N.J. Admin. Code § 5A:5-3.1

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

Section 5A:5-3.1 - Application requirement

(a) Applicants shall be eligible for admission consideration upon completion of the documentation and information reviews as follows:

1. To establish basic eligibility of all applicants, the following documentation and information reviews are required:

i. A completed application for admission;

ii. Service history:

(1) Proof of an other than dishonorable discharge; and

iii. Social history:

(1) A birth certificate;

(2) Marital status verification; and

(3) Verification of residency;

iv. Medical status:

(1) An application for Health Benefits (VA 10-10EZ);

(2) Medicare Part A, B, and D or other creditable prescription coverage;

(3) Other health insurances, including supplemental;

(4) The coverages under (a)1iv(1) and (2) above must be in effect at the time of admission if eligible and must remain in effect, as long as the individual is a resident of one of the New Jersey veterans' memorial homes. Eligible residents who do not maintain Medicare Part A and B and other supplemental health insurance shall not be allowed any medical fee deductions against their care and maintenance fee and shall be responsible for all related fees, as long as they select not to maintain medical insurance;

(5) A Medical History Release Form as determined by the U.S. Veterans' Administration; and

(6) A Medical Certification VA 10-10SH;

v. Financial disclosure:

(1) Assets will be reviewed and considered in determining financial responsibility;

(2) All financial transactions and transfer of resources, which have occurred within 36 months preceding the date of application, will be reviewed and considered as accountable assets;

(3) The value of all assets will be determined as of the date of application and revalued on the date of admission;

(4) Income from all sources shall be disclosed. Income shall be verified by submitting the most recent copy of the Federal and State income tax reports and other such documents as may be required;

(5) A copy of the applicant's long-term care insurance plan shall be provided during the admission process, if applicable; and

(6) A review shall be conducted of all irrevocable trusts;

vi. Verification of admission eligibility as defined in N.J.A.C. 5A:5-2.1; and

vii. Other:

(1) Verification of the responsible party for funeral arrangements and responsibility.

(A) Prepaid burial fund allowance not to exceed a face value of $ 12,000;

(2) Submission of advance directives for health care, if desired by the applicant, such as:

(A) A proxy directive (durable power of attorney for healthcare);

(B) An instructive directive (for example, a living will);

(C) A combined directive (durable power of attorney for health and fiscal matters);

(D) A Physician Order for Life Sustaining Treatment (POLST); and

(E) Appointment of a representational payor, if desired by the applicant.

(b) Applicants shall be admitted to the New Jersey veterans' memorial home upon completion of the following:

1. Approval of the admission committee (N.J.A.C. 5A:5-4);

2. A signed Admission Agreement;

3. VA forms (as determined by the U.S. Veterans' Administration);

4. A Medical History Release Form (VA 10-10SH); and

5. The social services packet with facility release forms.

N.J. Admin. Code § 5A:5-3.1

Amended by R.1998 d.3, effective 1/5/1998.
See: 29 N.J.R. 4215(b), 30 N.J.R. 63(a).
Inserted new (a)1iii(1)(C) and (a)1iv (6); in (a)1vi(1)(A) substituted "prepaid burial fund allowance" for "burial insurance" and "$ 7,500" for "$ 10,000"; and inserted new (a)1vi(2)(E) and (F).
Amended by R.2003 d.244, effective 6/16/2003.
See: 35 N.J.R. 62(a), 35 N.J.R. 2641(a).
In (a), substituted "VA 10-10EZ" for "VA 10-10" in the introductory paragraph of 1iii(1) and for "VA 10-10m" in 1iii(2), and rewrote 1iv(6).
Amended by R.2006 d.209, effective 6/5/2006.
See: 38 N.J.R. 1271(a), 38 N.J.R. 2418(b).
Deleted the last sentence of (a)1iii(1)(C), which required a written request to be submitted to the Chief Executive Officer within 30 days after initial admission, deleted "; (A) This Requirement" from (a)1iii(3) and substituted "36" for "18" in (a)1iv(3).
Amended by R.2008 d.298, effective 10/6/2008.
See: 40 N.J.R. 3782(a), 40 N.J.R. 5580(a).
In the introductory paragraph of (a)1iii(1), substituted a colon for a semicolon at the end; in (a)1iii(1)(A), deleted "and" from the end; in (a)1iii(1)(B), inserted "and" at the end; in (a)1iii(1)(C), inserted a comma following "effect", deleted the last sentence and substituted a semicolon for a period at the end; in (a)1iii(2), inserted a semicolon at the end; in (a)1iv(5), deleted "and" from the end; added new (a)1iv(6); recodified former (a)1iv6 as (a)1iv(7); in the introductory paragraph of (a)1vi(1), substituted a period for a semicolon at the end; in (a)1vi(1)(A), substituted "$ 12,000" for "$ 7,500"; and in (a)1vi(3), substituted "; and" for a period at the end.
Amended by R.2014 d.022, effective 1/21/2014.
See: 45 N.J.R. 2065(a), 46 N.J.R. 204(a).
Section was "Sequence of screening activities". Rewrote the section.