Community Care Program Policies & Procedures Manual

1 NJ Division of Developmental Disabilities 1 CCP Policies & Procedures Manual (Version ) January 2022 New Jersey Department of Human Services Division of Developmental Disabilities Community Care Program Policies & Procedures Manual PLEASE NOTE: This Manual is only applicable to services, Policies , Procedures , and standards related to individuals enrolled on the CCP who have been shifted into the Fee-for-Service system. NJ Division of Developmental Disabilities 2 CCP Policies & Procedures Manual (Version ) January 2022 Community Care Program Policies & Procedures Manual , Version January 2022 Section Description of Changes Overall Manual General grammatical, typo corrections, etc. Added links to referenced bulletins as available Section 1 Updated statement related to Home and Community Based Services Settings Final Rule Section 3 Added information about the Full and Short Eligibility Determination Applications Clarified that individuals assigned acuity differentiated residing in non-provider managed settings are to access the Behavioral Support Service separately from CBS, Day Habilitation, Individual Supports and Respite Revised individual budgets to reflect various service rate increases Revised NJ CAT section to explain DDD staff involvement Section 6 Clarified that the SC should send the Community Transitions Unit Case Transfer Form to the SC help desk rather than the assigned QAS In relation to scheduling and facilitating Planning Team Meetings.

2 Clarified that the SC shall inform the participant that service providers can be part of the meeting and inquire whether the SC is to include them Clarified that behavioral needs are to be documented in the ISP Clarified that medical needs are to be documented in the ISP and discussion on data collection take place Added reference to SC support of participant around decision making Added how the SC is to provide assistance around housing options Added how the SC is to provide assistance related to Electronic Visit Verification Section 7 Removed requirement that a new NJ CAT be completed every five years Clarified that the NJ CAT shall be reviewed annually at the ISP meeting and reassessments occur as needed Re-enforced that participant is at the center of the planning process Added a new section on Individual as the Decision Maker Clarified that discussion on potential Community integration opportunities occur, in addition to previous experiences Section 8 Removed restriction on parent.

3 Spouse and/or guardian from becoming a self-directed employee for certain services Revised budgets in the retirement table to reflect increases Added reference to legislation that provides a one-year extension to special education and related services for students through the 2022-2023 school year due to COVID-19 Section 9 Added language around Program re-locations Section 11 Re-ordered Policy and Procedure Manual sections to reflect priority order Updated CPR/FA requirements to reflect current American Red Cross and American Heart Association requirements as a written competency assessment is no longer required in their certification Added section on the Home and Community Based Services Settings Compliance Section 12 Updated language related to Service Provider Responsibilities and Claim Submission Updated language to reflect that electronic message (email) shall be used to notify the Division of residential discharge Section 14 Updated Provider Fiscal Sustainability section Section 17 Added clarification to Behavioral Supports description that necessary services are to be provided by the Behavioral Supports Provider at the Assessment/Plan Development rate Updated certification timelines for Day Habilitation and that a 5% absentee factor has been added to that rate Added budget flexibility in relation to Environmental Modifications, Goods and Services, and Vehicle Modifications Added detail around Goods and Services Activity Fees Updated Licensing Process section of Individual Supports Removed prohibition on parent, spouse or guardian being a self-directed employee for Individual Supports, Interpreter Services, Respite, and Transportation.

4 Provided additional information related to Support Coordination Agency caseload size Updated Support Coordinator Responsibilities to match the changes referenced in Section 6 Updated Conflict Free Policy for Support Coordination Services Added language that an entity rendering Supports Brokerage may not provide other waiver services to an individual to whom they provide Supports Brokerage. Appendix Updated rates to reflect increases Clarified that agency rented sites must be within Published Rent Standards Updated Quick Guide for Overlapping Services Flexibilities provided related to the COVID-19 Public Health Emergency can be found at under Developmental Disabilities NJ Division of Developmental Disabilities 3 CCP Policies & Procedures Manual (Version ) January 2022 Table of Contents 1 INTRODUCTION .. 13 Community Care Program Policies & Procedures Manual .

5 13 Overview of the Division of Developmental Disabilities .. 13 Mission and Goals .. 13 Key Themes .. 13 Division of Developmental Disabilities Responsibilities .. 14 2 VISIONING A LIFE COURSE TRANSITIONING TO ADULTHOOD .. 15 3 DIVISION OF DEVELOPMENTAL DISABILITIES ELIGIBILITY .. 16 Requirements for Division Eligibility .. 16 Intake/Application Process .. 16 Application .. 16 Additional Documents .. 17 Eligibility Determination Process .. 17 Tiering & Acuity Factor .. 18 Acuity Factor Requirements .. 18 Individual Budgets .. 19 Requesting the Supported Employment Component of the Individual Budget .. 20 Requesting NJ CAT Reassessment .. 20 Redetermination of Eligibility .. 20 Eligibility Appeal Rights .. 21 Discharge from the Division .. 21 Moving from the Supports Program to the Community Care Program .. 21 4 OVERVIEW OF THE Community CARE Program (CCP) .. 22 5 CCP ELIGIBILITY AND INDIVIDUAL ENROLLMENT.

6 23 Eligibility Criteria for the CCP .. 23 Allowable Types of Medicaid for the CCP .. 23 ICF/ID Level of Care (LOC) .. 23 CCP Waiting List .. 24 Individual Enrollment onto the CCP .. 24 Individual Responsibilities .. 24 Individual Disenrollment from the Community Care Program .. 25 Individual Disenrollment Process .. 25 6 CARE MANAGEMENT .. 27 NJ Division of Developmental Disabilities 4 CCP Policies & Procedures Manual (Version ) January 2022 Selection and Assignment of a Support Coordination Agency .. 27 Choosing a Support Coordination Agency .. 27 Process for Assigning a Support Coordination Agency .. 27 Changing Support Coordination Agencies .. 28 Role of the Support 28 Responsibilities of the Support Coordinator .. 28 Support Coordinator Deliverables .. 30 Community Transitions & Support Coordination .. 30 Transitions to Institutions from Community Settings.

7 30 Transitions from Institutional to Community 31 Transitions from Community Settings to Hospitalization .. 31 7 SERVICE PLAN .. 33 Operating Principles .. 33 Individual as the Decision Maker .. 34 Planning Team Membership .. 35 Responsibilities of Each Team Member .. 36 Responsibilities of the Plan Coordinator (Support Coordinator) .. 36 Responsibilities of the Individual (and guardian, where applicable) as a Planning Team Member .. 36 Responsibilities of the Service Provider as a Planning Team Member (when included) .. 37 Responsibilities of Other Planning Team Members .. 37 Development of the Individualized Service Plan .. 37 Assessments/Evaluations .. 37 Planning 40 Components of the Individualized Service Plan (ISP) .. 42 Participant Information .. 42 Outcomes and Services .. 42 Employment First .. 43 Voting Plan .. 44 Health and Nutrition Needs .. 44 Safety and Support Needs.

8 44 Emergency Contacts .. 44 Medication .. 44 Authorizations & Signatures .. 44 Resolving Differences of Opinion among Planning Team Members .. 45 NJ Division of Developmental Disabilities 5 CCP Policies & Procedures Manual (Version ) January 2022 Service Plan Approval .. 45 Service Approvals by the Division .. 46 Changes to the Service Plan .. 46 8 ACCESSING SERVICES .. 47 Identification of Needed Services .. 47 Use of Community Resources and Non-Division-Funded Services .. 47 Community Resources .. 47 Coordination with Other State Programs and Agencies .. 47 Accessing Division-Funded Services .. 48 Utilizing a Service 48 Hiring a Self-Directed Employee (SDE) Self-Hires .. 49 Accessing/Continuing Needed Services upon 21st Birthday .. 56 Prior Authorization of Services .. 57 Rounding of Service Units .. 57 Unit Accumulation.

9 57 Back-Up SDEs .. 58 Delivery of Services .. 58 Duplicative Services .. 58 Retirement .. 58 Retirement from Employment .. 58 Retirement from Employment/Day Services .. 59 9 PROVIDER ENROLLMENT .. 60 Prior to Submitting an Application .. 60 Submitting an Application to Become a Medicaid/DDD Approved Provider .. 60 Application Process .. 60 Adding Services .. 61 Adding Service Locations .. 61 Business Entity/Individual Practitioner .. 61 10 FISCAL INTERMEDIARY (FI) .. 62 Vendor Fiscal/Employer Agent Model .. 62 Agency with Choice Model .. 62 Fiscal Intermediary as Fiscal Conduit .. 62 11 ADDITIONAL PROVIDER 63 Policies & Procedures Manual .. 63 NJ Division of Developmental Disabilities 6 CCP Policies & Procedures Manual (Version ) January 2022 Organizational Governance Policy .. 64 Documentation of Qualifications .. 64 Staff Orientation, Training, and Professional Development.

10 64 Accessing Training through the College of Direct Support (CDS) .. 64 CPR and First Aid Training Entities .. 65 Health Insurance Portability and Accountability Act (HIPAA) .. 65 Return of Client Records .. 65 Home and Community Based Services (HCBS) Settings Compliance .. 65 12 SERVICE PROVISION .. 67 Service Provider Responsibilities .. 67 Documenting Progress toward ISP Outcomes .. 67 Claim Submission .. 67 Subcontracting .. 67 Discontinuing Services .. 68 Discontinuing Individual Supports in Residential Settings (Licensed and Unlicensed) .. 68 13 MONITORING (Participant) .. 69 Mandatory Monitoring .. 69 Plan Review Elements .. 70 Service Provider s Quality Assurance Responsibilities .. 70 14 PROVIDER FISCAL SUSTAINABILITY .. 71 Financial Reporting Requirements .. 71 Audited Financial 71 Notifications .. 72 Fiscal Sustainability Criteria .. 72 15 QUALITY ASSURANCE, TECHNICAL ASSISTANCE, & AUDITING.