N.J. Admin. Code § 10:53-2.1

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

Section 10:53-2.1 - Person-centered service plans

(a) In order for service providers to receive Medicaid/NJ FamilyCare reimbursement for HCBS, beneficiaries in assisted living residences, comprehensive personal care homes, and assisted living programs must have person-centered service plans that meet the requirements for general service and health service plans found at N.J.A.C. 8:36-7 and follow any applicable Managed Care Organization service plan requirements.

1. The beneficiary must have a leading role in creating the service plans, whenever possible, along with the participation of their representative, as needed, and defined by the beneficiary, or, where appointed, the beneficiary's guardian.

(b) To justify modifications to person-centered service plans, the following must be documented in the beneficiary's general service and/or health service plans:

1. The specific and individualized assessed need;

2. The positive interventions and supports used prior to any modifications to the person-centered service plans;

3. The less intrusive methods of meeting the need that have been tried, but did not work;

4. A clear description of the condition that is directly proportionate to the specific assessed need;

5. A regular collection and review of data to measure the ongoing effectiveness of the modification;

6. Established time limits for periodic reviews to determine if the modification is still necessary or can be terminated;

7. The informed consent of the beneficiary; and

8. Assurance that interventions and supports will cause no harm to the beneficiary.

(c) The person-centered planning process must offer informed choices to the beneficiary regarding the services and supports he or she receives and from whom.

N.J. Admin. Code § 10:53-2.1

Adopted by 54 N.J.R. 2389(a), effective 12/19/2022