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New Jersey Department of Human ServicesDivision of Developmental Disabilitieswww.nj.gov/humanservices/dddSupports ProgramPolicies & ProceduresManual1NJ Division of Developmental DisabilitiesSupports Program Policies & Procedures Manual (Version 6.0)March 2019
Supports Program Policies & Procedures Manual, Version 6.0 – March ion of Changes General grammatical, typo, etc. corrections, changed Molina to DXC Technology to reflect name change Added the “DSP Service” budget component with an explanation Added info regarding emergencies and CCP eligibility Provided clarification that an approved ISP must be completed within 30 days any time a new ISP is generated inorder for the SCA to claim for services Added other services requiring DDD approval Added guidance for circumstances in which ISP signatures have not been able to be obtained Provided clarification regarding hiring family members as Self-Directed Employees (SDE) Provided additional information about topics to cover in the provider’s Policies & Procedures Manual Removed the requirement for a “Rate Component Report” and changed date for submitting Fiscal SustainabilityCriteria Added indication that the DSP Service component applies to Career Planning, Community Based Supports,Community Inclusion Services, Day Habilitation, Prevocational Training, Respite, and Supported Employment Added a statement under relevant services to explain that providers must follow medication standards describedunder Day Habilitation and Prevocational Training if they are distributing medication while delivering these otherservices such as Community Inclusion Services Added a statement related to volunteering and the need to ensure there isn’t an “Employment Relationship” with theentity for which the individual is volunteering per Provided additional information regarding the daily rate for Support Coordination – when it is used, deliverables,etc. Provided clarification that an approved ISP must be completed within 30 days any time a new ISP is generated inorder 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 aspart of Day Habilitation 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 isreceiving Individual Support services using the daily rate Added Appendix M regarding the extension to come into compliance with Behavioral Support service qualifications Added Appendix N - interagency agreement with Wage & Hour in order to provide non paid experiences forindividuals when criteria outlined in this appendix are met.2NJ Division of Developmental DisabilitiesSupports Program Policies & Procedures Manual (Version 6.0)March 2019
Table of Contents1 INTRODUCTION . 131.1 Supports Program Policy Manual . 131.2 Overview of the Division of Developmental Disabilities . 131.2.1 Mission and Goals. 131.2.2 Key Themes . 141.2.3 Division of Developmental Disabilities Responsibilities . 142 VISIONING A LIFE COURSE – TRANSITIONING TO ADULTHOOD . 163 DIVISION OF DEVELOPMENTAL DISABILITIES ELIGIBILITY . 173.1 Requirements for Division Eligibility. 173.2 Intake/Application Process . 173.2.1 Application . 173.2.2 Additional Documents . 183.3 Eligibility Determination Process . 183.4 Tiering & Acuity Factor . 193.4.1 Acuity Factor Requirements . 193.5 Individual Budgets . 203.5.1 Requesting the Supported Employment Component of the Individual Budget . 213.5.2 Bump-Up. 213.6 Requesting NJ CAT Reassessment . 213.7 Redetermination of Eligibility . 223.8 Eligibility Appeal Rights . 223.9 Discharge from the Division . 223.10 Moving from the Supports Program to the Community Care Program . 224 OVERVIEW OF THE SUPPORTS PROGRAM . 234.1 Supports Program Private Duty Nursing (PDN) . 235 SUPPORTS PROGRAM ELIGIBILITY AND INDIVIDUAL ENROLLMENT . 245.1 Eligibility for the Supports Program . 245.1.1 Allowable Types of Medicaid for the Supports Program . 245.2 Individual Enrollment into the Supports Program . 245.2.1 Enrollment into the Supports Program Private Duty Nursing (PDN) . 255.3 Individual Responsibilities . 263NJ Division of Developmental DisabilitiesSupports Program Policies & Procedures Manual (Version 6.0)March 2019
5.4 Individual Disenrollment from the Supports Program . 275.4.1 Individual Disenrollment Process . 276 CARE MANAGEMENT . 296.1 Selection and Assignment of a Support Coordination Agency . 296.1.1 Choosing a Support Coordination Agency . 296.1.2 Process for Assigning a Support Coordination Agency . 296.1.3 Changing Support Coordination Agencies . 306.2 Role of the Support Coordinator . 306.3 Responsibilities of the Support Coordinator . 306.4 Support Coordinator Deliverables . 326.5 Community Transitions & Support Coordination . 326.5.1 Transitions to Institutions from Community Settings . 326.5.2 Transitions from Institutional to Community Settings . 336.5.2 Transitions from Hospitalization to Community Settings . 337 SERVICE PLAN . 357.1 Operating Principles . 357.2 Planning Team Membership. 367.3 Responsibilities of Each Team Member . 367.3.1 Responsibilities of the Plan Coordinator (Support Coordinator) . 367.3.2 Responsibilities of the Individual (and guardian, where applicable) as a Planning Team Member. 377.3.3 Responsibilities of the Service Provider as a Planning Team Member (when included) . 377.3.4 Responsibilities of Other Planning Team Members . 377.4 Development of the Individualized Service Plan . 387.4.1 Assessments/Evaluations . 387.4.2 Planning Meetings . 417.5 Components of the Individualized Service Plan (ISP) . 427.5.1 Participant Information . 437.5.2 Outcomes and Services . 437.5.3 Employment First Implementation . 447.5.4 Voting Plan. 447.5.5 Health & Nutrition Needs . 457.5.6 Safety & Supports Needs . 454NJ Division of Developmental DisabilitiesSupports Program Policies & Procedures Manual (Version 6.0)March 2019
7.5.7 Emergency Contacts . 457.5.8 Medication. 457.5.9 Authorizations & Signatures . 457.6 Resolving Differences of Opinion among Planning Team Members . 467.7 Service Plan Approval . 467.8 Service Approvals by the Division . 477.9 Changes to the Service Plan . 478 ACCESSING SERVICES . 488.1 Identification of Needed Services. 488.2 Use of Community Resources and Non-Division-Funded Services . 488.2.1 Community Resources . 488.2.2 Coordination with Other State Programs and Agencies . 488.3 Accessing Division-Funded Services . 498.3.1 Utilizing a Service Provider . 498.3.2 Hiring a Self-Directed Employee (SDE) “Self-Hires” . 518.3.3 Accessing/Continuing Needed Services upon 21st Birthday . 568.4 Prior Authorization of Services . 568.4.1 Rounding of Service Units . 568.4.2 Unit Accumulation . 578.4.3 Back-Up SDEs . 578.5 Delivery of Services. 578.6 Duplicative Services . 578.7 Retirement . 588.7.1 Retirement from Employment . 588.7.2 Retirement from Employment/Day Services. 589 PROVIDER ENROLLMENT . 599.1 Prior to Submitting an Application . 599.2 Submitting an Application to Become a Medicaid/DDD Approved Provider . 599.2.1 Application Process . 599.2.2 Adding Services. 609.2.3 Adding Service Locations . 609.3 Business Entity/Individual Practitioner . 605NJ Division of Developmental DisabilitiesSupports Program Policies & Procedures Manual (Version 6.0)March 2019
10 FISCAL INTERMEDIARY (FI) . 6111 ADDITIONAL PROVIDER REQUIREMENTS . 6211.1 Policies & Procedures Manual . 6211.2 Organizational Governance Policy . 6311.3 Documentation of Qualifications . 6311.4 Staff Orientation, Training, and Professional Development . 6311.4.1 Accessing Training through the College of Direct Support (CDS) . 6311.4.2 CPR and First Aid Training Entities . 6411.5 Health Insurance Portability and Accountability Act (HIPAA) . 6412 SERVICE PROVISION . 6512.1 Service Provider Responsibilities . 6512.2 Documenting Progress toward ISP Outcomes. 6512.3 Claim Submission . 6512.4 Discontinuing Services . 6513 MONITORING (Participant). 6713.1 Mandatory Monitoring . 6713.2 Plan Review Elements. 6813.3 Service Provider’s Quality Assurance Responsibilities . 6814 PROVIDER FISCAL SUSTAINABILITY . 6914.1 Financial Reporting Requirements . 6914.2 Notifications . 7014.3 Fiscal Sustainability Criteria . 7015 QUALITY ASSURANCE, TECHNICAL ASSISTANCE, & AUDITING . 7215.1 Service Provider Quality Management. 7215.1.1 Employee Development & Training . 7215.1.2 Mandated Background & Exclusion Checks . 7215.2 Incident Reporting & Risk Management . 7215.2.1 Reporting Incidents . 7215.2.2 Investigations and Follow Up . 7415.2.3 Assistance with Unusual Incident Reporting . 7515.3 Performance & Outcome Measures . 7515.3.1 Quality Focus Groups . 756NJ Division of Developmental DisabilitiesSupports Program Policies & Procedures Manual (Version 6.0)March 2019
15.3.2 National Core Indicators . 7515.3.3 Customer Satisfaction Measures . 7515.4 Quality Management Plan . 7615.4.1 Data Collection & Reporting . 7615.5 Division Oversight & Quality Monitoring . 7615.5.1 Auditing . 7715.5.2 Fraud Detection . 7715.6 Technical Assistance . 7716 PROVIDER DISENROLLMENT. 7916.1 Voluntary Provider Disenrollment – Provider Initiated . 7916.1.1 Provider & Support Coordinator Transition Responsibilities . 7916.2 Involuntary Provider Disenrollment – System Initiated . 8016.2.1 Technical Assistance & Remediation . 8016.3 Disenrollment Communication . 8217 SUPPORTS PROGRAM SERVICES . 8317.1 Assistive Technology. 8417.1.1 Description . 8417.1.2 Service Limits . 8417.1.3 Provider Qualifications . 8417.1.4 Examples of Assistive Technology Activities . 8517.1.5 Assistive Technology Policies/Standards . 8517.2 Behavioral Supports . 8617.2.1 Description . 8617.2.2 Service Limits . 8617.2.3 Provider Qualifications . 8617.2.4 Examples of Behavioral Supports Activities . 8717.2.5 Behavioral Supports Policies/Standards . 8717.3 Career Planning . 8917.3.1 Description . 8917.3.2 Service Limits . 8917.3.3 Provider Qualifications . 8917.3.4 Examples of Career Planning Activities . 897NJ Division of Developmental DisabilitiesSupports Program Policies & Procedures Manual (Version 6.0)March 2019
17.3.5 Career Planning Policies/Standards. 8917.4 Cognitive Rehabilitation . 9317.4.1 Description . 9317.4.2 Service Limits . 9317.4.3 Provider Qualifications . 9317.4.4 Examples of Cognitive Rehabilitation Activities . 9417.4.5 Cognitive Rehabilitation policies/standards . 9417.5 Community Based Supports . 9617.5.1 Description . 9617.5.2 Service Limits . 9617.5.3 Provider Qualifications . 9617.5.4 Examples of Community Based Supports Activities . 9617.5.5 Community Based Supports Policies/Standards . 9717.6 Community Inclusion Services . 9917.6.1 Description . 9917.6.2 Service Limits . 9917.6.3 Provider Qualifications .
2 NJ Division of Developmental Disabilities Supports Program Policies & Procedures Manual (Version 6.0) March 2019 Supports Program Policies & Procedures Manual, Version 6.0 - March 2019 Section Description of Changes
