N.J. Admin. Code § 10:73-4.4

Current through Register Vol. 56, No. 9, May 6, 2024

Section 10:73-4.4 - Eligibility and referral for YCM services

(a) A child, youth, or young adult may be eligible for YCM services if:

1. He or she meets the requirements of this subchapter and is:

i. Enrolled in Medicaid/NJ FamilyCare, as described at N.J.A.C. 10:49-2, and not enrolled in:

(1) The Medically Needy Program, except that pregnant women in that program may be eligible;

(2) The Home and Community Based Services Waiver Program;

(3) The DDD Waiver Program;

(4) The Traumatic Brain Injury Waiver Program;

(5) The Community Resources for People with Disabilities Waiver Program; or

(6) The Home Care Expansion Program; or

ii. Receiving services from the Children's System of Care and is not eligible for Medicaid/NJ FamilyCare; and

2. He or she has been determined by the Department of Children and Families, or its designated contract systems administrator (CSA), to require YCM services due to any one or any combination of the following:

i. He or she has emotional or behavioral health challenges which adversely affect his or her capacity to function in the community;

ii. The child, youth or young adult and his or her family or caregiver requires face-to-face assistance in obtaining and coordinating treatment, rehabilitation, financial and/or social services, without which the child, youth or young adult could reasonably be expected to require more intensive services, including, but not limited to, intensive case management services provided by a care management organization (CMO), to maintain an optimal functional capacity; and

iii. The child, youth, or young adult's CSOC assessment indicates a need for the level of case management services provided by a YCM.

(b) Referrals to YCMs for YCM services shall be made in accordance with this subchapter and only by the Department of Children and Families, or other agent designated by the Department of Children and Families, including, but not limited to, the CSA.

(c) A child, youth, or young adult shall not be referred for YCM services if:

1. The child, youth or young adult's sole diagnosis is:

i. Substance abuse; or

ii. Developmental disability;

2. The child, youth, or young adult's CSOC assessment, or an evaluation performed by an authorized agent of the Department of Children and Families, does not indicate a need for YCM services;

3. The child, youth or young adult no longer requires YCM services to effectively function within the home and community; or

4. The child, youth or young adult or his or her parent or caregiver refuse YCM services.

(d) A child, youth, or young adult shall be discharged from YCM services if:

1. The child, youth, or young adult's CSOC assessment, ISP, and other relevant information indicate that the child, youth, or young adult no longer needs YCM services; or

2. The child, youth or young adult or his or her parent or caregiver refuse YCM services.

(e) The youth case manager shall provide information to the child, youth or young adult, or to his or her parent or caregiver, regarding accessing the appropriate level of services to meet the needs of the child, youth or young adult and shall provide assistance in the transition to the level of case management services recommended in the ISP, if such services are needed, for any child, youth or young adult who is discharged from YCM services.

N.J. Admin. Code § 10:73-4.4

Repeal and New Rule, R.2006 d.421, effective 5/21/2007.
See: 38 N.J.R. 2585(a), 39 N.J.R. 2096(a).
Section was "Beneficiary eligibility".

Amended by 53 N.J.R. 1492(a), effective 9/7/2021