N.J. Admin. Code § 10:46-1.1

Current through Register Vol. 56, No. 24, December 18, 2024

Section 10:46-1.1 - Purpose; authority

(a) Pursuant to N.J.S.A. 30:1-12, 30:4-25.2, 30:4-25.3, 30:4-25.9, 30:4-25.11, 30:6D-1 et seq. ( P.L. 1985, c. 145), and 30:4-60 et seq. ( P.L. 1995, c. 155), the Division of Developmental Disabilities, Department of Human Services (Division), intends this chapter to establish guidelines and criteria for determination of eligibility for services to individuals with developmental disabilities.

(b) Pursuant to N.J.S.A. 30:4-25.9, the applicant shall apply for and maintain all current and future benefits for which he or she may be eligible, including, but not limited to, Medicare, Medicaid, any other State or Federal benefits, and any third-party support pursuant to statute, rule, court order, or contract. The Division offers services funded through Medicaid and Medicaid waivers. In order for the Division to provide waiver services to an individual, the individual must be eligible for the waiver, the service provided must be a waiver service, and the setting in which the service is provided must meet waiver requirements. The individual, guardian, or representative-payee, as applicable, must apply for the appropriate waiver and comply with all the requirements of eligibility for these benefits. The individual, guardian, or representative-payee is also responsible for maintaining eligibility for those benefits. Medicaid eligibility is determined by and through the appropriate eligibility agency.

(c) When an individual receives residential services from the Division funded through contract reimbursement, he or she is required to contribute to the cost of care and maintenance. The requirements and financial ability of the individual and that of his or her legally responsible relatives to contribute to the cost of care and maintenance are set forth at N.J.A.C. 10:46D, Contributions for Care and Maintenance Requirements. Pursuant to N.J.S.A. 30:4-25.9, the obligation to make payments is a condition of eligibility.

(d) The availability of services shall be limited to the Division's funding in a given fiscal year.

(e) If an individual fails to obtain and maintain Medicaid eligibility as determined by the appropriate Medicaid eligibility agency, the individual remains responsible for the full cost of care and the Division reserves the right to charge the individual for any expense that the Division incurs while providing services without Federal assistance.

(f) To the extent practicable, Division applications, publications, and other written materials shall be provided in the individual's primary language and in alternate formats as needed.

N.J. Admin. Code § 10:46-1.1

Amended by 53 N.J.R. 1839(a), effective 11/1/2021