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New Jersey Department of Human ServicesDivision of Developmental Disabilitieswww.nj.gov/humanservices/dddCommunity Care ProgramPolicies & Procedures ManualPLEASE NOTE: This manual is only applicable to services, policies, procedures, and standardsrelated to individuals enrolled on the CCP who have been shifted into the Fee-for-Service system.NJ Division of Developmental DisabilitiesCCP Policies & Procedures Manual (Version 4.0)1January 2022

SectionOverallManualSection 1Section 3Section 6Section 7Section 8Section 9Section 11Section 12Section 14Section 17AppendixCommunity Care Program Policies & Procedures Manual, Version 4.0 – January 2022Description of Changes General grammatical, typo corrections, etc. Added links to referenced bulletins as available Updated statement related to Home and Community Based Services Settings Final Rule 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 theBehavioral 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 Clarified that the SC should send the “Community Transitions Unit Case Transfer Form” to the SC help desk ratherthan the assigned QAS In relation to scheduling and facilitating Planning Team Meetings, clarified that the SC shall inform the participant thatservice 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 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 Removed restriction on parent, 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 studentsthrough the 2022-2023 school year due to COVID-19 Added language around program re-locations 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 asa written competency assessment is no longer required in their certification Added section on the Home and Community Based Services Settings Compliance 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 Updated Provider Fiscal Sustainability section Added clarification to Behavioral Supports description that necessary services are to be provided by the BehavioralSupports 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, InterpreterServices, Respite, and Transportation. 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 towhom they provide Supports Brokerage. Updated rates to reflect increases Clarified that agency rented sites must be within Published Rent Standards Updated Quick Guide for Overlapping ServicesFlexibilities provided related to the COVID-19 Public Health Emergency can be found athttps://nj.gov/humanservices/coronavirus.html under Developmental DisabilitiesNJ Division of Developmental DisabilitiesCCP Policies & Procedures Manual (Version 4.0)2January 2022

Table of Contents1 INTRODUCTION . 131.1 Community Care Program Policies & Procedures Manual . 131.2 Overview of the Division of Developmental Disabilities . 131.2.1 Mission and Goals . 131.2.2 Key Themes . 131.2.3 Division of Developmental Disabilities Responsibilities. 142 VISIONING A LIFE COURSE – TRANSITIONING TO ADULTHOOD . 153 DIVISION OF DEVELOPMENTAL DISABILITIES ELIGIBILITY . 163.1 Requirements for Division Eligibility . 163.2 Intake/Application Process . 163.2.1 Application . 163.2.2 Additional Documents . 173.3 Eligibility Determination Process . 173.4 Tiering & Acuity Factor. 183.4.1 Acuity Factor Requirements. 183.5 Individual Budgets . 193.5.1 Requesting the Supported Employment Component of the Individual Budget . 203.6 Requesting NJ CAT Reassessment. 203.7 Redetermination of Eligibility . 203.8 Eligibility Appeal Rights . 213.9 Discharge from the Division . 213.10 Moving from the Supports Program to the Community Care Program . 214 OVERVIEW OF THE COMMUNITY CARE PROGRAM (CCP) . 225 CCP ELIGIBILITY AND INDIVIDUAL ENROLLMENT. 235.1 Eligibility Criteria for the CCP . 235.1.1 Allowable Types of Medicaid for the CCP . 235.1.2 ICF/ID Level of Care (LOC) . 235.1.3 CCP Waiting List . 245.2 Individual Enrollment onto the CCP . 245.3 Individual Responsibilities . 245.4 Individual Disenrollment from the Community Care Program . 255.4.1 Individual Disenrollment Process. 256 CARE MANAGEMENT . 27NJ Division of Developmental DisabilitiesCCP Policies & Procedures Manual (Version 4.0)3January 2022

6.1 Selection and Assignment of a Support Coordination Agency . 276.1.1 Choosing a Support Coordination Agency . 276.1.2 Process for Assigning a Support Coordination Agency . 276.1.3 Changing Support Coordination Agencies . 286.2 Role of the Support Coordinator. 286.3 Responsibilities of the Support Coordinator. 286.4 Support Coordinator Deliverables . 306.5 Community Transitions & Support Coordination . 306.5.1 Transitions to Institutions from Community Settings . 306.5.2 Transitions from Institutional to Community Settings. 316.5.3 Transitions from Community Settings to Hospitalization . 317 SERVICE PLAN . 337.1 Operating Principles . 337.1.1 Individual as the Decision Maker . 347.2 Planning Team Membership . 357.3 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 . 367.3.3 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 . 377.4.1 Assessments/Evaluations . 377.4.2 Planning Meetings. 407.5 Components of the Individualized Service Plan (ISP) . 427.5.1 Participant Information . 427.5.2 Outcomes and Services . 427.5.3 Employment First . 437.5.4 Voting Plan . 447.5.5 Health and Nutrition Needs . 447.5.6 Safety and Support Needs. 447.5.7 Emergency Contacts. 447.5.8 Medication . 447.5.9 Authorizations & Signatures . 447.6 Resolving Differences of Opinion among Planning Team Members . 45NJ Division of Developmental DisabilitiesCCP Policies & Procedures Manual (Version 4.0)4January 2022

7.7 Service Plan Approval. 457.8 Service Approvals by the Division . 467.9 Changes to the Service Plan . 468 ACCESSING SERVICES . 478.1 Identification of Needed Services . 478.2 Use of Community Resources and Non-Division-Funded Services . 478.2.1 Community Resources . 478.2.2 Coordination with Other State Programs and Agencies . 478.3 Accessing Division-Funded Services . 488.3.1 Utilizing a Service Provider. 488.3.2 Hiring a Self-Directed Employee (SDE) “Self-Hires” . 498.3.3 Accessing/Continuing Needed Services upon 21st Birthday . 568.4 Prior Authorization of Services . 578.4.1 Rounding of Service Units . 578.4.2 Unit Accumulation . 578.4.2 Back-Up SDEs . 588.5 Delivery of Services . 588.6 Duplicative Services . 588.7 Retirement . 588.7.1 Retirement from Employment . 588.7.2 Retirement from Employment/Day Services . 599 PROVIDER ENROLLMENT . 609.1 Prior to Submitting an Application. 609.2 Submitting an Application to Become a Medicaid/DDD Approved Provider . 609.2.1 Application Process . 609.2.2 Adding Services . 619.2.3 Adding Service Locations . 619.3 Business Entity/Individual Practitioner . 6110 FISCAL INTERMEDIARY (FI) . 6210.1 Vendor Fiscal/Employer Agent Model . 6210.2 Agency with Choice Model . 6210.3 Fiscal Intermediary as Fiscal Conduit . 6211 ADDITIONAL PROVIDER REQUIREMENTS. 6311.1 Policies & Procedures Manual . 63NJ Division of Developmental DisabilitiesCCP Policies & Procedures Manual (Version 4.0)5January 2022

11.2 Organizational Governance Policy . 6411.3 Documentation of Qualifications . 6411.4 Staff Orientation, Training, and Professional Development . 6411.4.1 Accessing Training through the College of Direct Support (CDS) . 6411.4.2 CPR and First Aid Training Entities . 6511.5 Health Insurance Portability and Accountability Act (HIPAA). 6511.6 Return of Client Records . 6511.7 Home and Community Based Services (HCBS) Settings Compliance . 6512 SERVICE PROVISION . 6712.1 Service Provider Responsibilities . 6712.2 Documenting Progress toward ISP Outcomes . 6712.3 Claim Submission . 6712.4 Subcontracting . 6712.5 Discontinuing Services . 6812.5.1 Discontinuing Individual Supports in Residential Settings (Licensed and Unlicensed) . 6813 MONITORING (Participant) . 6913.1 Mandatory Monitoring . 6913.2 Plan Review Elements . 7013.3 Service Provider’s Quality Assurance Responsibilities . 7014 PROVIDER FISCAL SUSTAINABILITY . 7114.1 Financial Reporting Requirements . 71Audited Financial Statements. 7114.2 Notifications . 7214.3 Fiscal Sustainability Criteria . 7215 QUALITY ASSURANCE, TECHNICAL ASSISTANCE, & AUDITING . 7415.1 Service Provider Quality Management . 7415.1.1 Employee Development & Training . 7415.1.2 Mandated Background & Exclusion Checks . 7415.2 Incident Reporting & Risk Management . 7415.2.1 Reporting Incidents . 7415.2.2 Investigations and Follow Up . 7515.2.3 Assistance with Incident Reporting. 7615.3 Performance & Outcome Measures . 7615.3.1 Quality Focus Groups . 76NJ Division of Developmental DisabilitiesCCP Policies & Procedures Manual (Version 4.0)6January 2022

15.3.2 National Core Indicators . 7715.3.3 Customer Satisfaction Measures . 7715.4 Quality Management Plan . 7715.4.1 Data Collection & Reporting . 7715.5 Division Oversight & Quality Monitoring . 7715.5.1 Auditing . 7815.5.2 Fraud Detection . 7815.6 Technical Assistance . 7816 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 COMMUNITY CARE PROGRAM SERVICES . 8317.1 Assistive Technology . 8417.1.1 Description .

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 4.0) January 2022 .