N.J. Admin. Code § 10:142-6.3

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

Section 10:142-6.3 - Change in scope, duration, and/or amount of services

(a) The outcome of the reassessment pursuant to N.J.A.C. 10:142-6.2 shall determine the number of PCA hours needed to be used as the basis for determining the budget allocation under the program as described in N.J.A.C. 10:142-4.1.

(b) The reassessment package documents as described in N.J.A.C. 10:142-3.1(c) shall be reviewed by the Division, following completion of the reassessment by the MCOs for participants enrolled in managed care, or by Division staff for individuals enrolled in fee-for-services. The Division shall communicate the results of the reassessment to the participant, pursuant to contract provisions between the Department and MCOs.

(c) A change in the monthly cash allocation may not be initiated without an approved modified cash management plan (CMP). The Division shall inform the participant in writing of any need to modify the CMP pursuant to N.J.A.C. 10:142-4.7, resulting from the reassessment outcome and the subsequent change in the monthly cash allocation under (b) above.

(d) The Division will provide a time frame for completion and deadline for submission by participant of any modified CMP. Failure to complete a modified CMP by the requested date assigned by the State program office may result in disenrollment from the program due to non-compliance.

N.J. Admin. Code § 10:142-6.3

Adopted by 49 N.J.R. 3993(a), effective 12/18/2017