ommunity are Program Policies & Procedures Manual

1 1 NJ Division of Developmental Disabilities CCP Policies & Procedures Manual (Version ) March 2019 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. 2 NJ Division of Developmental Disabilities CCP Policies & Procedures Manual (Version ) March 2019 Community Care Program Policies & Procedures Manual , Version March 2019 Section Description of Changes Overall Manual General grammatical, typo, etc.

2 Corrections, changed Molina to DXC Technology to reflect name change 3 Added the DSP Service budget component with an explanation Added info regarding emergencies and CCP eligibility 6 Provided clarification that an approved ISP must be completed within 30 days any time a new ISP is generated in order for the SCA to claim for services 7 Added other services requiring DDD approval Added guidance for circumstances in which ISP signatures have not been able to be obtained 8 Added DSP Service budget component to the retirement table Provided clarification regarding hiring family members as Self-Directed Employees (SDE) 11 Provided additional information about topics to cover in the provider s Policies & Procedures Manual 14 Removed the requirement for a Rate Component Report and changed date for submitting Fiscal Sustainability Criteria 17 Added indication that the DSP Service component applies to Career Planning, Community Inclusion Services, Day Habilitation, Individual Supports, Prevocational Training, Respite.

3 And Supported Employment Corrected procedure code for Community Transition Services Clarified when Community Inclusion Services can be rendered if the Individual Supports daily rate is being utilized Added information regarding need for Division review is the same provider is rendering Community Inclusion Services and daily rate Individual Supports Added information regarding the 5% absentee rate factored into the Individual Supports daily rate Aligned Individual Support services standard regarding SDEs with other services to reflect that SDEs providing Individual Support services cannot be a spouse, parent, or guardian of the individual Added a statement under relevant services to explain that providers must follow medication standards described under Day Habilitation and Prevocational Training if they are distributing medication while delivering these other services such as Community Inclusion Services Added a statement related to volunteering and the need to ensure there isn t an Employment Relationship with the entity for which the individual is volunteering per Provided additional information regarding the daily rate for Support Coordination when it is used, deliverables, etc.

4 Provided clarification that an approved ISP must be completed within 30 days any time a new ISP is generated in order for the SCA to claim for services Updated transportation documentation to note that start and end times are not necessary Rephrase exceptions under Transportation to clarify that transportation can be provided to community activities as part of Day Habilitation Appendix Updated help desk information Updated links to documentation Adjusted rates in Appendix H to reflect DSP wage increase Provided additional clarification to Appendix K regarding services that can be provided when an individual is receiving Individual Support services using the daily rate Added Appendix N regarding the extension to come into compliance with Behavioral Support service qualifications Added Appendix O - interagency agreement with Wage & Hour in order to provide non paid experiences for individuals when criteria outlined in this appendix are met.

5 3 NJ Division of Developmental Disabilities CCP Policies & Procedures Manual (Version ) March 2019 Table of Contents 1 INTRODUCTION .. 13 Community Care Program Policies & Procedures Manual .. 13 Overview of the Division of Developmental Disabilities .. 13 Mission and Goals .. 13 Key Themes .. 14 Division of Developmental Disabilities Responsibilities .. 15 2 VISIONING A LIFE COURSE TRANSITIONING TO ADULTHOOD .. 16 3 DIVISION OF DEVELOPMENTAL DISABILITIES ELIGIBILITY .. 17 Requirements for Division Eligibility .. 17 Intake/Application Process .. 17 Application .. 17 Additional Documents .. 18 Eligibility Determination Process .. 18 Tiering & Acuity Factor .. 19 Acuity Factor Requirements.

6 20 Individual Budgets .. 20 Requesting the Supported Employment Component of the Individual Budget .. 21 Requesting NJ CAT Reassessment .. 21 Redetermination of Eligibility .. 22 Eligibility Appeal Rights .. 22 Discharge from the 22 Moving from the Supports Program to the Community Care Program .. 23 4 OVERVIEW OF THE COMMUNITY CARE Program (CCP) .. 24 5 CCP ELIGIBILITY AND INDIVIDUAL ENROLLMENT .. 25 Eligibility Criteria for the CCP .. 25 Allowable Types of Medicaid for the CCP .. 25 ICF/ID Level of Care (LOC) .. 26 CCP Waiting List .. 26 Individual Enrollment onto the CCP .. 26 4 NJ Division of Developmental Disabilities CCP Policies & Procedures Manual (Version ) March 2019 Individual Responsibilities.

7 27 Individual Disenrollment from the Community Care Program .. 27 Individual Disenrollment Process .. 28 6 CASE MANAGEMENT .. 29 Selection and Assignment of a Support Coordination Agency .. 29 Choosing a Support Coordination Agency .. 29 Process for Assigning a Support Coordination Agency .. 29 Changing Support Coordination Agencies .. 30 Role of the Support Coordinator .. 30 Responsibilities of the Support Coordinator .. 30 Support Coordinator Deliverables .. 32 Community Transitions & Support Coordination .. 32 Transitions to Institutions from Community Settings .. 32 Transitions from Institutional to Community Settings .. 33 Transitions from Hospitalization to Community Settings .. 34 7 SERVICE PLAN.

8 35 Operating Principles .. 35 Planning Team Membership .. 36 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 .. 37 Responsibilities of the Service Provider as a Planning Team Member (when included) .. 37 Responsibilities of Other Planning Team Members .. 38 Development of the Individualized Service Plan .. 38 Assessments/Evaluations .. 38 Planning Meetings .. 41 Components of the Individualized Service Plan (ISP) .. 43 Participant Information .. 43 Outcomes and Services .. 44 Employment First Implementation .. 45 5 NJ Division of Developmental Disabilities CCP Policies & Procedures Manual (Version ) March 2019 Voting Plan.

9 45 Nutrition and Health Needs .. 45 Safety and Support Needs .. 46 Emergency Contacts .. 46 Medication .. 46 Authorizations & Signatures .. 46 Resolving Differences of Opinion among Planning Team Members .. 47 Service Plan Approval .. 47 Service Approvals by the Division .. 48 Changes to the Service Plan .. 48 8 ACCESSING SERVICES .. 50 Identification of Needed Services .. 50 Use of Community Resources and Non-Division-Funded Services .. 50 Community Resources .. 50 Coordination with Other State programs and Agencies .. 50 Accessing Division-Funded Services .. 51 Utilizing a Service Provider .. 51 Hiring a Self-Directed Employee (SDE) Self-Hires .. 53 Accessing/Continuing Needed Services upon 21st Birthday.

10 58 Prior Authorization of Services .. 58 Rounding of Service Units .. 59 Unit Accumulation .. 59 Back-Up SDEs .. 60 Delivery of Services .. 60 Duplicative Services .. 60 Retirement .. 60 Retirement from Employment .. 60 Retirement from Employment/Day Services .. 60 9 PROVIDER 62 Prior to Submitting an Application .. 62 6 NJ Division of Developmental Disabilities CCP Policies & Procedures Manual (Version ) March 2019 Submitting an Application to Become a Medicaid/DDD Approved Provider .. 62 Application Process .. 62 Adding Services .. 63 Adding Service Locations .. 63 Business Entity/Individual Practitioner .. 63 10 FISCAL INTERMEDIARY (FI) .. 64 11 ADDITIONAL PROVIDER REQUIREMENTS.