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Subchapter 1 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Section 10:155-1.4 - Initial application process

Current through Register Vol. 56, No. 14, July 15, 2024
Applications may be submitted on a year-round basis to the
				  local agency. The name, address, and phone number for the local agencies shall
				  be available from the State Office. The local agency shall forward written
				  applications on forms provided by the State Office. Applications also may be
				  submitted online through the State website:
www.njcatastrophicfund.org
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 155 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Subchapter 1 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Section 10:155-1.5 - State Office and Commission review process

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Upon
				receipt of the paper application from the local agency, or the web application
				from the family, the State Office shall consider the providers' and vendors'
				charges submitted.
(b) Providers
				shall demonstrate licensure or certification by appropriate State or Federal
				agencies, if requested by the State Office.
(c) Prior to the Commission's batched review
				of applications, the State Office shall prepare a disbursement schedule for
				each application in accordance with
				10:155-1.6, 1.7 and 1.8.
(d) In a cycle of batch reviews, the
				Commission shall review the applications and the State Office's disbursement
				schedule for each application based on the annual cap and the sliding payment
				schedule. A decision on the Fund's level of assistance for each case will be
				determined. The calendar for the batch reviews shall be made available to the
				public by the State Office, as required by the Open Public Meetings
				Act.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 155 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Subchapter 1 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Section 10:155-1.6 - Eligibility standard

Current through Register Vol. 56, No. 14, July 15, 2024
Incurred, out-of-pocket medical expenses greater than 10
				  percent of the first $ 100,000 of annual income for a family plus 15 percent of
				  the excess income over $ 100,000 threshold shall be required for eligibility
				  consideration. Those expenses above the family responsibility and up to the cap
				  shall be considered for reimbursement after the eligibility standard is
				  determined and met (see examples in Appendix I).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 155 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Subchapter 1 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Section 10:155-1.7 - Limits on Fund disbursements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The amount of
				Fund's disbursements on behalf of a child shall be capped at $ 100,000 per
				year.
(b) A one-time vehicle
				allowance will be capped at $ 7,500 for the purchase or lease of a specialized
				vehicle. The allowance does not include modifications, which can be considered
				separately. The one-time vehicle allowance of $ 7,500 shall be included in the
				total disbursement cap, in the year the vehicle allowance was
				disbursed.
(c) The amount of the
				home modification allowance shall be capped at $ 25,000 per year.
(d) The amount of the speech, language and
				hearing services allowance shall be capped at $ 3,000 per year.
(e) The amount of the applied behavioral
				analysis services shall be capped at $ 6,000 per year.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 155 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Subchapter 1 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Section 10:155-1.8 - Sliding payment schedule

Current through Register Vol. 56, No. 14, July 15, 2024
If adequate funds do not exist in the Fund at the point in
				  time when a particular batch is being considered by the Commission to pay all
				  applicants the amount of their expenses below the annual cap, a sliding payment
				  schedule shall be used in an effort to distribute the available monies to
				  applicants in an equitable way that considers a family's income, assets and
				  other factors which impact the ability to pay for care.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 155 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Subchapter 1 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Section 10:155-1.9 - Allocation distribution plan

Current through Register Vol. 56, No. 14, July 15, 2024
Because the Fund's actual level of assistance to families,
				  as determined by the Commission, shall in most, if not all, cases be less than
				  the child's medical expenses, the Commission shall determine how the Fund's
				  available monies shall be distributed among eligible providers and vendors.
				  Input from the family shall be sought in the analysis preceding this
				  determination, with guidance from the State Office.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 155 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Subchapter 1 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Section 10:155-1.10 - Local agency responsibilities

Current through Register Vol. 56, No. 14, July 15, 2024
The local agency shall make referrals and assist in the
				  application process for other programs and benefits (for example, Medicaid,
				  Hospital Charity Care, and other programs), where applicable.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 155 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Subchapter 1 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Section 10:155-1.11 - State Office responsibilities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The State
				Office shall:
1. Screen applications to
				determine whether a child's eligible medical expenses meet the eligibility
				standard;
2. Maintain oversight to
				the local agency responsible for assisting families with Program, accepting
				applications and providing local outreach/information;
3. Administer the Fund on a day-to-day basis
				on behalf of the Commission;
4.
				Monitor providers eligibility (that is, certification or other
				credentials);
5. Determine the
				reasonableness of providers and vendor charges;
6. Prepare application for review and
				consideration of the Commission;
7.
				Oversee payments to providers, vendors, and, in some cases, families;
				and
8. Negotiate or settle the
				recovery of funds disbursed in accordance with the provisions of this
				chapter.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 155 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Subchapter 1 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Section 10:155-1.12 - Commission responsibilities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				Catastrophic Illness in Children Relief Fund Commission shall be responsible
				to:
1. Develop policies and procedures for
				operation of the Fund; and
2. Meet
				to review and make decision on applications of families for financial
				assistance in regularly scheduled cycles.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 155 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Subchapter 1 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Section 10:155-1.13 - Time period for measuring expenses and income

Current through Register Vol. 56, No. 14, July 15, 2024
In screening a child/family for eligibility for the Fund,
				  expenses and income shall be measured by any prior consecutive 12-month time
				  period in the seven years (84 months) prior to the date the application for
				  assistance is postmarked and mailed, faxed, or electronically delivered to the
				  State Office. The income will be reported for the same prior consecutive
				  12-month time period. Applications may be accepted any time throughout the
				  year.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 155 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Subchapter 1 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Section 10:155-1.15 - Ineligible health services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Categories of
				health and health-related expenses that are not eligible for consideration
				shall include, but are not limited to, the following:
1. Special education required as result of
				medical condition;
2. Elective
				cosmetic surgery/treatment; and
3.
				Modifications to vacation and secondary homes.