N.J. Admin. Code § 10:60-6.2
Current through Register Vol. 56, No. 24, December 18, 2024
Section 10:60-6.2 - Eligibility for MLTSS(a) Individuals qualify for MLTSS by meeting established Medicaid financial requirements and Medicaid clinical and age and/or disability requirements for nursing facility services contained in N.J.A.C. 10:69, 70, 71, or 72. 1. For children who meet the nursing home level of care, and who are applying for MLTSS, there is no deeming of parental income or resources in the determination of eligibility.2. Once qualified to receive MLTSS, the individual must be enrolled with a managed care organization (MCO) in order to receive MLTSS services. Limited MLTSS services may be authorized by DMAHS after the individual has been determined clinically eligible for MLTSS and prior to enrollment into the MCO.(b) Individuals who were enrolled in the Home and Community-Based Waiver programs listed below with an enrollment date of on or before July 1, 2014, were automatically transferred into MLTSS through their managed care organization (MCO). 2. Community Resources for People with Disabilities (CRPD);3. Traumatic Brain Injury (TBI); and4. AIDS Community Care Alternatives Program (ACCAP).(c) Participation in managed long-term services and supports is voluntary. Individuals receiving MLTSS are required to receive care management services including, but not limited to, outreach and face-to-face visits. Failure to cooperate with care management services may result in removal from the MLTSS benefit package. Individuals who have been removed from the MLTSS benefit package may file an appeal of the removal in accordance with N.J.A.C. 10:49-10.N.J. Admin. Code § 10:60-6.2
Adopted by 50 N.J.R. 1992(b), effective 9/17/2018