N.J. Admin. Code § 10:140-4.3
Current through Register Vol. 56, No. 11, June 3, 2024
Section 10:140-4.3 - Consumer cost share obligation fees and requirements(a) A consumer's cost share obligation for personal assistance services shall only be determined by the gross annual income of the consumer. A consumer will have the responsibility for a cost share obligation only if that consumer's individual annual gross income exceeds the applicable eligibility limit of 350 percent of the Federal Poverty Level (FPL). 1. A consumer whose annual gross income is less than 350 percent of the FPL, for his or her family size, shall not be required to pay a cost share for personal assistance services.(b) Failure of the consumer to pay the appropriate cost share obligation within 60 days of the date of billing, without good cause, shall be grounds for termination or suspension from the Personal Assistance Services Program.(c) The Consumer Cost Share Obligation Table (set forth in the table at (j) below) indicates income ranges and associated percentages of the total cost of the service to be paid by a consumer whose income falls within those ranges and shall be applied to eligible consumers. For the purposes of assessing consumer fees pursuant to the Consumer Cost Share Obligation Table set forth at (j) below, the county designated agency shall calculate family size and the consumer's individual annual gross income pursuant to the FPL at 350 percent.(d) Each consumer shall have a current Worker's Compensation liability policy, which covers an employee's work-related personal injury claims prior to the direct employment of a domestic household employee under the program. This policy shall be paid for by the consumer.(e) Each consumer shall provide verification of annual gross income for determination of applicable cost share obligation fees upon application to the Personal Assistance Services Program and every 12 months thereafter. The determination of the cost share obligation fees shall be made by the county designated agency and redetermined every 12 months at a minimum. 1. Acceptable verification includes, but is not limited to, pay stubs, W-2 forms or copies of the actual 1040 form filed with the Internal Revenue Service, business records, pension statements, and/or correspondence from employers or agencies (for example, Social Security Administration, State employment agencies).2. Redetermination of cost share obligation fees shall be required prior to the 12-month requirement as stated in this subsection, in situations in which the consumer has a change in Program activity affecting changes in income. Such changes would include, acquisition of new employment, loss of employment, increase or decrease in employment salary/wages (that is, hourly wage increase, promotion, demotion, layoff, etc.), loss of, or gain of, a new benefit (that is, Social Security, SSI, AFDC benefits, private disability, alimony/child support, pensions/annuities, workers compensation, insurance payments, estate/trust income, rental income, or royalties, etc.), or increase or decrease in benefit payments.(f) If the costs of an eligible consumer's personal assistance services are covered in whole or in part by another State or Federal government program or insurance contract, the government program or insurance carrier shall be the primary payer and the Personal Assistance Services Program shall be the secondary payer.(g) The consumer receiving personal assistance services and each of their employees shall sign time sheets attesting to the hours of service rendered, and the individual personal assistant or provider agency shall then be paid by a fiscal intermediary service organization. Bills verifying receipt for services rendered or items purchased shall be submitted to the fiscal intermediary service organization for payment.(h) Upon determination of the applicable cost share obligation pursuant to the table in (j) below, the fiscal intermediary service organization shall provide the consumer with a billing of the cost share obligation to be paid by the consumer on a monthly basis.(i) All collected consumer cost share obligations shall be retained by the fiscal intermediary service organization for the provision of personal assistance services.(j) The table below shall be updated annually in accordance with the change in the Federal Poverty Level (FPL) as published by the U.S. Department of Labor. The amounts of the cost share obligations will be revised annually by a notice of administrative change published in the New Jersey Register; however, any change in the "income increment" or in the applicable percentage of the cost share obligation as listed in the table below shall be promulgated through rulemaking pursuant to the Administrative Procedure Act, N.J.S.A 52:14B-1 et seq. Click here to view
N.J. Admin. Code § 10:140-4.3
Amended by 48 N.J.R. 1818(b), effective 9/6/2016Administrative Change, 50 N.J.R. 2151(a).Administrative Change, 53 N.J.R. 717(a), effective 4/5/2021.Administrative Change, 54 N.J.R. 1608(a)Administrative Change, 55 N.J.R. 1928(b), effective 7/31/2023Amended by 56 N.J.R. 261(a), effective 2/20/2024