N.J. Admin. Code § 10:60C-3.2

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

Section 10:60C-3.2 - Screening and application process for PCA participants enrolled in Medicaid/NJ FamilyCare fee-for-services

(a) For both Medicaid/NJ Family Care eligible fee-for-service participants receiving PCA services through a traditional provider agency, and for new applicants who are interested in applying for the Personal Preference Program, an application must be made directly to the Division of Medical Assistance and Health Services.

1. If the participant is currently receiving traditional agency delivered PCA services, the Division will obtain the most recent PCA assessment and authorization of PCA service hours from the home care provider agency.

2. For new applicants opting for participant-directed services, the Division will arrange for a PCA assessment in accordance with N.J.A.C. 10:60-3.1.

3. If the PCA assessment process at (a)1 and 2 above determines that a new applicant does not meet the eligibility criteria for PCA services, the Division shall issue a letter denying PCA (and, therefore, PPP) services. In the event an applicant disagrees with the decision, he or she will be afforded appeal rights pursuant to N.J.A.C. 10:60C-9.1 and 9.3.

(b) The Division shall make a referral to the counseling agency to assign a consultant to outreach the participant, pursuant to N.J.A.C. 10:60C-3.1(d), and complete a self-direction enrollment package, pursuant to N.J.A.C. 10:60C-3.1.

(c) Upon completion of the self-direction enrollment package described at N.J.A.C. 10:60C-3.1(b), the consultant shall notify the Division that the applicant is prepared to begin self-directing PCA services, and submit the package to the Division.

N.J. Admin. Code § 10:60C-3.2

Amended and recodified from 10:142-3.2 by 56 N.J.R. 2294(a), effective 12/2/2024