N.J. Admin. Code § 10:54-5.20

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:54-5.20 - Home Care Services; Home and Community-Based Services Waiver programs; general

(a) Individuals served in the Home and Community-Based Services Waiver program shall be medically in need of nursing facility care, as determined by the professional staff designated by the Department of Health and Senior Services but elect to remain at home with community-based services.

(b) The cost of providing home care services for a beneficiary enrolled in a Home and Community-Based Waiver shall not exceed the cost of institutional care.

(c) Home and Community-Based Waiver services are provided within a case managed delivery system, as follows:

1. "Case/Care Management" means a system in which a social worker or professional nurse is responsible for the planning, locating, coordinating and monitoring of a group of services designed to meet the health needs of the Medicaid beneficiaries being served. The case manager is responsible for the initial and ongoing assessment of the need for home care services and is the pivotal person in establishing a service plan to meet those needs.

(d) Each program targets specific groups to be served, such as the blind, the disabled, the elderly, children or those with Acquired Immune Deficiency Disease (AIDS) or survivors of traumatic brain injuries.

1. Each program has distinct parameters relative to the operation of the specific waiver program. These include, but are not limited to, beneficiary eligibility and enrollment criteria; target populations; available services, including any limitation on those services; cost caps; program policies; and operational procedures. These parameters are contained in the waiver document approved by the Centers for Medicare and Medicaid Services (CMS) and maintained by the Department of Human Services or agency responsible for the operation of the specific waiver. See 10:54-5.16(a).

(e) Certain aspects of Medicaid financial eligibility are waived, in accordance with N.J.A.C. 10:49.

N.J. Admin. Code § 10:54-5.20

Amended by R.2001 d.51, effective 2/5/2001.
See: 32 N.J.R. 3929(a), 33 N.J.R. 555(a).
In (c)1, substituted "beneficiaries for "recipients".
Amended by R.2012 d.124, effective 7/2/2012.
See: 43 N.J.R. 1477(a), 44 N.J.R. 1884(a).
In (a), substituted "professional staff designated by the Department of Health and Senior Services" for "Medical Assistance Customer Center (MACC)" and inserted "community-based"; in (b), inserted "providing" and "for a beneficiary enrolled in a Home and Community-Based Waiver"; in the introductory paragraph of (c), substituted "Home and Community-Based Waiver" for "Expanded services and/or variation of"; in (c)1, inserted "/Care" and "and ongoing", and deleted a comma following "coordinating" and the second occurrence of "services"; in the introductory paragraph of (d), deleted a comma following "children" and "(AIDS)"; and added (d)1.