N.J. Admin. Code § 10:46C-2.3

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

Section 10:46C-2.3 - Initial notification that an individual has been reached on the Priority Waiting List for Community Care Program Services

(a) When an individual is reached chronologically on the Priority Waiting List, the Division shall notify the individual or legal guardian in writing, or by alternate means used by the individual to communicate. In addition, the Division will contact the individual or legal guardian to further explain the process and discuss CCP and SP services and options.

1. An individual must meet the level of care (LOC) requirements for an Intermediate Care Facility for Individuals with Intellectual Disabilities to be eligible to enroll in the CCP. Individuals who do not meet the LOC requirements will receive services through enrollment in the SP.

2. Case management or the support coordinator, as applicable, will coordinate the development of a new individualized service plan, if needed.

(b) In the event that two or more individuals have the same assignment date to the Priority Waiting List:

1. The first criterion used to break the tie will be the initial date of assignment to the General Waiting List.

2. If more than one individual has the same original date of assignment to the General Waiting List, the second criterion used to break the tie will be the date of eligibility for functional services.

(c) Upon being reached on the Priority Waiting List, the individual or legal guardian shall be responsible for applying for all benefits for which the individual is entitled, in compliance with the provisions of N.J.A.C. 10:46, prior to receiving services from the Division. Application for benefits includes, but is not limited to, applying for the Medicaid DDD Community Care Program (CCP) and Social Security and Supplemental Security Income (SSI).

1. If the individual is determined to be ineligible for the Community Care Program, the individual shall be removed from the Priority Waiting List and shall be ineligible to receive services the Division provides through the CCP.

i. The individual shall remain eligible to receive those services the Division provides through the Supports Program, subject to annual appropriations.

2. If the individual is able to establish eligibility for the Community Care Program within six months of the date he or she was determined ineligible, the individual shall be placed back on the Priority Waiting List with his or her original date of assignment to the Priority Waiting List.

3. If the individual is unable to establish CCP eligibility within six months, the individual shall be removed from the Priority Waiting List and may apply to the WRT for a new assignment to the Priority Waiting List, pursuant to N.J.A.C. 10:46C-2.2.

(d) In order for the Division to enroll an individual in the CCP, the Division must have funding available to provide waiver services for the individual and the individual must be eligible for functional services in accordance with the provisions of N.J.A.C. 10:46.

(e) When an individual is reached chronologically on the Priority Waiting List and accepts an offer of services, the individual or legal guardian must complete the CCP application, submit all required documentation, and participate in the development of an individualized service plan before services begin.

N.J. Admin. Code § 10:46C-2.3

Amended by 52 N.J.R. 797(a), effective 4/6/2020