N.J. Admin. Code § 10:164B-6.2

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:164B-6.2 - Sliding fee scale for co-payments

(a) Co-payment fees shall apply to eligible persons rendered respite care services in accordance with the co-payment fee scale set forth in (b) below.

1. In all cases the point at which cost-sharing shall be initiated will be based upon the most current Supplemental Security Income (SSI) guidelines in effect under section 1611(c)(1)(A) of the Social Security Act, 42 U.S.C. § 1382, as increased pursuant to section 1617 of the Act, 42 U.S.C. § 1382f.

2. The threshold beyond which an eligible person becomes ineligible for program services is 300 percent of the SSI guidelines.

(b) The sliding fee scale shall be as follows:

Income as a percentage of the Monthly	Percent of Costs To Be Paid By
SSI level	Eligible Person
175%	5%
176%-207%	10%
208%-238%	15%
239%-269%	20%
270%-300%*	25%

* Institutional SSI level

(c) The sponsor agency shall bill all co-payments within six weeks following provision of the services contained in the service plan.

(d) When co-payment is not made within 90 days of billing, the sponsor agency shall suspend service until payment is made.

1. The sponsor agency shall provide written notice of this action to the eligible person 10 days prior to the effective date of the proposed suspension of services.

(e) The sponsor agency shall not be held liable for the uncollected co-payment, as long as sponsor agency has expended reasonable efforts to collect any or all co-payments.

(f) Sponsor agencies may seek a reduction or waiver of co-payment through submission of a written request to the Department of Human Services, Division of Aging Services, Statewide Respite Care Program, PO Box 807, Trenton, New Jersey 08625-0807.

(g) The Department shall only consider requests for reduction or waiver of co-payment for the following reasons:

1. Death of the client; or

2. Demonstrated financial hardship.

(h) The sponsor agency shall be prohibited from reducing or waiving a co-payment without written approval from the Department.

N.J. Admin. Code § 10:164B-6.2

Amended by R.1988 d.505, effective 11/7/1988.
See: 20 N.J.R. 1051(a), 20 N.J.R. 2774(a).
Amended by R.1993 d.256, effective 6/7/1993.
See: 25 N.J.R. 876(a), 25 N.J.R. 2557(b).
Recodified from N.J.A.C. 8:82-6.3 and amended by R.2004 d.241, effective 7/6/2004.
See: 35 N.J.R. 2633(a), 36 N.J.R. 3278(a).
Amended by R.2010 d.022, effective 1/19/2010.
See: 41 N.J.R. 2874(a), 42 N.J.R. 478(a).

Amended by 49 N.J.R. 1419(a), effective 6/5/2017