N.J. Admin. Code § 10:60C-4.3

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

Section 10:60C-4.3 - Standards for use of the budget

(a) The budget may be used for participant-directed goods and services, to eliminate or diminish the need for personal care, and promote independence related to ensuring completion of activities of daily living with respect to each participant's individual needs including, but not limited to:

1. Hiring and paying workers with an hourly rate of pay;

2. Purchasing home care services from an accredited agency to supplement or back up self-hired workers;

3. Transportation services for participant and/or employees, to assist with activities of daily living and errands;

4. Household-related appliances and electronic equipment/devices;

5. Technology for safety and independence not otherwise covered by Medicaid/NJ FamilyCare;

6. Purchase and installation of environmental modifications;

7. Purchase and installation of vehicular modifications related to accessibility, including repairs to vehicle modifications and related equipment;

8. Purchasing health insurance for a worker;

9. Costs of training and education for a worker;

10. Purchasing a background check on workers;

11. Purchasing services (laundry or cleaning services, errands, and meal preparation) with Division approval to supplement personal care services on a time limited basis for the benefit of the participant;

12. Adult day care for the benefit of the participant only; and

13. Respite care to relieve unpaid caregivers.

(b) Participants shall submit a written description on the CMP, of any proposed purchase of goods and services as described in (a) above, and explain how the requested item/service relates directly to their individual personal care needs.

(c) Participants shall submit required invoices or receipts for above goods and services to the VF/EA before any payments will be issued. Reimbursement shall be made directly to the participant if he or she provides documentation (for example, receipt/credit card statement) showing he or she has already paid for the item or service. In all other cases, the VF/EA will issue a payment to the vendor.

(d) Participants shall be allowed to use up to 10 percent of the total monthly cash allocation, in the form of cash, for expenses related to activities of daily living not otherwise covered by Medicaid/NJ FamilyCare benefits. The cash amount(s) must be itemized in the CMP and reviewed and approved at the discretion of the Division. The Division reserves the right to deny any item(s) and may request receipts/invoices as proof of payment for those items indicated.

(e) All requests for the purchase of the goods and services under (a)4 through 7 above shall require the participant to submit estimates from three different vendors verifying the item(s) of purchase and vendor's qualifications. The vendor's qualifications and proof of liability insurance shall be verified by the participant. The Division shall review all estimates and approve the final purchase of said goods and services.

(f) The participant/representative shall negotiate requests for environmental or vehicular modifications as described in (a)6 and 7 above, and obtain a written estimate, for the total cost of the work to be performed by a vendor/contractor, including fees for permits and applicable taxes. Administrative costs may not be included in the estimate.

1. A start-up payment, not to exceed 50 percent of the total estimate, may be issued to the vendor/contractor to begin the modification, at the discretion of the participant/authorized representative. The remaining balance shall be paid upon successful completion of the job.

2. Written permission from the property owner must be obtained for any work to be performed to a residence that is owned by someone other than the participant.

(g) In situations in which a participant resides in a rental property any request to use the cash allocation for a home appliance or environmental modification as described in (a)4 and 6 above shall not be afforded, subject to the Fair Housing Act of 1968.

N.J. Admin. Code § 10:60C-4.3

Amended and recodified from 10:142-4.3 by 56 N.J.R. 2294(a), effective 12/2/2024