Supports Program Policies & Procedures Manual

NJ Division of Developmental Disabilities 1

Supports Program Policies & Procedures Manual (Version 9.0) April 2024

New Jersey Department of Human Services

Division of Developmental Disabilities

www.nj.gov/humanservices/ddd

Supports Program

Policies & Procedures

Manual

NJ Division of Developmental Disabilities 2

Supports Program Policies & Procedures Manual (Version 9.0) April 2024

Supports Program Policies & Procedures Manual, Version 9.0 – April 2024

Section

Description of Changes

Overall

Manual

 General grammatical, typo corrections, updates to form names, email addresses, and links where applicable, etc.

Section 1

 Added the term self-directed services, in addition to self-direction, to the description of persons for whom this manual

applies.

 Added the definition of Competitive Integrated Employment under Employment First.

Section 3

 Added criteria describing limited circumstances where a person ages 18 through 21 may receive division services

 Revised individual budgets to reflect rate increases since last revision.

Section 6

 Added detail about Support Coordination Agency (SCA) and Division responsibilities when a person changes SCAs or if

an SCA is undergoing corrective action.

Section 7

 Added more information on Supportive Decision Making.

Section 8

 Revised individual budgets for retirement to reflect rate increases since last revision.

 Updated data related to Reasonable and Customary wages.

 Simplified language related to Interpreter Services, Supports Brokerage, and Transportation self-directed employee rates.

 Added that a self-directed employee may not to be regularly scheduled to work more than 16 consecutive hours in a 24-

hour period.

 Removed reference to COVID-19 Legislation allowing an additional year of educational entitlement as it is no longer

applicable.

Section 9

 Added information for DDD/Medicaid Approved Providers about how they can update their information in the publicly

available Provider Search database.

Section 11

 Better defined which Policy and Procedure Manual sections are needed for which service type.

 Added more detail around the return of client records by Support Coordination Agencies.

 Re-worded Organizational Governance section to be more easily understood. Added that Board Members must also

adhere to background check requirements found in Section 15.1.2.

Section 13

 Added timeframes for the uploading of documentation to iRecord by Support Coordinators.

Section 15

 Updated Investigations and Follow Up section to more clearly communicate that Support Coordination Agencies, unless

otherwise directed, need to complete investigations for incidents involving abuse, neglect, or exploitation in connection

with delivery of services provided by them.

Section 16

 Clarified that Sanctions for a Support Coordination Agency can include a reduction in census.

Section 17

 Added to first page of section that a Direct Support Professional and/or Self-Directed Employee may not to be regularly

scheduled to work more than 16 consecutive hours in a 24-hour period.

 Edited to Support Coordination service definition to reflect that the Division may impose a reduction of census, that

trainings required by the Division must be completed per the timeframes listed in Appendix E, and that Support

Coordination Agency (SCA) Heads must meet the criteria of a Supervisor in order to act as one. Additionally, added that

enforcement of a minimum SCA census of 60 clients after 12 months of operation will be enforced starting on April 1,

2025.

 Updated the Respite service definition

Appendix

 Updated definition of Self-Directed Employee in Appendix A to add that they are paid by a DDD approved Fiscal

Intermediary.

 Updated listing of forms in Appendix D.

 Updated Quick Reference Guide to Mandated Staff Training in Appendix E.

 Updated rates to reflect increases since last revision in Appendix H.

 Updated Appendix I with most recent version of Medicaid Newsletter.

 Added Appendix S – Quick Guide to Required Content Areas for Provider Policy and Procedure Manuals

 
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Supports Program Policies & Procedures Manual (Version 9.0)            April 2024 
Table of Contents 
INTRODUCTION ....................................................................................................................................................... 13 
1 Supports Program Policy Manual .................................................................................................................. 13 
2 Overview of the Division of Developmental Disabilities ............................................................................... 13 
2.1 Mission and Goals ................................................................................................................................... 13 
2.2 Key Themes............................................................................................................................................. 13 
2.3 Division of Developmental Disabilities Responsibilities ......................................................................... 14 
VISIONING A LIFE COURSE – TRANSITIONING TO ADULTHOOD .......................................................................... 15 
DIVISION OF DEVELOPMENTAL DISABILITIES ELIGIBILITY .................................................................................... 16 
1 Requirements for Division Eligibility.............................................................................................................. 16 
1.5 Limited Circumstances Where a Person Ages 18 through 21 May Receive Division Services ................... 16 
2 Intake/Application Process ............................................................................................................................ 17 
2.1 Application .............................................................................................................................................. 17 
2.2 Additional Documents ............................................................................................................................ 18 
3 Eligibility Determination Process ................................................................................................................... 18 
4 Tiering & Acuity Factor .................................................................................................................................. 19 
4.1 Acuity Factor Requirements ................................................................................................................... 19 
5 Individual Budgets ......................................................................................................................................... 20 
5.1 Requesting the Supported Employment Component of the Individual Budget .................................... 21 
5.2 Bump-Up ................................................................................................................................................. 21 
6 Requesting NJ CAT Reassessment ................................................................................................................. 21 
7 Redetermination of Eligibility ........................................................................................................................ 22 
8 Eligibility Appeal Rights ................................................................................................................................. 22 
9 Discharge from the Division .......................................................................................................................... 22 
10 Moving from the Supports Program to the Community Care Program ...................................................... 22 
OVERVIEW OF THE SUPPORTS PROGRAM ........................................................................................................... 23 
1 Supports Program + Private Duty Nursing (PDN) .......................................................................................... 23 
SUPPORTS PROGRAM ELIGIBILITY AND INDIVIDUAL ENROLLMENT .................................................................... 24 
1 Eligibility for the Supports Program .............................................................................................................. 24 
1.1 Allowable Types of Medicaid for the Supports Program ....................................................................... 24 
2 Individual Enrollment into the Supports Program ........................................................................................ 24 
2.1 Enrollment into the Supports Program + Private Duty Nursing (PDN) ................................................... 25 
3 Individual Responsibilities ............................................................................................................................. 26 
4 Individual Disenrollment from the Supports Program .................................................................................. 26 

 
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4.1 Individual Disenrollment Process ........................................................................................................... 27 
CARE MANAGEMENT ............................................................................................................................................ 29 
1 Selection and Assignment of a Support Coordination Agency ...................................................................... 29 
1.1 Choosing a Support Coordination Agency .............................................................................................. 29 
1.2 Process for Assigning a Support Coordination Agency ........................................................................... 29 
1.3 Changing Support Coordination Agencies .............................................................................................. 30 
2 Role of the Support Coordinator ................................................................................................................... 30 
3 Responsibilities of the Support Coordinator ................................................................................................. 30 
4 Support Coordinator Deliverables ................................................................................................................. 32 
5 Community Transitions & Support Coordination .......................................................................................... 33 
5.1 Transitions to Institutions from Community Settings ............................................................................ 33 
5.2 Transitions from Institutional to Community Settings ........................................................................... 34 
5.2 Transitions from Community Settings to Hospitalization ...................................................................... 34 
SERVICE PLAN ....................................................................................................................................................... 35 
1 Operating Principles ...................................................................................................................................... 35 
1.1 Individual as Decision Maker ...................................................................................................................... 36 
2 Planning Team Membership.......................................................................................................................... 38 
3 Responsibilities of Each Team Member ........................................................................................................ 38 
3.1 Responsibilities of the Plan Coordinator (Support Coordinator) ........................................................... 38 
3.2 Responsibilities of the Individual (and guardian, where applicable) as a Planning Team Member ....... 39 
3.3 Responsibilities of the Service Provider as a Planning Team Member (when included) ....................... 39 
3.4 Responsibilities of Other Planning Team Members ............................................................................... 39 
4 Development of the Individualized Service Plan ........................................................................................... 39 
4.1 Assessments/Evaluations ....................................................................................................................... 40 
4.2 Planning Meetings .................................................................................................................................. 43 
5 Components of the Individualized Service Plan (ISP) .................................................................................... 44 
5.1 Participant Information .......................................................................................................................... 44 
5.2 Outcomes and Services .......................................................................................................................... 45 
5.3 Employment First ................................................................................................................................... 46 
5.4 Voting Plan .............................................................................................................................................. 46 
5.5 Health & Nutrition Needs ....................................................................................................................... 46 
5.6 Safety & Supports Needs ........................................................................................................................ 46 
5.7 Emergency Contacts ............................................................................................................................... 46 
5.8 Medication .............................................................................................................................................. 46 

 
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5.9 Authorizations & Signatures ................................................................................................................... 46 
6 Resolving Differences of Opinion among Planning Team Members ............................................................. 48 
7 Service Plan Approval .................................................................................................................................... 48 
8 Service Approvals by the Division .................................................................................................................. 48 
9 Changes to the Service Plan .......................................................................................................................... 49 
ACCESSING SERVICES ............................................................................................................................................ 50 
1 Identification of Needed Services .................................................................................................................. 50 
2 Use of Community Resources and Non-Division-Funded Services ............................................................... 50 
2.1 Community Resources ............................................................................................................................ 50 
2.2 Coordination with Other State Programs and Agencies ........................................................................ 50 
3 Accessing Division-Funded Services .............................................................................................................. 51 
3.1 Utilizing a Service Provider ..................................................................................................................... 51 
3.2 Hiring a Self-Directed Employee (SDE) “Self-Hires” ............................................................................... 53 
3.2.0.1 Establishing a Self-Directed Employee (SDE) Hourly Wagefor Services Where the Direct Support 
Professional Service Applies ............................................................................................................................ 53 
3.2.0.2 Establishing a Self-Directed Employee (SDE) Hourly Wage for Services Where the Direct Support 
Professional Service Does Not Apply ............................................................................................................... 56 
3.3 Accessing/Continuing Needed Services upon 21
st
 Birthday ................................................................... 63 
4 Prior Authorization of Services ...................................................................................................................... 63 
4.1 Rounding of Service Units....................................................................................................................... 64 
4.2 Unit Accumulation .................................................................................................................................. 64 
4.3 Back-Up SDEs .......................................................................................................................................... 64 
5 Delivery of Services ....................................................................................................................................... 65 
6 Duplicative Services ....................................................................................................................................... 65 
7 Retirement ..................................................................................................................................................... 65 
7.1 Retirement from Employment ............................................................................................................... 65 
7.2 Retirement from Employment/Day Services .......................................................................................... 65 
PROVIDER ENROLLMENT ...................................................................................................................................... 66 
1 Prior to Submitting an Application to Become a Medicaid/DDD Approved Provider ................................... 66 
2 Submitting an Application to Become a Medicaid/DDD Approved Provider ................................................ 66 
2.1 Application Process ................................................................................................................................ 66 
2.2 Adding Services ....................................................................................................................................... 67 
2.3 Adding Service Locations ........................................................................................................................ 67 
2.5 Adding Service Locations ........................................................................................................................ 67 

 
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3 Business Entity/Individual Practitioner ......................................................................................................... 67 
FISCAL INTERMEDIARY (FI) ................................................................................................................................. 68 
1 Vendor Fiscal/Employer Agent Model......................................................................................................... 68 
2 Agency with Choice Model .......................................................................................................................... 68 
3 Fiscal Intermediary as Fiscal Conduit .......................................................................................................... 68 
ADDITIONAL PROVIDER REQUIREMENTS ........................................................................................................... 69 
1 Policies & Procedures Manual ..................................................................................................................... 69 
2 Organizational Governance Policy ............................................................................................................... 70 
3 Documentation of Qualifications ................................................................................................................ 71 
4 Staff Orientation, Training, and Professional Development ....................................................................... 71 
4.1 Accessing Training through the College of Direct Support (CDS) ......................................................... 71 
4.2 CPR and First Aid Training Entities ....................................................................................................... 71 
5 Health Insurance Portability and Accountability Act (HIPAA) ..................................................................... 72 
6 Return of Client Records .............................................................................................................................. 72 
7 Home and Community Based Services (HCBS) Settings Compliance .......................................................... 72 
8 Emergency Preparedness and Response Plan (EPRP) ................................................................................. 73 
9 Infection Control and Prevention ................................................................................................................ 74 
SERVICE PROVISION ............................................................................................................................................ 75 
1 Service Provider Responsibilities ................................................................................................................. 75 
2 Documenting Progress toward ISP Outcomes ............................................................................................ 75 
3 Claim Submission ......................................................................................................................................... 75 
4 Subcontracting Services............................................................................................................................... 75 
5 Discontinuing Services ................................................................................................................................. 76 
5.2 Provider Ready Directory ..................................................................................................................... 76 
MONITORING (Participant) ................................................................................................................................. 78 
1 Mandatory Monitoring ................................................................................................................................ 78 
2 Plan Review Elements.................................................................................................................................. 79 
3 Service Provider’s Quality Assurance Responsibilities ................................................................................ 79 
PROVIDER FISCAL SUSTAINABILITY ..................................................................................................................... 80 
1 Financial Reporting Requirements .............................................................................................................. 80 
2 Notifications ................................................................................................................................................ 80 
3 Fiscal Sustainability Criteria ......................................................................................................................... 81 
QUALITY ASSURANCE, TECHNICAL ASSISTANCE, & AUDITING ........................................................................... 83 
1 Service Provider Quality Management........................................................................................................ 83 

 
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1.1 Employee Development & Training ..................................................................................................... 83 
1.2 Mandated Background & Exclusion Checks ......................................................................................... 83 
2 Incident Reporting & Risk Management ..................................................................................................... 83 
2.1 Reporting Incidents .............................................................................................................................. 83 
2.2 Investigations and Follow Up ............................................................................................................... 85 
2.3 Assistance with Unusual Incident Reporting ........................................................................................ 85 
3 Performance & Outcome Measures ............................................................................................................ 86 
3.1 Quality Focus Groups............................................................................................................................ 86 
3.2 National Core Indicators ....................................................................................................................... 86 
3.3 Customer Satisfaction Measures .......................................................................................................... 86 
4 Quality Management Plan ........................................................................................................................... 87 
4.1 Data Collection & Reporting ................................................................................................................. 87 
5 Division Oversight & Quality Monitoring .................................................................................................... 87 
5.1 Auditing ................................................................................................................................................ 88 
5.2 Fraud Detection .................................................................................................................................... 88 
5.3 Human Rights Committee (HRC) .............................................................................................................. 88 
6 Technical Assistance .................................................................................................................................... 88 
PROVIDER DISENROLLMENT ............................................................................................................................... 90 
1 Voluntary Provider Disenrollment – Provider Initiated ............................................................................... 90 
1.1 Provider & Support Coordinator Transition Responsibilities ............................................................... 90 
2 Involuntary Provider Disenrollment – System Initiated .............................................................................. 91 
2.1 Technical Assistance & Remediation .................................................................................................... 91 
3 Disenrollment Communication ................................................................................................................... 93 
SUPPORTS PROGRAM SERVICES ......................................................................................................................... 94 
1 Assistive Technology .................................................................................................................................... 95 
1.1 Description ........................................................................................................................................... 95 
1.2 Service Limits ........................................................................................................................................ 95 
1.3 Provider Qualifications ......................................................................................................................... 95 
1.4 Examples of Assistive Technology Activities ........................................................................................ 95 
1.5 Assistive Technology Policies/Standards .............................................................................................. 96 
2 Behavioral Supports .................................................................................................................................... 97 
2.1 Description ........................................................................................................................................... 97 
2.2 Service Limits ........................................................................................................................................ 97 
2.3 Provider Qualifications ......................................................................................................................... 97 

 
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2.4 Examples of Behavioral Supports Activities ......................................................................................... 98 
2.4.3 Need for Human Rights Committee (HRC) Review ........................................................................... 98 
2.5 Behavioral Supports Policies/Standards ............................................................................................... 98 
3 Career Planning ......................................................................................................................................... 100 
3.1 Description ......................................................................................................................................... 100 
3.2 Service Limits ...................................................................................................................................... 100 
3.3 Provider Qualifications ....................................................................................................................... 100 
3.4 Examples of Career Planning Activities .............................................................................................. 100 
3.5 Career Planning Policies/Standards .................................................................................................... 100 
4 Cognitive Rehabilitation ............................................................................................................................ 103 
4.1 Description ......................................................................................................................................... 103 
4.2 Service Limits ...................................................................................................................................... 103 
4.3 Provider Qualifications ....................................................................................................................... 103 
4.4 Examples of Cognitive Rehabilitation Activities ................................................................................. 104 
4.5 Cognitive Rehabilitation policies/standards ....................................................................................... 104 
5 Community Based Supports ...................................................................................................................... 105 
5.1 Description ......................................................................................................................................... 105 
5.2 Service Limits ...................................................................................................................................... 105 
5.3 Provider Qualifications ....................................................................................................................... 105 
5.4 Examples of Community Based Supports Activities ........................................................................... 105 
5.5 Community Based Supports Policies/Standards ................................................................................ 106 
6 Community Inclusion Services ................................................................................................................... 108 
6.1 Description ......................................................................................................................................... 108 
6.2 Service Limits ...................................................................................................................................... 108 
6.3 Provider Qualifications ....................................................................................................................... 108 
6.4 Examples of Community Inclusion Services Activities ........................................................................ 108 
6.5 Community Inclusion Services Policies/Standards ............................................................................. 108 
7 Day Habilitation ......................................................................................................................................... 111 
7.1. Description ........................................................................................................................................ 111 
7.2 Service Limits ...................................................................................................................................... 111 
7.3 Provider Qualifications ....................................................................................................................... 111 
7.4 Day Habilitation Activities Guidelines ................................................................................................ 112 
7.5 Day Habilitation Policies/Standards ................................................................................................... 113 
8 Environmental Modifications .................................................................................................................... 124 

 
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8.1 Description ......................................................................................................................................... 124 
8.2 Service Limits ...................................................................................................................................... 124 
8.3 Provider Qualifications ....................................................................................................................... 124 
8.4 Examples of Environmental Modifications ......................................................................................... 124 
8.5 Environmental Modifications Policies/Standards .............................................................................. 124 
9 Goods & Services ....................................................................................................................................... 126 
9.1 Description ......................................................................................................................................... 126 
9.2 Service Limits ...................................................................................................................................... 126 
9.3 Provider Qualifications ....................................................................................................................... 126 
9.5 Goods & Services Policies/Standards ................................................................................................. 126 
10 Interpreter Services ................................................................................................................................. 130 
10.1 Description ....................................................................................................................................... 130 
10.2 Service Limits .................................................................................................................................... 130 
10.3 Provider Qualifications ..................................................................................................................... 130 
10.4 Interpreter Services Policies/Standards ........................................................................................... 130 
11 Natural Supports Training ....................................................................................................................... 132 
11.1 Description ....................................................................................................................................... 132 
11.2 Service Limits .................................................................................................................................... 132 
11.3 Provider Qualifications ..................................................................................................................... 132 
11.4 Examples of Natural Supports Training ............................................................................................ 132 
11.5 Natural Supports Training Policies/Standards .................................................................................. 133 
12 Occupational Therapy ............................................................................................................................. 135 
12.1 Description ....................................................................................................................................... 135 
12.2 Service Limits .................................................................................................................................... 135 
12.3 Provider Qualifications ..................................................................................................................... 135 
12.4 Examples of Occupational Therapy Activities .................................................................................. 135 
12.5 Occupational Therapy Policies/Standards ........................................................................................ 135 
13 Personal Emergency Response System (PERS) ........................................................................................ 137 
13.1 Description ....................................................................................................................................... 137 
13.2 Service Limits .................................................................................................................................... 137 
13.3 Provider Qualifications ..................................................................................................................... 137 
13.4 Examples of PERS Activities .............................................................................................................. 137 
13.5 PERS Policies/Standards ................................................................................................................... 137 
14 Physical Therapy ...................................................................................................................................... 138 

 
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14.1 Description ....................................................................................................................................... 138 
14.2 Service Limits .................................................................................................................................... 138 
14.3 Provider Qualifications ..................................................................................................................... 138 
14.4 Examples of Physical Therapy Activities ........................................................................................... 138 
14.5 Physical Therapy Policies/Standards ................................................................................................ 138 
15 Prevocational Training ............................................................................................................................. 140 
15.1 Description ....................................................................................................................................... 140 
15.2 Service Limits .................................................................................................................................... 140 
15.3 Provider Qualifications ..................................................................................................................... 140 
15.4 Examples of Prevocational Training ................................................................................................. 140 
15.5 Prevocational Training Policies/Standards ....................................................................................... 141 
16 Respite ..................................................................................................................................................... 149 
16.1 Description ....................................................................................................................................... 149 
16.2 Service Limits .................................................................................................................................... 149 
16.3 Provider Qualifications ..................................................................................................................... 150 
16.4 Respite Options ................................................................................................................................ 150 
16.5 Respite Policies/Standards ............................................................................................................... 151 
17 Speech, Language, and Hearing Therapy ................................................................................................ 153 
17.1 Description ....................................................................................................................................... 153 
17.2 Service Limits .................................................................................................................................... 153 
17.3 Provider Qualifications ..................................................................................................................... 153 
17.4 Examples of Speech, Language, and Hearing Therapy Activities ..................................................... 153 
17.5 Speech, Language, and Hearing Therapy Policies/Standards........................................................... 153 
18 Support Coordination .............................................................................................................................. 155 
18.1 Description ....................................................................................................................................... 155 
18.2 Service Limits .................................................................................................................................... 155 
18.3 Unit Distinction for Support Coordination ....................................................................................... 155 
18.4 Provider Qualifications ..................................................................................................................... 155 
18.5 Support Coordination Policies/Standards ........................................................................................ 156 
18.6 Resources/Technical Assistance ....................................................................................................... 162 
18.7 Communication/Feedback ............................................................................................................... 163 
19 Supported Employment – Individual & Small Group Employment Support ........................................... 164 
19.1 Descriptions ...................................................................................................................................... 164 
19.2 Service Limits .................................................................................................................................... 164 

 
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19.3 Provider Qualifications ..................................................................................................................... 165 
19.4 Examples of Supported Employment Activities ............................................................................... 165 
19.5 Supported Employment Policies/Standards ..................................................................................... 165 
20 Supports Brokerage ................................................................................................................................. 170 
20.1 Description ....................................................................................................................................... 170 
20.2 Service Limits .................................................................................................................................... 170 
20.3 Provider Qualifications ..................................................................................................................... 170 
20.4 Examples of Supports Brokerage Activities ...................................................................................... 171 
20.5 Supports Brokerage Policies/Standards ........................................................................................... 171 
20.5.0.1 Examples of Supports Brokerage Responsibilities ..................................................................... 171 
21 Transportation ......................................................................................................................................... 173 
21.1 Description ....................................................................................................................................... 173 
21.2 Service Limits .................................................................................................................................... 173 
21.3 Provider Qualifications ..................................................................................................................... 173 
21.4 Transportation Options .................................................................................................................... 173 
21.5 Transportation Policies/Standards ................................................................................................... 174 
22 Vehicle Modifications .............................................................................................................................. 176 
22.1 Description ....................................................................................................................................... 176 
22.2 Service Limits .................................................................................................................................... 176 
22.3 Provider Qualifications ..................................................................................................................... 176 
22.4 Examples of Vehicle Modifications ................................................................................................... 176 
22.5 Vehicle Modifications Policies/Standards ........................................................................................ 176 
HOUSING SUPPORTS FOR INDIVIDUALS IN THE SUPPORTS PROGRAM ........................................................... 178 
1 Funding Support for Residential Services and Housing ............................................................................. 178 
1.1 Community Based Supports ............................................................................................................... 178 
1.2 Housing Voucher through the Supportive Housing Connection (SHC) .............................................. 178 
APPENDIX A – GLOSSARY OF TERMS ..................................................................................................................... 182 
APPENDIX B – HELPFUL LINKS TO THE DIVISION ................................................................................................... 186 
APPENDIX C – DIVISION HELP DESKS ..................................................................................................................... 187 
APPENDIX D – DOCUMENTS .................................................................................................................................. 188 
QUICK REFERENCE GUIDE TO SERVICE DELIVERY DOCUMENTATION ................................................................... 189 
APPENDIX E – QUICK REFERENCE GUIDE TO MANDATED STAFF TRAINING ......................................................... 190 
APPENDIX F – QUICK REFERENCE GUIDE TO SERVICE APPROVALS ....................................................................... 195 
APPENDIX G - PROVIDING SERVICES WITHIN A SOCIAL ENTERPRISE SETTING ..................................................... 198 

 
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APPENDIX H – SUPPORTS PROGRAM SERVICES QUICK REFERENCE GUIDE .......................................................... 200 
APPENDIX I – NEWSLETTER VOLUME 26 NUMBER 14 – SEPTEMBER 2016 .......................................................... 203 
APPENDIX J – DVRS/CBVI/DDD MEMORANDUM OF UNDERSTANDING ............................................................... 205 
APPENDIX K – QUICK REFERENCE GUIDE TO OVERLAPPING CLAIMS FOR SUPPORTS PROGRAM SERVICES ........ 215 
APPENDIX L – NEWSLETTER VOLUME 28 NO. O1 .................................................................................................. 218 
APPENDIX M – EXTENSION TO COME INTO COMPLIANCE WITH BEHAVIORAL SUPPORTS QUALIFICATIONS ..... 220 
APPENDIX N – INTERAGENCY AGREEMENT BETWEEN WAGE & HOUR IN THE U.S. DEPARTMENT OF LABOR, DVRS, 
CBVI, AND DDD ...................................................................................................................................................... 221 
APPENDIX O – PER-MEMBER, PER-MONTH FEE FOR AGENCY WITH CHOICE FI MODEL ...................................... 225 
APPENDIX P – NEWSLETTER VOLUME 30 NO.19 – AUGUST 2020 ........................................................................ 226 
APPENDIX Q – NEWSLETTER VOLUME 31 NO.23 – October 2021 ....................................................................... 228 
APPENDIX R – RESERVED ....................................................................................................................................... 230 
APPENDIX S - Quick Guide to Required Content Areas for Provider Policy and Procedure Manuals ............ 231

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Supports Program Policies & Procedures Manual (Version 9.0) April 2024

INTRODUCTION

1.1 Supports Program Policy Manual

The purpose of the New Jersey Division of Developmental Disabilities (Division) Supports Program Policy Manual

is to provide additional clarity on practices governing the Supports Program within the approved Comprehensive

Medicaid Waiver (CMW).

This manual contains the current policies and practices governing all aspects of the Supports Program including but

not limited to eligibility, care management, service delivery and standards, and quality assurance. These policies

apply to all individuals enrolled in the Supports Program, and this manual has been developed to provide uniform

direction and guidance to individuals, families, Division personnel, and service providers.

The Division adheres to all State and federal laws, regulations, and rules that relate to the operation of the Division

and the programs it administers. The Division is required to develop policies and procedures for program operations

that conform to State and federal requirements.

The Division will review/revise the Supports Program policies as needed. Questions or requests for manual

revisions should be directed to the Division’s Supports Program Help Desk at DDD.FeeForService@dhs.nj.gov.

In addition to following the policies and procedures described in this manual, compliance with all applicable

Division Circulars is required. Division Circulars are available at

https://nj.gov/humanservices/ddd/providers/staterequirements/circulars/.

This manual applies to policies and procedures utilized by individuals who elect self-direction/self-directed

services and/or provider-managed services who have shifted fully into this Fee-for-Service system.

1.2 Overview of the Division of Developmental Disabilities

1.2.1 Mission and Goals

The Division of Developmental Disabilities assures the opportunity for individuals with developmental disabilities

to receive quality services and supports, participate meaningfully in their communities and exercise their right to

make choices.

This mission and Division goals are founded within these Core Principles:

 Ensure Health and Safety while Respecting the Rights of Individuals

 Promote and Expand Community-Based Supports and Services to Avoid Institutional, Segregated and Out-

of-State Services

 Promote Individual Choice, Natural Relationships and Equity in the Provision of Supports and Services

 Ensure Access to Needed Services From Other State and Local Agencies

 Support Provider Agencies in Achieving Core Principles

 Ensure that Services are High in Quality and Culturally Competent

 Ensure Financial Accountability and Compliance with all Laws and Ethical Codes

 Ensure Clear, Consistent Communication and Responsiveness to Stakeholders

 Promote Collaboration and Partnerships with Individuals, Families, Providers and All Other Stakeholders

1.2.2 Key Themes

In addition to the Core Principles described in Section 1.2.1, all services and supports provided through Division

funding are based on the following key themes which have emerged through the ongoing realization of the

Division’s New Vision for Support Across the Life Course.

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Individual Choice

The Division is committed to providing increased opportunities for individuals with developmental disabilities to

make individualized, informed choices and self-direct their services. Choice is not unlimited, however, and

individuals enrolled in Division-funded programs will be expected to meet all requirements and comply with all

standards and policies outlined in this manual and through the Participant Enrollment Agreement found in Appendix

D. The Division respects individuals’ rights to make choices that may differ from those desired by the people

around them, including family, friends, and professional staff. Individuals with developmental disabilities have the

right to assume risk in their own lives.

Shift from Segregated Settings/Supports to Integrated Supports

Individuals with developmental disabilities in New Jersey should have the opportunity – like everyone else – to

fully participate in their local communities. The Division provides a variety of home and community-based supports

and services to individuals with developmental disabilities to assist them in realizing full community participation

and continues to reform the system to enhance community-based services and minimize the need for segregated or

institutional services.

Employment Focus

Historically, individuals with intellectual and developmental disabilities have been either unemployed or

underemployed. In an effort to address this issue, New Jersey has adopted an employment focused approach to

encourage discussions around employment for the individuals it serves. As a result, Division personnel, Support

Coordinators, planning team members, etc. need to begin with the presumption that everyone receiving Division-

funded supports and services must have the opportunity for competitive integrated employment (CIE) in the general

workforce. The Workforce Innovation and Opportunity Act (WIOA) defines CIE as work that is performed on a

full or part-time basis for which an individual with a disability is:

 Compensated at or above minimum wage and comparable to the customary rate paid to employees without

disabilities performing similar duties and with similar training and experience;

 Receiving the same level of benefits provided to other employees without disabilities in similar positions;

 At a location where the employee interacts with other individuals without disabilities; and

 Presented opportunities for advancement similar to other employees without disabilities in similar

positions.

Outcomes related to an individual’s path to employment must be indicated in the Individualized Service Plan and a

facilitated discussion to determine which path is appropriate for each individual will be assisted through use of the

Pathway Assessment within the employment sections captured in iRecord. If someone has indicated that

employment is not currently being pursued, an explanation as to why employment is not an option at this time along

with information regarding what needs to change in order for employment to be pursued must be provided.

Additional policies, practices, and standards continue to be revised or developed as a result of this directive.

1.2.3 Division of Developmental Disabilities Responsibilities

 Determine individual eligibility

 Meet and comply with waiver assurances

 Ensure assessment is available and completed

 Identify individual budget “up to” amounts

 Assign the chosen Support Coordination Agency or auto assign, as applicable

 Approve service providers in collaboration with Medicaid

 Monitor service providers to ensure standards, policies, etc. are being met

 Provide approval/denial for identified services that cannot be approved by the SC Supervisor

 Provide ongoing quality assurance of the service plan and provision of services

 Initiate service provider termination with Medicaid, as applicable

 Discharge individuals from the Division or dis-enroll individuals from the Supports Program, as applicable

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2 VISIONING A LIFE COURSE – TRANSITIONING TO ADULTHOOD

As a student moves from the school system into the adult service system, it is important to plan for their future by

ascertaining their vision for life as an adult and assisting them in identifying services and supports that may be

needed to reach that vision. The Division has made a commitment to support this planning on an ongoing basis by

supplementing the efforts of the New Jersey Department of Education and local school districts in assisting students

with the transition into adulthood. To that end, the Division’s Planning for Adult Life project assists students with

intellectual and developmental disabilities between the ages of 16-21 and their families in charting a life course for

adulthood. As such, informational sessions, webinars, and resource guides/materials on various topics - including

but not limited to: employment, postsecondary education, housing, legal/financial planning, self-direction and

advocacy, and accessing the adult service system - can be found at www.planningforadultlife.org. The Division

also disseminates information targeted to “aging out” youth each year and begins the process of support

coordination assignment as early as April of the year in which a young person is aging out of the school system to

allow a seamless transition into adult services once they graduate. Finally, the Division works closely with the

Department of Children & Families (DCF) to transition students aging out of DCF’s Children’s System of Care

(CSOC) to ensure that there is no disruption in services.

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3 DIVISION OF DEVELOPMENTAL DISABILITIES ELIGIBILITY

This section outlines the criteria for eligibility for the Division and the process used to apply for services and

determine eligibility.

3.1 Requirements for Division Eligibility

The eligibility criteria to receive services from the Division are described in Division Circular #3 (N.J.A.C. 10:46)

which establishes guidelines and criteria for determination of eligibility for services to individuals with

developmental disabilities. Below represents key elements:

 An individual must be determined eligible for services before the Division can provide services.

 An individual must meet the functional criteria of having a developmental disability.

o In general, individuals must document that they have a chronic physical and/or mental impairment

that:

 manifests in the developmental years, before age 22;

 is lifelong; and

 substantially limits them in at least three of these life activities: self-care; learning;

mobility; communication; self-direction; economic self-sufficiency; the ability to live

independently

 In order to receive Division services, individuals are responsible to apply, become eligible for, and maintain

Medicaid eligibility.

 An individual must establish that New Jersey is their primary residence at the time of application.

 At 18 years of age individuals may apply for eligibility. At 21 years of age, eligible individuals may receive

Division services.

 The determination of an applicant’s eligibility for Division services shall be completed as expeditiously as

possible.

3.1.5 Limited Circumstances Where a Person Ages 18 through 21 May Receive

Division Services

Under the Individuals with Disabilities Education Act (IDEA), students with disabilities, ages 3 through 21 are

entitled to a free, appropriate public education (FAPE). Students are entitled to receive the special education and

related services identified through their Individualized Education Program (IEP), as determined by the IEP team.

The IEP contains goals aligned with academic achievement, and behavioral and functional performance, as well as

post-secondary goals related to training, education, employment and, if appropriate, independent living. The local

educational agency (LEA) is responsible for ensuring all services are provided at no cost to the student or parents.

The level of services and protections provided under the IDEA to students with disabilities are not equivalent

to those offered through the New Jersey Division of Developmental Disabilities’ (Division) adult service

system as Division services are not an entitlement. For this reason, individuals with disabilities who have

established eligibility for Division services receive them when they turn 21 and are no longer eligible to receive

services in the public education system under the IDEA.

The Division recognizes that each year there may be a small number of eligible young adults with developmental

disabilities ages 18 through 21 who have met both graduation requirements and the goals in their Individualized

Education Program (IEP) and are not eligible to remain in high school until age 21. An individual, if eligible for

Division services, may be eligible to enroll in the Division as early as the age of 18 if they have graduated and are

seeking Division services to:

 Support immediate enrollment at an institute of higher education or trade school not funded by the

Division of Developmental Disabilities; and/or

 Support established competitive integrated employment.

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In both of the above circumstances, the services being sought from the Division would not otherwise have been the

responsibility of their LEA to provide. Please note that this flexibility does not allow individuals to enroll in

Division services before the age of 21 for other reasons such as enrolling in a Division-funded adult day habilitation

program.

If you feel the above circumstance applies to you we strongly suggest you contact a Division Representative for

Options Counseling at least six months prior to your anticipated graduation. This is to ensure that you would be

eligible to access Division Services before electing to graduate prior to the age of 21. Please email

DDD.TransitionH[email protected]j.gov for more information.

There are also organizations in New Jersey such as the SPAN Parent Advocacy Network and The Arc of New Jersey

Family Institute that can assist families with children who receive special education and related services if you have

questions about the IEP process.

3.2 Intake/Application Process

To receive services funded by the Division, an individual must apply to become eligible. This process can begin

once the individual reaches 18 years of age; however, Division-funded services and supports will not be available

until the individual reaches 21 years of age. Eligibility criteria are outlined in Section 3.1 and 3.1.5 of this manual.

There are two versions of the application to determine eligibility:

You must use the Full Application for Determination of Eligibility if either:

a. You did not apply before for developmental disability services from either the NJ Division of

Developmental Disabilities or the NJ Children’s System of Care (PerformCare), OR

b. You received a service through the NJ Children’s System of Care (PerformCare) but never completed

PerformCare’s Application for Determination of Eligibility for Children Under Age 18.

You may use the Short Application for Determination of Eligibility if either:

a. You applied before for developmental disability services through the NJ Division of Developmental

Disabilities (DDD) and were notified by DDD that you were eligible, OR

b. You applied before for developmental disability services through the NJ Children’s System of Care

(PerformCare) and were notified by PerformCare that you were eligible.

The application process begins by contacting the Division Community Services Office representing the region in

which the individual resides or downloading the application from the Division website at

https://www.nj.gov/humanservices/ddd/individuals/applyservices/. Upon request, the intake worker can provide

assistance in completing the application.

3.2.1 Application

Depending on which application is completed (Full or Short) all or some of the following application forms might

be completed and signed as part of a complete application package:

 Application for Eligibility – The person completing the application must sign this form;

 ICD/10 Form – Completed by a medical professional;

 Health Information Portability and Accountability Act (HIPAA) documents;

o Notice of Privacy Practices and Acknowledgement Form – Please read the Department of

Human Services Notice of Privacy Practices and sign the Acknowledgement Form;

o Authorization for Disclosure of Health Information to Family and Involved Persons – Gives

the Division permission to talk with people the Applicant chooses about their health information.

This form must be completed and signed;

o Authorization for the Release of Health Information – Gives the Division permission to send

copies of the Applicant’s health records to people or organizations chosen by the Applicant. This

form must be completed and signed;

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 Consent Form – for use with any documentation related to the developmental disability and/or functional

limitations.

3.2.2 Additional Documents

In addition to the application, the individual must include as many of the available documents below that relate to

their disability. The more documentation that is provided, the easier it will be to process the application.

3.2.2.1 Documentation of Developmental Disability

 Medical Documentation of Disability

 Physician’s Statement

 Most Recent Psychological Evaluation (+ IQ Scores)

 All Available Psychological Reports

 Most Recent Child Study Team or School Reports

3.2.2.2 Legal Documentation of Age, US Citizenship, NJ Residency

 Photocopy of Birth Certificate

 Photocopy of Social Security Card or Proof of US Citizenship or Green Card

 Photocopy of one of the following:

o Voter Registration form

o Pay Stub

o W2 form

o Real Estate Tax Bill

o Permanent Change of Station Orders to New Jersey (if the individual’s legal guardian is in the U.S.

Military Service)

3.2.2.3 Other Documents

 Photocopy of Guardianship Order (if applicable)

 Photocopy of Medicaid Card

 Division of Vocational Rehabilitation Services (DVRS) Records/Evaluations

 SSI annual award letter

 Letter certifying Medicaid eligibility

If there are questions about whether or not the individual may meet the criteria for Division eligibility, contact the

Division Community Services Office, and a Division Intake Staff member there will discuss your situation and

guide you through the process for applying for eligibility.

3.3 Eligibility Determination Process

More detailed information regarding the eligibility determination process can be found in Division Circular #3

(N.J.A.C. 10:46). Specifically, information regarding timeframes associated with the process can be found in

N.J.A.C. 10:46 – 4.1 and 4.2.

When the application is complete, the intake worker will create a case file for the individual. The application,

including all necessary documentation (listed in Section 3.2), will be reviewed to determine that the individual has

met the initial requirement.

When the application as been determined to be complete, the intake worker will refer the individual and/or

family/responsible person, or guardian, if applicable, to complete the New Jersey Comprehensive Assessment Tool

(NJ CAT) to begin the process of determining whether or not the individual meets the functional criteria – functional

limitations in at least three or more areas of the major activities of daily living – to be eligible for the Division.

The NJ CAT is comprised of the Functional Criteria Assessment (FCA) and the Developmental Disabilities

Resource Tool (DDRT).

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The FCA portion of the NJ CAT will be used to assess the seven areas of major activities of daily living (self-care;

learning; mobility; communication; self-direction; economic self-sufficiency; the ability to live independently), and

will be used to make a preliminary determination whether the individual has functional limitations in at least three

of these areas.

To complete the NJCAT, a trained DDD facilitator will conduct a face-to-face meeting with the individual and their

guardian. The individual/guardian may also wish to have other family members, service providers and/or

caregivers participate as well.

The facilitator will access the NJCAT online and, as prompted by the screen, will verbally ask each NJCAT

question. The facilitator will enter each answer online only after the answer has been agreed upon by all meeting

participants.

When all questions have been answered, the facilitator will submit the completed NJCAT electronically to the

Rutgers University Developmental Disabilities Planning Institute (DDPI), where scores are tabulated and the tier is

established.

Once the NJ CAT has been completed, the intake team will make a final decision concerning eligibility.

 If the applicant is found to have met the functional criteria, along with the other identified eligibility criteria

listed in Section 3.2, the intake worker will verify Medicaid eligibility.

 If there is any question of functional eligibility, a face-to-face interview will be conducted and the intake

worker may refer the case to a psychologist, if necessary. Following the interview or psychologist review,

the matter will be reviewed by the Statewide Intake Coordinator and the Intake Review Team (IRT). If the

IRT finds that the individual is functionally eligible, the intake worker will verify Medicaid coverage. If

the IRT finds that the individual is not functionally eligible, the intake worker will advise the individual by

letter.

 If the individual is found ineligible, the intake worker will advise the individual by letter.

If the applicant has Medicaid at the time of their application to the Division and has been found to have met the

functional criteria, a full eligibility letter will be sent to the individual.

If the applicant does not have Medicaid eligibility, a letter will be sent to the individual that will indicate that they

do meet functional criteria but must be Medicaid eligible in order to receive Division-funded services. Once the

intake worker receives proof of Medicaid coverage, a full eligibility letter will be sent to the individual.

If found eligible, Division-funded services and supports will be made available once the individual reaches the age

of 21.

3.4 Tiering & Acuity Factor

Results of the NJ CAT are calculated and summarized into a score based on the following main areas: self-care,

behavior, and medical. This resulting score establishes the “tier” in which each individual has been assigned based

on their support needs.

These tiers will be used to determine the individual’s budget amount as well as to determine the reimbursement rate

a provider will receive for that individual for particular services. There are five base tiers: A, B, C, D, & E (as well

as an exception tier – Tier F – to be utilized in very rare cases). In addition, an acuity differentiated factor will be

added to the tier for individuals with high clinical support needs based on medical and/or behavioral concerns. The

acuity-based tiers are Aa, Ba, Ca, Da, Ea (and again, an exception Fa).

3.4.1 Acuity Factor Requirements

When an individual has been assigned the acuity differentiated factor, the Support Coordinator must complete the

Support Coordinator section of the Addressing Enhanced Needs Form (Appendix D) to indicate, to the best of their

knowledge, the areas that need to be supported by the service provider(s) when the individual is receiving their

services. This information will be based on the Support Coordinator’s review of the NJ CAT and will be submitted

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to the service provider as part of the process to determine individual and provider compatibility and to assist the

provider in understanding the individual’s behavioral/medical needs. Once the Support Coordinator has completed

their section of the form, it will be submitted to the service provider rendering the acuity differentiated service (i.e.,

individual supports, community based supports, day habilitation, and/or respite) to complete the Service Provider

section of the Addressing Enhanced Needs Form (Appendix D) to communicate how they plan to provide the

clinical level of support (through staffing, equipment, etc.) to ensure the individual’s safety. This form is first

completed prior to service delivery but can be revised as the provider learns more about the individual. The

individual/guardian shall have the opportunity to be involved in the process. Copies of the completed form will be

uploaded to iRecord by the Support Coordinator, kept in the individual file maintained by the service provider. This

form shall be updated at least annually and revised more frequently during the plan year as necessary.

When an individual is assigned the acuity differentiated factor and resides in their own home it is presumed that

agency staff hired by the individual (should that be preferred over utilizing self-directed employees) will provide

the medical and/or Behavioral Supports Monitoring needed during service delivery. However, as multiple agencies,

a combination of agency and self-directed employees, or varying hours of agency staff may be used, Behavioral

Supports Assessment/Plan development as described in section 17.2 of this manual, if needed, may be accessed

separately to ensure a consistent behavior support plan across providers and settings. As such, before staff (self-

directed employees or otherwise) are deployed to work with the individual they shall have received reasonable

training in the needs of the individual and, as applicable, the behavioral support plan and how to complete any

needed data collection associated with that plan. It is the responsibility of the individual/family/support coordinator

to provide the current ISP, BSP, etc. to the agency and communicate their expectations for the service.

3.5 Individual Budgets

Individual budgets, based on tiering, for participants enrolled in the Supports Program include the following

components: Employment/Day Supports, Individual/Family Supports, Direct Support Professional (DSP) Service

(funding allocated to individual budgets for the purpose of providing a legislatively mandated DSP wage increase.

Only applies to services as indicated in Section 17 and is used when all other budget categories are depleted), and

Supported Employment (as needed). Some services included in an individual’s Service Plan can be funded through

multiple budget components, while others can only be funded by one of the components. Individuals enrolled in

the Supports Program will have access to the following budget amounts (with the addition of the Supported

Employment component as needed) associated with the tier in which they are assessed:

Tier

Employment/

Day

Individual/Family

Supports

Supported

Employment

Total

Individual

Budget

$20,564

$7,442

Available as needed

$28,006

$28,628

$7,442

Available as needed

$36,070

$26,208

$14,883

Available as needed

$41,091

$36,519

$14,883

Available as needed

$51,402

$32,429

$14,883

Available as needed

$47,312

$45,159

$14,883

Available as needed

$60,042

$48,096

$22,324

Available as needed

$70,420

$66,932

$22,324

Available as needed

$89,256

$63,821

$22,324

Available as needed

$86,145

$88,820

$22,324

Available as needed

$111,144

Information about which services can be purchased through which budget component is included for each service

described in Section 17. Support Coordination services and Financial Management services are administrative costs

that do not come out of the individual budget.

The individual budget covers the service plan year. For example, if an individual’s ISP is approved in May, the

individual budget will provide funding for services until the next annual ISP is completed and approved in May of

the following year. If the individual experiences changes in their level of care, behavior, or medical needs during

the course of the plan year, a NJ CAT reassessment should be requested as described in Section 3.6.

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3.5.1 Requesting the Supported Employment Component of the Individual Budget

The Supported Employment component of the individual budget can be accessed in situations when the individual

budget does not sustain the level of Supported Employment – Individual Employment Support needed in order for

the individual to find or keep a competitive job in the general workforce. The individual must make every effort

to utilize his/her individual budget to cover his/her Supported Employment needs prior to requesting this additional

funding. To request the Supported Employment component, the Support Coordinator must submit a completed

Supported Employment Funding Request form (Appendix D) to DDD.EmploymentHelpdesk@dhs.nj.gov. This

form will be reviewed by the Division to ensure that other available services would not be able to provide the level

of support necessary for the individual to remain employed. The Division may request or conduct an observational

evaluation on the job site to assist in the determination process and/or provide technical guidance as needed. The

Division will inform the individual and Support Coordinator of the determination. Other Division funded services

remain available while this determination is being made.

3.5.2 Bump-Up

If the individual experiences changes in life circumstances that result in a need for additional temporary

services (an injury that requires additional supports to provide assistance during the day or hospitalization

of the individual’s caregiver, for example) that exceed his/her individual budget, a short-term increase in

the budget, known as a “bump up,” may be available to improve the situation. This bump-up is capped at

$5,000 per individual, will be effective for up to one year, and can only be provided once every three

years. A bump-up request can only be submitted for individuals currently enrolled in the Supports Program (SP).

The process for submitting a request for a bump-up is as follows:

1. An individual, family member or Support Coordinator must submit an email requesting a bump-up to the

following address DDD.SPBum[email protected]ov, which must contain the individual’s initials and

DDD ID# in the subject line. The Statewide Intake Coordinator will review the information requested and

provided and make a determination

2. The body of the email must contain the following information:

 Summary of the current situation

 The temporary service(s) being requested

 Length of time a service(s) will be needed (start & end dates)

 A breakdown of unit type, frequency, rate, total units, total cost

 Acknowledgement that the individual and/or family member requesting a bump-up is aware that if

approved the additional funding will be effective for up to one year, and can only be provided once

every three years.

3. A determination will be rendered within 3 business days of the initial request, unless additional information

or meeting is requested by the Statewide Intake Director.

3.6 Requesting NJ CAT Reassessment

Individuals/guardians may request a reassessment at any time. Please note that, based on the responses provided,

a reassessment may result in a reduction in tier level, no change in tier level, or an increase in tier level.

The process for submitting a request to be reassessed is as follows:

1. The individual/guardian requests a copy of the most recently completed NJ CAT from their Support

Coordinator;

2. The individual/guardian reviews the NJ CAT and notes any changes directly on the assessment;

3. The individual/guardian completes the “Request for Reassessment Form” found on the Division’s website

under “FFS Information/Resources” at

https://nj.gov/humanservices/ddd/individuals/applyservices/assessment/;

4. The individual/guardian submits the completed “Request for Reassessment Form,” NJ CAT changes, and

any supporting documents to the assessment request email address at:

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DDD.DDPIAssessmentRequest[email protected] or mail the documents to the following address:

Department of Human Services

Division of Developmental Disabilities

P.O. Box 726

Trenton, NJ 08625-0726

Attention: NJ CAT Reassessment Unit

5. The Division designee assigned to the mailbox will reach out to the designated “informant” within three

(3) business days from the initial contact to acknowledge receipt of request and provide the name of the

Division staff person assigned to facilitate the reassessment;

6. The Division staff person assigned to facilitate will reach out within five (5) business days to discuss

scheduling a meeting date.

3.7 Redetermination of Eligibility

The Division may reevaluate an individual’s eligibility at any time.

Individuals must maintain Medicaid eligibility to remain eligible for Division services.

3.8 Eligibility Appeal Rights

Individuals who have been determined ineligible for Division services may appeal the decision in accordance with

the provisions of Division Circular #3 (N.J.A.C. 10:46-5.1) and Division Circular #37, “Appeals Procedure”

(N.J.A.C. 10:48 et seq.).

An initial appeal shall be made in writing to:

Assistant Commissioner

Division of Developmental Disabilities,

P.O. Box 726,

Trenton, NJ 08625-0726

3.9 Discharge from the Division

An individual may be discharged from the Division due to any of the following:

 They no longer meet the functional criteria necessary to be eligible for the Division;

 They choose to no longer receive services from the Division;

 They do not maintain Medicaid eligibility;

 They no longer reside in the State of New Jersey; or

 They do not comply with this manual, Division policies or waiver program requirements.

An individual who has been discharged from Division services must go back through the intake process to be

reinstated.

3.10 Moving from the Supports Program to the Community Care Program

Enrollment in the Supports Program is available to any individual who has been determined eligible for Division

services.

Enrollment in the Community Care Program (CCP) is only available to an individual determined eligible for

Division services who also meets the required level of care for the program (See section 5.1.2 in the Community

Care Program Policies & Procedures Manual) and who either (a) has been reached on the Community Care Program

Waiting List (See section 5.1.3 of the Community Care Program Policies & Procedures Manual) or (b) has been

determined by the Division to be in an emergent circumstance as defined by Division Circular 12 (N.J.A.C. 10:46B).

The Support Coordinator can initiate the process for requesting Division review of an emergent circumstance, and

subsequent level of care review, by contacting their agency’s assigned Division QAS.

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4 OVERVIEW OF THE SUPPORTS PROGRAM

The Supports Program is the Division initiative included in the Comprehensive Medicaid Waiver (CMW) that was

approved by the Centers for Medicare & Medicaid Services (CMS) on October 1, 2012. The CMW provides

statewide reform for Medicaid services, shifts the focus of services and supports to community-based, and allows

New Jersey to draw down increased federal funds.

The Supports Program provides needed supports and services for adult individuals, 21 and older, living with their

families or in other unlicensed settings. It has been designed to help New Jersey better serve adults with

developmental disabilities and significantly reduce the number of individuals waiting for supports and services.

The Supports Program will provide all enrolled participants with employment/day services and individual/family

support services based on their assessed level of need. Individuals and their families will have the flexibility to

choose the options and opportunities for support services that will best meet their needs with the assistance of

Support Coordinators who will assist them in developing an Individualized Service Plan and link them to

appropriate services.

With the exception of individuals enrolled in another Home & Community Based Setting (HCBS) or Managed

Long Term Services & Supports (MLTSS) program (including the CCP), all adult individuals who are eligible for

both Division services and Medicaid will be able to access the Supports Program.

4.1 Supports Program + Private Duty Nursing (PDN)

In circumstances where an individual has been assessed by the Managed Care Organization (MCO) to need Private

Duty Nursing (PDN) but is better served through services available through the Supports Program rather than those

services available through Managed Long Term Services and Supports (MLTSS), they can be enrolled in the

Supports Program and receive PDN through Medicaid. This individual would not be enrolled in MLTSS as federal

rules prohibit enrollment on more than one waiver program at a time.

To be eligible for Supports Program + PDN, an individual must meet the criteria described in Section 5.1 and qualify

to receive PDN services. In order to qualify to receive PDN services, the individual’s MCO will conduct the NJ

Choice Assessment to determine whether or not the individual meets level of care for PDN. If the individual does

meet level of care, then the MCO will conduct another assessment to determine the amount of PDN the individual

can receive through their MCO. The enrollment process for the Supports Program + PDN is described in Section

5.2.1. Once the individual is deemed eligible for the Supports Program + PDN, the MCO and Division will work

together to coordinate services.

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5 SUPPORTS PROGRAM ELIGIBILITY AND INDIVIDUAL ENROLLMENT

5.1 Eligibility for the Supports Program

In addition to meeting the requirements for Division eligibility (as described in Section 3.1), an individual eligible

for the Supports Program must meet the following criteria:

 At least 21 years old

 Deemed eligible for Division services as described in Section 3.3

 Has and maintains Medicaid eligibility

 Lives in an unlicensed setting – own home or family home

 Is not currently enrolled in another HCBS or MLTSS program (including the CCP) or, if enrolled in another

program, agrees to dis-enroll in order to enroll in the Supports Program

5.1.1 Allowable Types of Medicaid for the Supports Program

 Supplemental Security Income Medicaid

 Workability Medicaid

 NJ FamilyCare

 Supports Program Medicaid Only

5.1.1.1 Accessing Supports Program Medicaid Only

If an individual is not receiving Medicaid through SSI, WorkAbility, or NJ Care or has a type of Medicaid not

approved for waiver enrollment (typically someone who is not eligible for Medicaid as a “Disabled Adult Child –

DAC”), the individual will need to apply for Supports Program Medicaid Only. The process for accessing Supports

Program Medicaid Only is as follows:

 The Supports Program Notice of Expected Admission (NOEA) gets completed by the Support Coordinator

and submitted to the Supports Program Unit

 The Supports Program Unit reviews the NOEA to ensure it is completed accurately and contains all

necessary information and then forwards the information to the Division’s Waiver Unit

 The Division’s Waiver unit sends a Medicaid application packet to the family

 The family completes the Medicaid application packet and sends it back to the Division’s Waiver unit

 The Division’s Waiver unit submits the completed application and supporting documents to the Institutional

Support Services (ISS) staff at Medicaid

 ISS processes the Medicaid packet, determines if the individual meets the financial requirements for the

Supports Program Medicaid, and determines if the individual is Medicaid eligible

 Once ISS determines the individual is Medicaid eligible, they notify the Division’s Waiver unit who then

forwards that information to the Supports Program Unit

 The Supports Program Unit then initiates the process to enroll the individual into the Supports Program

Additional information about Medicaid eligibility and the Division can be found on the Division’s website at

https://nj.gov/humanservices/ddd/individuals/applyservices/medicaid/.

5.2 Individual Enrollment into the Supports Program

The following steps will be taken to enroll an individual into the Supports Program:

 The individual will go through the intake and eligibility determination process (outlined in Sections 3.2 and

3.3) and be assigned a budget amount based on the assessed level of need found through completion of the

NJ Comprehensive Assessment Tool (NJ CAT) – if the most recent completion of the NJ CAT was done

more than 2 years prior to enrollment into the Supports Program, a reassessment may be conducted;

 When the individual has completed the Intake/Application process and is determined eligible to receive

DDD services, their assigned Intake Worker will provide them with a Support Coordination Agency

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Selection Form to complete. Once completed, the form is returned to the Intake Worker for assignment to

a Support Coordination Agency;

 Upon receipt of the Support Coordination Agency Selection Form, the Division will confirm that the

individual meets the eligibility criteria for the Supports Program;

 The individual will be assigned a Support Coordination Agency through the process described in Section

6.1.2;

 The Support Coordinator will ensure that the individual has access to or a copy of the Supports Program

Policies & Procedures Manual and will explain the Participant Enrollment Agreement and obtain a signed

copy from the individual/guardian;

 Once the Support Coordinator obtains the signed Participant Enrollment Agreement, the individual will be

enrolled into the Supports Program and the Support Coordinator will follow procedures described in this

manual to assist the individual in accessing services.

5.2.1 Enrollment into the Supports Program + Private Duty Nursing (PDN)

As described in Section 4.1, individuals who have been assessed to be eligible for PDN but are better served by the

Supports Program than Managed Long Term Services and Supports (MLTSS) can enroll in the Supports Program

and still receive PDN through Medicaid funding. The process to access the Supports Program + PDN is described

in the following sections.

5.2.1.1 Individual Already Enrolled in MLTSS

When an individual has been enrolled in MLTSS in order to access PDN services but their needs can be better met

through the Division, they can choose to disenroll from MLTSS and enroll in the Supports Program + PDN. The

process to enroll this individual into the Supports Program + PDN is as follows:

 The Division is informed that the individual wishes to enroll in the Supports Program + PDN

 Division staff reviews the individual’s information to ensure that they meet all eligibility criteria for the

Division as well as the Supports Program

 If the individual meets Supports Program enrollment criteria, Options Counseling is provided by a Division

staff person or Support Coordinator

 The individual submits a request to disenroll from MLTSS to their assigned Managed Care Organization

(MCO) Care Manager

 Once the Division is notified that the request for disenrollment has been received, the Division initiates the

enrollment process

 The Division coordinates with MLTSS to transition individual from MLTSS services to Supports Program

+ PDN

5.2.1.2 Individual Not Currently Enrolled in MLTSS

When an individual is not currently enrolled in MLTSS, is in need of PDN services, and is better served by the

Division, they can enroll in the Supports Program + PDN. The process to enroll this individual into the Supports

Program + PDN is as follows:

5.2.1.2.1 Individual is Currently Enrolled in the Supports Program

 The Division is informed that the individual wishes to enroll in the Supports Program + PDN

 Individual requests a nursing assessment through his/her MCO Case Manager

 MCO Case Manager requests NJ Choice Assessment to determine PDN eligibility

 Individual is informed of the result of the NJ Choice

 Support Coordinator adds PDN to the ISP as a generically funded service and communicates with the

individual’s MCO Case Manager to ensure PDN services are being provided

5.2.1.2.2 Individual is Not Currently Enrolled in the Supports Program

 The Division is informed that the individual wishes to enroll in the Supports Program + PDN

 Division staff reviews the individual’s information to ensure that they meet all eligibility criteria for the

Division as well as the Supports Program

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 If the individual meets Supports Program enrollment criteria, Options Counseling is provided by a Division

staff person or Support Coordinator and enrollment into the Supports Program is initiated

 The Division is informed that the individual wishes to enroll in the Supports Program + PDN

 Individual requests a nursing assessment through their MCO Case Manager

 MCO Case Manager requests NJ Choice Assessment to determine PDN eligibility

 Individual is informed of the determination regarding nursing eligibility

 Support Coordinator adds PDN to the ISP as a generically funded service and communicates with the

individual’s MCO Case Manager to ensure PDN services are being provided

5.2.1.2.3 Individuals Approaching 21 Needing to Continue Private Duty Nursing (PDN)

If an individual turning 21 is no longer eligible for nursing services because they are turning 21 and are deemed

eligible for PDN, they can be enrolled in the Supports Program + PDN upon their 21

birthday. The process to

enroll this individual into the Supports Program + PDN is as follows:

 The Division is made aware that someone eligible for Division services is turning 21 and needs to continue

nursing services

 Division staff reviews the individual’s information to ensure that they meet all eligibility criteria for the

Division as well as the Supports Program

 A referral form is submitted to the Supports Program Unit

 The Supports Program Unit submits referral to the MCO in order to assess for nursing and complete the NJ

Choice

 Division staff initiate obtaining documents necessary for Supports Program enrollment (i.e. Support

Coordination Agency Selection Form)

 Up to 60 days prior to the individual’s 21

birthday, they will be assigned a Support Coordination Agency

 The Support Coordinator uploads the signed Participant Enrollment Agreement to iRecord, begins

facilitating the PCPT, and develops the ISP in order for ISP approval to be completed on the individual’s

birthday

 The Division continues to track individuals awaiting Supports Program + PDN enrollment in order to keep

updated

 Support Coordinator adds PDN to the ISP as a generically funded service and communicates with the

individual’s MCO Case Manager to ensure PDN services are being provided

5.3 Individual Responsibilities

In addition to following the terms and conditions of the Supports Program as outlined in the Participant Enrollment

Agreement, the individual is responsible for the following:

 Maintaining/keeping allowable Medicaid coverage to continue services

 Meeting with the Support Coordinator and providing all information necessary to ensure that the

Individualized Service Plan can be created within 30 days of Supports Program enrollment

 Participating in the development of the ISP and sharing in any decision making associated with the plan

 Following the individual budget according to Waiver guidelines

 Providing/completing all required paperwork and following the policies and procedures in this manual

 Contacting the Support Coordinator in the event that a change in service provider is wanted/needed

 Contacting the Support Coordinator if there are changes in the individual’s life that may require a change

to the ISP or services

 Participating in monthly phone contacts and quarterly visits with the SC and understanding that these visits

are mandatory and may occur in the home, day program, or place of employment as agreed upon with the

SC and that, annually, at least one of these quarterly visits must take place in the home

5.4 Individual Disenrollment from the Supports Program

As outlined in the Participant Enrollment Agreement, the State may disenroll an individual from the program and/or

discontinue all payment, as applicable, to a provider/self-directed employee, if one or more of the following

circumstances occur:

(a) The participant has not provided all information and documents required;

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(b) The Support Coordinator or the State has reasonable cause to believe that the participant has been or is

engaged in willful misrepresentation, exploitation, or Medicaid fraud or abuse related to the provision of

services under the Participant Enrollment Agreement;

(d) The participant refuses to allow, or does not participate in, monthly, quarterly, and annual contacts/visits

conducted by the Support Coordinator in accordance with guidelines provided in the Supports Program

Policies & Procedures Manual;

(e) The participant fails to submit on a timely basis documents and records required in relation to the provision

of services;

(f) The participant fails to report changes in care needs and financial circumstances that may affect eligibility;

(g) The participant is no longer Medicaid eligible;

(h) The participant has moved out of the State;

(i) The participant no longer meets the Level of Care for the Supports Program;

(j) The participant has enrolled in another HCBS or MLTSS program (including the CCP).

(k) The participant has failed to abide by any terms of the Participant Enrollment Agreement;

(l) The participant is not accessing Supports Program services other than Support Coordination for greater than

90 days

(m) The participant chooses to voluntarily disenroll from the Division and/or the Supports Program.

5.4.1 Individual Disenrollment Process

In the event that a participant chooses to voluntarily disenroll from Division services, they will provide signed

documentation stating their intention to disenroll from all Division services, including waiver services, by

submitting the Voluntary Discharge from Division Services form (Appendix D).

In the event of non-voluntary disenrollment, the Division will provide written notification to the participant.

The State shall provide 30 days notice to the participant in the event of disenrollment or discontinuation of payment

due to (a), (d), or (e) above. During this 30-day time period, the Support Coordinator and Division will provide

assistance and support as needed to help the individual in addressing the issue(s) for which they are being

disenrolled. If the issue(s) have been resolved within those 30 days, the individual’s waiver status may not be

terminated.

The following process will be followed to address (l) above:

 When an ISP is developed without Supports Program services, the Support Coordinator will explain to the

individual that they will be disenrolled if Supports Program services are not accessed within 90 days.

 During monthly monitoring (in the month after the ISP is approved and the following month, if applicable),

the Support Coordinator will determine the status of accessing Supports Program services and remind the

individual of disenrollment if the individual continues not to access Supports Program services.

 At 60 days without a Supports Program service other than Support Coordination, the Support Coordination

Agency will provide written notification to the individual explaining that the Division will be notified that

the individual is not utilizing Supports Program services and the disenrollment process will begin at 90

days if the individual continues not to access Supports Program services.

 At 90 days without a Supports Program service other than Support Coordination, the Support Coordination

Agency will notify the Division and provide information about any extenuating circumstances (such as lack

of availability of services).

 The Division will send written notification to the individual (and copy the Support Coordinator) explaining

that they will be dis-enrolled from the Supports Program if they are not in need of Supports Program

services within the next 10 days.

 If the Division or Support Coordinator does not receive a response by the date indicated in the notification,

the Division will dis-enroll the individual from the Supports Program, indicate the reason for disenrollment

in iRecord notes, and notify the Support Coordination Agency.

Due to lack of need rather than difficulty in accessing services due to lack of capacity/availability

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 Individuals who do not voluntarily dis-enroll from the Supports Program are notified in writing and are

entitled to the opportunity to request a Fair Hearing as governed by Medicaid regulations.

In the event that an individual is dis-enrolled from the Supports Program, the Support Coordination Agency (SCA)

will receive alerts through iRecord, and the Support Coordinator (or someone designated by the SCA) shall notify

all service providers supporting the individual within 24 hours of notification of disenrollment. In addition, after

30 days the providers will automatically be updated with an ISP that has been approved to “inactive” and services

will be ended as of that date.

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6 CARE MANAGEMENT

Care management for Supports Program services is provided through Medicaid/Division approved Support

Coordination Agencies

. This section provides a summary of the Support Coordinator’s responsibilities. More

detailed information about Support Coordination services is provided in Section 17.19.

6.1 Selection and Assignment of a Support Coordination Agency

Each person eligible to receive services through the Supports Program must have a Support Coordinator

6.1.1 Choosing a Support Coordination Agency

The individual has the opportunity to choose their preferred Support Coordination Agency from a database

(https://irecord.dhs.state.nj.us/providersearch) of approved agencies. Guides to assist individuals and families in

choosing a Support Coordination Agency are available at

http://rwjms.rutgers.edu/boggscenter/projects/infopeopleandfamilies.html. When the individual has completed the

Intake/Application process and is determined eligible to receive DDD services, their assigned Intake Worker will

provide them with a Support Coordination Agency Selection Form to complete. The individual will indicate their

preferred Support Coordination Agency on the Support Coordination Agency Selection Form. Once completed,

the form is returned to the Intake Worker for assignment to a Support Coordination Agency. As long as the selected

agency provides support coordination services in the county in which the individual resides, has capacity to add the

individual to its services, and meets the conflict free policy described in Section 17.18.5.7, the Division will assign

the preferred Support Coordination Agency. If the individual does not indicate a preference or the preferred Support

Coordination Agency does not meet the previously mentioned criteria to serve the individual, the Division will auto

assign the Support Coordination Agency based on location and available capacity.

A list of Medicaid/DDD approved Support Coordination Agencies can be generated through the Provider Search

Database at https://irecord.dhs.state.nj.us/providersearch.

To find a Support Coordination Agency using the Provider Search Database follow these steps:

 Select the “Filter” dropdown menu to the right of your screen

 Check the “Support Coordination” box under the “Service” dropdown menu

 Check the county in which the individual resides under the “County Served” dropdown menu

 Check the Language preferred, as applicable

 Click on the magnifying glass to the right of the “Filter” dropdown menu and a list of approved Support

Coordination Agencies will be generated

 This list can be printed or exported to an excel spreadsheet by clicking on the applicable icon found to the

left of your screen under the “Name, Service” box

Once assigned, the Support Coordination Agency will identify a Support Coordinator within its agency. The

individual can inform the Support Coordination Agency of any preference they may have in Support Coordinator,

but there is no guarantee that the Support Coordination Agency will be able to assign the preferred Support

Coordinator to the individual.

6.1.2 Process for Assigning a Support Coordination Agency

Assignment of the Support Coordination Agency is conducted through the following process:

 The individual receives the Support Coordination Agency Selection Form from their Intake Worker;

 The individual/guardian/family completes and submits the Support Coordination Agency Selection Form

as directed. Please note that Support Coordination Agency Selection Forms will only be accepted when

completed by the individual/guardian/family;

 A Support Coordination Agency is assigned by the Division after submission of the Support Coordination

Agency Selection Form based on the indicated preference or through auto assignment if no preference is

On occasion, Case Managers with the Division may be utilized in more intensive situations or during transitions from

institutional settings to community settings.

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indicated or in cases where the preferred agency does not meet the criteria indicated in Section 17.19 to

serve the individual;

 A secure email notification of assignment is provided to the Support Coordination Agency (the individual

or a designee will also receive an email regarding Support Coordination Agency assignment if their email

address was included within the Support Coordination Agency Selection Form);

 The Support Coordination Agency will identify a Support Coordinator within the agency;

 The assigned Support Coordinator will contact the individual to introduce themself and begin the planning

process.

6.1.3 Changing Support Coordination Agencies

If the individual wishes to change Support Coordinators, they must follow the policies/procedures set forth by the

Support Coordination Agency to request a change in Support Coordinator. The Support Coordination Agency

should make every effort to accommodate the request and assign a new Support Coordinator to the individual but

is not obligated to do so.

Because the rate for Support Coordination services is monthly, the individual must commit to a calendar month of

services from the assigned Support Coordination Agency before a change can be conducted. If the individual wishes

to change Support Coordination Agencies, they must indicate that request on the Support Coordination Agency

Change Form and submit it to the Division by following the directions indicated on the form. Typically, Support

Coordination reassignments are conducted on the 1

of the month due to the monthly rate for Support Coordination

Services. The reassignment process will follow the assignment process indicated in Section 6.1.2.

As soon as the new Support Coordination Agency is assigned, the previous Support Coordination Agency will no

longer have access to the individual’s information or be able to upload associated documents for that individual on

iRecord. All information already gathered and developed – including contact and demographic information,

planning documents such as the Person-Centered Planning Tool (PCPT) and ISP, monitoring tools, etc. – will

become available to the newly assigned Support Coordination Agency through iRecord. In the event the previously

assigned Support Coordination Agency (SCA) has not uploaded documentation to iRecord, a hard copy of all

applicable documents must be distributed to the SCA’s Division-assigned Quality Assurance Specialist within three

business days. Examples of documentation include monitoring tools, case notes, and service planning

documents. The previous SCA may not contact individuals previously served or send letters, notification, or other

communication without prior approval from the Division.

In the event that a Support Coordination Agency closes, is suspended or terminated, is sanctioned by the Division

with a reduction of census, otherwise dis-enrolls, etc. the Division will notify the individual of the need to reassign

their Support Coordination Agency and provide the Support Coordination Agency Selection Form. The new Support

Coordination Agency will be assigned as described in Section 6.1.2. Support Coordination Agencies in the process

of disenrollment are prohibited from involvement in the new Support Coordination Agency selection process for

the individuals affected. The Division will provide all communication regarding disenrollment, choice of agency,

and process to individuals and/or families directly.

6.2 Role of the Support Coordinator

The Support Coordinator manages Support Coordination services for each individual by performing the following

four general functions: individual discovery, plan development, coordination of services, and monitoring. These

functions are further described in Section 17.18.

6.3 Responsibilities of the Support Coordinator

The Support Coordinator is responsible for:

 Using and coordinating community resources and other programs/agencies in order to ensure that waiver

services funded by the Division will be considered only when the following conditions are met:

o Other resources and supports are insufficient or unavailable;

o Other services do not meet the needs of the individual; and

o Services are attributable to the person’s disability.

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 Accessing these community resources and other programs/agencies by:

o Utilizing resources and supports available through natural supports within the individual’s

neighborhood or other State agencies;

o Developing a thorough understanding of programs and services operated by other local, State, and

federal agencies;

o Ensuring these resources are used and making referrals as appropriate; and

o Coordinating services between and among the varied agencies so the services provided by the

Division complement, but do not duplicate, services provided by the other agencies.

 Developing a thorough understanding of the services funded by the Division and ensuring these services

are utilized in accordance with the parameters defined in Section 17 of this manual.

 Interviewing the individual and ensuring they are at the center of the planning process and in determining

the outcomes, services, supports, etc. that they desire. Also interviewing, if appropriate, the family or other

involved individuals/agency staff; reviewing/compiling various assessments or evaluations to make sure

this information is understandable and useful for the planning team to assist in identifying needed supports;

and facilitating completion of discovery tools, if applicable.

 Scheduling and facilitating planning team meetings in collaboration with the individual; informing the

individual and parent/guardian that the service provider(s) can be part of the planning team, asking the

individual and parent/guardian if they would like to include the service provider(s) at the ISP meeting, and

inviting the service provider(s) to the ISP meeting; writing the PCPT and ISP; and distributing the ISP (and

PCPT when the individual consents) to the individual, all team members, and the identified service

providers; and reviewing the ISP through monitoring conducted at specified intervals.

 Ensuring that, for individuals assigned an acuity, that the Addressing Enhanced Needs Form is updated at

least annually and revised more frequently during the plan year as necessary. The individual/guardian shall

have the opportunity to be involved in the process. See Section 3.4 for more information.

 Ensuring that there has been a discussion regarding a behavior plan for individuals with behavioral concerns

and that a behavior plan is in place as needed, particularly when the individual is assigned acuity due to

behavior. This shall be documented in the individual’s ISP.

 Ensuring that there has been a discussion regarding the medical needs of the individual and that these needs

are documented in the ISP. This is to include the need for data collection of bowel movements, urine output,

seizure activity, etc. Should the planning team agree that such data collection is medically necessary, and

the individual’s primary care physician provides a prescription for it, this shall also be documented in the

ISP along with the responsible party who will record and store the information.

 Writing the PCPT and ISP; and distributing the ISP (and PCPT when the individual consents) to the

individual, all team members, and the identified service providers; and reviewing the ISP through

monitoring conducted at specified intervals.

 Annual completion of the Participant Rights and Responsibilities form with the individual/guardian,

uploading it to iRecord, and providing a signed copy minimally to the individual/guardian, residential, and

day service provider (as applicable).

 Obtaining authorization from the SC Supervisor for Division-funded services.

 Monitoring and following up to ensure delivery of quality services, and ensuring that services are provided

in a safe manner, in full consideration of the individual’s rights. This includes ensuring that for individuals

residing in provider-owned or controlled residential settings (i.e., Group Homes, Supervised Apartments,

etc.) and/or attending day habilitation programs, pre-vocational programs and group supported employment

programs that any restriction (Examples include, but are not limited to: Inability to access food at any time

due to a medical disorder; Inability to have access to items due to PICA) is supported by a specific assessed

need and justified in the person-centered service plan (i.e. ISP). Please see section 11.7 Home and

Community Based Services (HCBS) Settings Compliance for more information.

 Notifying the Division’s HCBS Helpdesk at DDD.HCBShelpd[email protected]j.gov if they are notified that a

provider-owned or controlled setting is not in compliance with section 11.7 Home and Community Based

Services (HCBS) Settings Compliance.

 Maintaining a confidential case record that includes but is not limited to the NJ Comprehensive Assessment

Tool (NJ CAT), completed Support Coordinator Monitoring Tools, PCPTs, ISPs, notes/reports, annual

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satisfaction surveys, annual physical and dental examinations (for those who reside in a licensed residential

program), and other supporting documents uploaded to the iRecord for each individual served.

 Ensuring individuals served are free from abuse, neglect, and exploitation; reporting suspected abuse or

neglect in accordance with specified procedures; and providing follow-up as necessary.

 Ensuring that incidents are reported in a timely manner in accordance with policy and follow-up

Responsibilities are identified and completed.

 When a Support Coordinator is alerted that an individual assigned them has had an interaction with law

enforcement/court system that results in a criminal charge, summons, or complaint they will discuss the

availability of resources with the individual/guardian. This may include, but not be limited to: The Arc of

New Jersey Criminal Justice Advocacy Program; Resources listed in the Legal and Advocacy Services

section of the most recent publication of NJ Resources; etc. The Support Coordinator shall assist with the

submission of a referral based on the expressed preference of the individual/guardian and document in an

iRecord case note.

 Notifying the individual, planning team, and service provider and revising the ISP whenever services are

changed, reduced, or services are terminated.

 Reporting any suspected violations of contract, certification or monitoring/licensing requirements to the

Division.

 Entering required information into iRecord in an accurate and timely manner.

 Ensuring that individuals/families are offered informed choice of service provider.

 Linking the individual to service providers by providing information about service providers; assisting in

narrowing down the list of potential service providers; reaching out to providers to confirm service capacity,

determine intake/eligibility requirements, gather and submit referral information as needed, establish

provider capacity to implement strategies to reach identified ISP outcomes, and confirm start date, units of

service, etc.

 Becoming aware of items/documentation the service provider will need prior to serving the individual and

assist/ensure they are provided prior to the start of services.

 Notifying the individual regarding any pertinent expenditure issues.

 Conducting contacts on a monthly basis, face-to-face visits on a quarterly basis, and in-home face-to-face

home visit on an annual basis that includes review of the ISP and is documented on the Support Coordinator

Monitoring Tool.

 Completing/entering notes/reports as needed.

 Providing support, as needed, in relation to supporting the individual in their decision making as outlined

in section 7.1.1 Individual as Decision Maker.

 Reporting data to the Division as required and upon request.

 At the direction of Division staff, completion of surveys that may be required, etc.

 Including the Individual Supports – Daily Rate service provider in the planning process.

 Alerting the planning team that, with a doctor’s order, certain charting can occur as medically necessary

such as food intake, blood glucose levels, etc.

 Ensuring involved service provider(s) have received notification to begin services.

 Ensuring that the individual is aware of different housing options that can be utilized in the community

(including those that are not disability specific) so that they are supported in the least restrictive setting

based on their individual needs and preferences. This includes assisting them in application for housing

assistance.

 In relation to Electronic Visit Verification (EVV), the Support Coordinator shall be responsible for

confirming with the individual/family which staff, if any, are live-in caregivers paid by DDD through the

participant’s individual budget. Should a live-in caregiver exist, the Support Coordinator shall complete

the Live-In Caregiver Attestation form at the time of service-plan development, whenever there is a change

in live-in caregiver status and annually thereafter. Once complete, the form shall be uploaded to iRecord.

6.4 Support Coordinator Deliverables

The deliverables listed below serve as documentation that services were provided within the month in order for the

Support Coordination Agency to claim for services. However, the monthly rate received for providing Support

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Coordination services includes all of the responsibilities required as the entity providing care management for all

individuals served as outlined throughout this manual – particularly within Sections 6, 7, 8, 12, and 17.18.

 Monthly contact documented on the Support Coordinator Monitoring Tool

 Quarterly face-to-face contact documented on the Support Coordinator Monitoring Tool

 Annual home visit documented on the Support Coordinator Monitoring Tool

 Completed PCPT & approved ISP by 30 days from date the individual is enrolled onto the CCP or when a

new ISP is generated due to annual ISP date, changes to the individual budget, a change in the individual’s

tier assignment, or a change in waiver enrollment (going from the CCP to the Supports Program, for

example). In circumstances where a new plan is generated, the SCA is expected to continue meeting

deliverables, such as completing the monthly contacts, but will not be able to claim for payment for

completing these deliverables unless/until the newly generated ISP is complete.

If meeting the previously mentioned deliverables is delayed due to the individual (or family) failing to comply with

attending meetings, participating in mandated contacts, allowing access to the home for visits, etc., the Support

Coordinator should notify the individual that non-compliance regarding Division policy will be reported to the

Division. If non-compliance continues, the SC Supervisor shall upload a Seeking Out Support (SOS) form and

email the Support Coordination Help Desk at DD[email protected]ov to ensure follow-up with the

individual to determine the reasons why non-compliance has occurred. Ongoing non-compliance for circumstances

beyond those that may be unavoidable (such as hospitalization) may result in termination from Division services.

Information regarding these incidents of non-compliance, attempted or successful contacts with the individual (or

family), reasons for non-compliance, etc. shall be documented through case notes entered into iRecord.

Updates related to any and all significant events should be documented in case notes by the Support Coordinator.

Documentation should be timely and frequent for high risk or high acuity situations. Case Notes shall be up to date

at all times with the most recent contact or events occurring with the individual.

If meeting these deliverables is delayed due to system issues with the Division, the SC Supervisor shall notify the

Support Coordination Help Desk at DDD.SCHelpdesk@dhs.nj.gov.

6.5 Community Transitions & Support Coordination

6.5.1 Transitions to Institutions from Community Settings

When an individual is transitioned from a community setting into an institutional setting (nursing home, ICF/ID,

etc.) for the purpose of rehabilitation, respite, etc. if there is an assigned Support Coordinator, the Support

Coordinator will retain the case up to 180 days from the date of admission. The Support Coordinator must then

transition the individual to a Division Case Manager.

This transition will proceed as follows:

 Support Coordination will complete monthly monitoring in accordance with established Support

Coordinator Responsibilities and Deliverables as described in Section 13.

 Support Coordination will conduct all placement activities to transition the individual back to the

community if the individual is returning to their original placement or a new placement is identified.

 If the individual has not transitioned after being in an institutional setting for 180 days, Support

Coordination will transfer the case to a Division Case manager to complete the transition using the

Community Transitions Unit Case Transfer Form (Appendix D).

o Support Coordination will forward request to have case assigned to the assigned Division

Monitoring Team through the DDD SC Helpdesk.

o The assigned Division Monitoring Team will forward the form to the Community Transitions Unit.

o The case will be reassigned in iRecord from the Support Coordination Agency to the Division.

o The Community Transitions Unit will then be responsible for all placement activities.

 If long term placement in a Skilled Nursing Facility (SNF) occurs, an individual will be placed on an

inactive caseload as they will no longer be eligible for Waiver services.

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6.5.2 Transitions from Institutional to Community Settings

When an individual moves from an institutional setting (nursing home, developmental center, ICF/ID, etc.) to a

community placement, a transition from a Division Case Manager to a Support Coordinator in the community may

take place. This transition will proceed as follows:

 Before discharge from the institution, the Division Case Manager will develop a service plan that remains

in place for 90 days.

 The Division Case Manager will continue to work with the individual for a period of 90 days from the date

of the community placement.

 Upon placement in the community, the individual will select a Support Coordination agency (or be auto-

assigned based on preference) following Support Coordination selection procedures described in Section

6.1.2.

 30 days following the date of the community placement, a Support Coordinator will be assigned to overlap

with the Division Case Manager for the remaining 60 days to ensure continuity of care.

 The Division Case Manager will be the primary person responsible for the transition during the first 60

days, after which the Support Coordinator will become the primary person responsible for the individual’s

transition and service planning process. The Case Manager will be responsible for ensuring the Support

Coordinator is apprised of the individual’s background, important health indices, and any other pertinent

information during a case review before the 60-day period ends. The Case Manager will provide support

and assistance to the Support Coordinator to ensure a smooth transition of care management services.

 The Support Coordinator will be responsible for developing a new service plan within the first 30 days of

assignment and then monitoring every 30 days thereafter in accordance with established Support

Coordinator Responsibilities and Deliverables as described in Section 13.

 At the conclusion of 90 days, the Division Case Manager will be removed from the case unless serious

health and safety issues warrant a longer transition period. The Support Coordinator will then be solely

assigned and responsible for the monitoring of the individual and the new service plan will commence.

 Upon the approval of the Support Coordinator service plan, billing will shift from the Case Management to

Support Coordination. At no time will both services be claimed.

Days

Care Management Roles

0 – 30 Days

Division Case Manager responsible, Support Coordination Agency selected

0 – 60 Days

Division Case Manager responsible, Support Coordinator assigned after 30 days

60 – 90 Days

Support Coordinator responsible, Division Case Manger providing assistance

90+ Days

Support Coordinator responsible, Division Case Manager removed

6.5.2 Transitions from Community Settings to Hospitalization

When an individual already utilizing Support Coordination services is hospitalized, the Support Coordinator

continues to provide services for up to 30 days. When an institutional setting placement lasts more than 30 days,

but is considered short term, the Support Coordinator must transition the individual to a Division Case Manager for

monitoring. If long term placement in a Skilled Nursing Facility (SNF) occurs, an individual will be placed on an

inactive caseload as they will no longer be eligible for Supports Program services. This transition will proceed as

follows:

 Prior to the 30

day of hospitalization, the Support Coordination Supervisor must notify the assigned

Division staff of the potential need for Division Case Management assignment.

 Once the Division Case Manager is assigned, the Support Coordinator must ensure that the Case Manager

is apprised of the individual’s background, important health indices, and any other pertinent information

during a case review, and revise the service plan to stop any ongoing services.

 The Division Case Manager will then be responsible for the continued monitoring of the individual until

such time that the person is discharged. During this time, the Support Coordination Agency cannot bill for

Support Coordination services.

 Upon discharge from an institutional setting beyond 30 days, the procedure for Transitions from Institutions

to Community Placement will be followed to ensure continuity of care during the transition back to Support

Coordination. The discharge date will begin the 90-day transition period and the Support Coordinator will

revise the service plan as applicable as described in Section 7.8.

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7 SERVICE PLAN

It is a requirement that each person who has been determined eligible to receive services from the Division has an

Individualized Service Plan (ISP) developed in iRecord according to the standards specified in this policy manual

and through Support Coordination Orientation and other training opportunities. The plan will be developed by a

planning team of appropriate persons to include, but not be limited to, the individual, the Support Coordinator, and

the individual’s parent or guardian as appropriate. It is highly recommended that identified providers are also

included within the planning team unless the individual has indicated that they do not wish to include the provider.

The Support Coordinator shall inform the individual and individual’s parent or guardian as appropriate that the

service providers can be included on the planning team and ask the individual/family/guardian if they want the

service provider(s) to be included in the ISP meeting. If providing residential services (Individual Supports – Daily

Rate), the provider must be included on the planning team. This plan, which is developed based on assessed needs

identified through the NJ Comprehensive Assessment Tool (NJ CAT); the Person-Centered Planning Tool (PCPT);

and additional documents as needed, identify the individual’s outcomes and describes the services needed to assist

the individual in attaining the outcomes identified in the plan. An approved ISP authorizes the provision of safe,

secure, and dependable support and assistance in areas that are necessary for the individual to achieve full social

inclusion, independence, and personal and economic well-being.

7.1 Operating Principles

The ISP must be in the best interests of the individual served and also must empower individuals. The plan must

be centered upon the strengths, resources, and needs of the individual served.

The plan must be based upon evaluations and assessments, the preferences of the individual, and a written statement

of the individual’s personally defined outcomes. Services identified in the plan must be designed to allow the

individual to meet their personally defined outcomes and function as independently and successfully as possible.

The plan must also address utilizing resources and supports available through natural supports within the

individual’s neighborhood or other State agencies. Services funded by the Division will be considered only when

other resources and supports are insufficient or unavailable, the services do not meet the needs of the individual,

and the services are attributable to the person’s disability.

In designing the plan, the planning team should consider the unique characteristics and needs of the individual as

expressed by the individual and others who know the person, such as family, friends, service providers, etc.

Outcomes, services, and providers identified in the plan should:

 Recognize and respect rights;

 Encourage independence;

 Recognize and value competence and dignity;

 Respect cultural/religious needs and preferences;

 Promote employment and social inclusion;

 Preserve integrity;

 Support strengths;

 Maintain the quality of life;

 Enhance all domains/areas of development;

 Promote safety and economic security.

Support Coordinators and approved service providers must include the individual in problem-solving and decision-

making, and ensure that services are provided in a non-intrusive manner.

The planning team functions as an interdisciplinary team. An interdisciplinary team is one in which persons of

various backgrounds interact and work together to develop one whole, integrated plan for the individual. An

interdisciplinary process encourages mutual sharing of the strengths and insights of all team members, including

the individual, rather than reliance on professionals who concentrate on a specific discipline. Planning team

members are encouraged to participate in discussions related not only to their primary area of expertise but to all

aspects of the individual’s life.

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7.1.1 Individual as Decision Maker

Support Coordinators and approved service providers must include individuals with intellectual and developmental

disabilities (IDD) in problem solving and decision-making. Support Coordinators, and others invited to be part of

the person's Planning Team, should provide sufficient information to ensure that individuals can make informed

decisions and are supported to do so in the least restrictive manner. Support Coordinators can encourage

independent decision-making and self-determination for persons with IDD by fostering exposure and understanding

in important life categories that may include residential, medical, educational, vocational and legal areas. This

includes understanding the resources available to individuals.

Alternatives to Guardianship

Some may assume guardianship is the only option available to protect the interests of individuals with IDD.

However, it is important to recognize that most people with IDD can manage their own affairs with support,

assistance and guidance from others, such as family and friends.

The appointment of a guardian is a serious matter

and must not be based solely on a person’s age, disability, or perceived ability to understand context and make

decisions independently. It is the avenue of last resort for many reasons, including but not limited to:

 It limits an individual’s autonomy over how to live and from whom to receive supports to carry out that

choice;

 It transfers the individual’s rights of autonomy to another individual or entity; and

 Many individuals with IDD experience guardianship as stigmatizing and inconsistent with their exercise of

adult roles and responsibilities.

Like their peers without disabilities, individuals with IDD are presumed competent once they turn 18 years old. As

necessary and based on their individual needs, they may need assistance to develop as decision-makers through

education, supports, and life experiences. Supported Decision-Making (SDM) (e.g., use of plain language,

information provided in video or audio form, time to review and discuss choices, role-playing activities to

understand choices, assistance with creating pros and cons lists, having a supporter present at important medical

meetings and/or medical appointments, etc.) and other less restrictive means of decision-making supports (e.g.,

health-care proxies, advance directives, powers of attorney, etc.) should be tried before pursuing guardianship.

Support Coordinators and service providers should also consult with professionals as appropriate for support and

advice in assisting individuals with IDD with SDM. For example, a governmental agency might be consulted

concerning benefits or services.

SDM allows individuals with disabilities to make choices about their own lives with support from a team of people

they choose. In practice, many persons without disabilities engage in similar consultative practices throughout their

lives to help them make challenging decisions. SDM is an alternative to guardianship; instead of having a guardian

make a decision for the person with the disability, the person with the disability is supported to make their own

decisions.

Resources on Supported Decision Making and Other Supports:

 https://www.parentcenterhub.org/buzz-feb2020-issue2/ - Includes an 11-minute video on Supported

Decision Making.

 https://www.autismnj.org/article/supported-decision-making-as-an-alternative-to-guardianship/

 https://www.thearcfamilyinstitute.org/resources/guardianship-go-bag.html?page=2

 https://www.nj.gov/education/specialed/parents/docs/GuardianshipBrochure2.pdf

The Support Coordinator shall facilitate a discussion at the annual Planning Team meeting (which includes the

individual with IDD) on decision-making. Areas of discussion shall include whether SDM or other less restrictive

options than guardianship can be used to support the individual in their decision-making. This discussion shall also

include less-common circumstances where consent may potentially be needed for a medical (e.g. general anesthesia

for a dental procedure) or legal matter (e.g. signing a lease or residency agreement) will be addressed.

https://www.aaidd.org/news-policy/policy/position-statements/guardianship

https://supporteddecisions.org/about-supported-decision-making/

 
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If there is no guardian in place and an emergency presents, Support Coordinators can work with Administrators at 
DDD,  who  have  authority to  grant  informed  consent  in  certain  limited  circumstances  involving the  medical, 
psychiatric, surgical or dental treatment of individuals with IDD. Guidelines for this emergency consent process are 
set forth in N.J.S.A. 30:4-7.2 and N.J.S.A. 30:4-7.3; they require that a licensed physician, psychiatrist, surgeon or 
dentist certify that the treatment to be performed is essential and beneficial to the general health and welfare of an 
individual with IDD or will improve their opportunity for recovery or prolong or save their life. 
 
Guardianship 
If the Planning Team determines that less-restrictive methods have been attempted without success or are otherwise 
not  realistic  based  on  the  needs  of  the  individual,  the  Support  Coordinator  shall  facilitate  a  discussion  on 
guardianship.  This conversation shall take place with the individual present at the annual Planning Team Meeting, 
or earlier based on individual circumstances.   
Please note that only the court can appoint a guardian and the Support Coordinator’s role is to initiate a discussion 
and engage in next steps at the direction of the individual and their Planning Team. Next steps could include a 
referral through the DDD Liaison to the Bureau of Guardianship Services (BGS) (see below). In all cases a licensed, 
independent clinician completes assessment(s) verifying guardianship need prior to any guardianship proceedings 
being filed in court and the individual with IDD is provided legal counsel to protect their rights at the time of a 
guardianship hearing to assert their wishes. 
In this option of last resort, the Planning Team shall determine whether the consensus is that guardianship may be 
needed and, if so, whether limited or full (plenary) guardianship may be needed.  Limited guardianship preserves 
an individual’s rights to make decisions in certain life areas, appointing a guardian to assist a person in areas deemed 
to require assistance.  Life areas that might require decision-making through guardianship, or less restrictive options, 
may include educational, vocational, residential, legal, or medical decisions.  
In circumstances where a person has already been assigned a guardian, they shall discuss whether the guardianship 
remains appropriate and, if not, what changes the Planning Team suggests are needed in that area.  The outcome of 
this discussion is to be documented in the ISP.  In instances where a person has a guardian assigned but the Planning 
Team believes that they have the capacity to make decisions partially or fully, then actions to restore themselves as 
guardian should occur.   
In circumstances where a person has been assigned a guardian who is no longer viable or available, then the 
individual with IDD does not automatically resume their own decision-making abilities.  Instead, a new proceeding 
must be made with the court to replace the guardian through the substitute guardianship process.  The Support 
Coordinator  will  use  this  opportunity  to  educate  the  Planning  Team  on  less  restrictive  options  and  provide 
information and resources to the individual and the Planning Team members. 
Guardianship  may  be  obtained  privately  by  the  family  or  through  the  Bureau  of  Guardianship  Services 
(BGS).   More  information  about  guardianship  can  be  found 
at https://nj.gov/humanservices/ddd/individuals/guardianship/.    If  it  is  determined  that  guardianship,  substitute 
guardianship,  or  restoration  of  guardianship  should  be  obtained  through  BGS,  the  Support  Coordinator  shall 
complete the needed referral material to initiate the process (See Guardianship section under Support Coordination 
Documents  and  Forms  at  https://nj.gov/humanservices/ddd/providers/support/  for  more  information).   Support 
Coordination Agencies shall also assist with completion of paperwork, service, and other activities related to the 
establishment of guardianship when indicated, as well as for those less restrictive options. 
Some information in this section was derived from numerous sources, including the  American Association on 
Intellectual and Developmental Disabilities, the Arc of New Jersey, the Center for Public Representation, the 
National  Research  Center  for  Supported  Decision  Making,  and  the  New  Jersey  Council  on  Developmental 
Disabilities.  
 

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7.2 Planning Team Membership

The membership of the planning team will vary depending upon the needs and wishes of the individual.

The planning team will include at a minimum:

 Individual;

 Support Coordinator, who shall serve as plan coordinator and provide support to the individual as meeting

facilitator or serve as meeting facilitator when the individual will not be fulfilling that role;

 Individual’s parent/family or legal guardian, as appropriate;

 Any service provider and/or additional person(s), approved by the individual, whose participation is

necessary to develop a complete and effective plan.

The Division encourages the individual to include providers who are currently authorized to serve the individual on

the planning team and encourages identified providers to attend the planning meeting(s) when invited to participate

as planning team members. At a minimum, the Support Coordinator must contact the provider to ensure they are

capable of implementing the strategies necessary to assist the individual in progressing toward their personally

defined outcomes, accurate information regarding services, units, start/end dates, etc. are entered into the plan, and

that there is agreement regarding acceptance into the services offered by the provider and the date in which services

will begin.

Occasionally, there may be a need for non-participating persons, such as staff in training or observers from

monitoring groups, to be present at team meetings. Since these persons are not planning team members, the Support

Coordinator shall seek prior approval for their presence from the individual. The Division reserves the right to

attend and participate in planning team meetings.

7.3 Responsibilities of Each Team Member

7.3.1 Responsibilities of the Plan Coordinator (Support Coordinator)

The Support Coordinator, as plan coordinator, is responsible for the following tasks:

 Ensuring that the individual is at the center of the planning process;

 Identifying team members – based on the individual’s input – and scheduling meetings of the planning

team;

 Notifying team members, preferably in writing, of planning team meetings within 5 working days;

 Ensuring that copies of all current evaluations and assessments are available to the team members prior

to the team meetings, if possible;

 Actively participating in team meetings;

 Coordinating meetings of the planning team as outlined in Section 8.3.1, when the individual has

decided not to facilitate the meeting themselves;

 Writing the PCPT as a result of the person-centered planning process and by incorporating previously

developed person-centered planning documents (from schools, other States, family members, etc.);

 Writing the ISP in clear and understandable language based upon consensus reached during the team

meeting;

 Distributing copies of the completed ISP (and upon consent from the individual/person responsible, the

PCPT) to all team members and service providers within 3 working days from the date of SC Supervisor

approval of the ISP, and ensuring that copies of the ISP are available in all settings where the individual

receives services;

 Ensuring that all data is entered into the iRecord;

 Monitoring and reviewing the ISP;

 Completing other assignments as determined by the planning team;

 Ensuring the individual receives services to meet medical/functional needs (within the availability of

funds for State-funded services);

 Other relevant responsibilities as outlined in Section 6.3 of this manual.

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7.3.2 Responsibilities of the Individual (and guardian, where applicable) as a Planning Team Member

Areas of responsibility include but are not limited to the following:

 Being available to meet for the required ISP planning meeting and reviews. If the guardian is

unavailable for planning meetings, then they should be available for discussion outside of the meeting

and to sign the ISP upon completion;

 Providing documentation for eligibility determination/redetermination;

 Actively participating in planning meetings;

 Reporting issues with service providers including potential/suspected fraud and abuse;

 Reporting changes of address;

 Reporting changes in individual circumstances which may cause the need for changes to the ISP or

effect the provision of services;

 Signing appropriate consents;

 Providing appropriate documentation to obtain requested assistance from the Division;

 Providing documentation of annual physical and dental exams for individuals residing in a licensed

residential setting;

 Providing other documentation as requested by the Division (i.e. any changes in insurance policies with

the effective date, third party liability information, burial insurance policies, etc.);

 Complying with and maintaining Medicaid eligibility;

 Informing the Intake Director in the Division’s Community Services Office serving the region in which

the individual resides of significant temporary or permanent changes to the individual or caregiver that

cause the need for a bump-up or reassessment, respectively;

 Requesting that the Support Coordinator invite other persons to participate as team members, if

necessary.

7.3.3 Responsibilities of the Service Provider as a Planning Team Member (when included)

Areas of responsibility include but are not limited to the following:

 Providing details regarding the services available within their agency;

 Contributing to the development of outcomes specific to the services they will be or are already

providing;

 Assisting with the establishment of units, start/end dates, etc. for identified services and confirming

their accuracy within the ISP;

 Reporting changes in individual service needs/preferences that may cause the need for changes to the

ISP or effect the provision of services.

 Providing documentation of annual physical and dental exams for individuals residing in the provider’s

licensed residential setting.

7.3.4 Responsibilities of Other Planning Team Members

Other planning team members are responsible for the following tasks:

 Reviewing provided information related to the individual, including the PCPT, previous ISP(s),

available assessments, and evaluation data, as appropriate/relevant;

 Actively participating in the planning team meeting and working cooperatively to achieve consensus

in the spirit of the ISP operating principles;

 Recording data relative to assigned outcomes, as relevant;

 Notifying the Support Coordinator and requesting a special team meeting to be scheduled whenever

there is a significant change in the individual’s status;

 Completing other assignments as determined by the planning team.

7.4 Development of the Individualized Service Plan

The ISP must be developed and approved within 30 days of Supports Program enrollment. The content of an

individual’s service plan stems from the person-centered planning process and will vary depending on the unique

characteristics and specific needs of the individual and the individual’s service settings. The ISP shall be based on

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the results of mandated assessments/evaluations and can incorporate additional information from optional discovery

tools and evaluations/assessments of the individual.

7.4.1 Assessments/Evaluations

7.4.1.1 Mandated assessments/evaluations

These tools are required by the Division and are known as the NJ Comprehensive Assessment Tool (NJ CAT) and

the Person-Centered Planning Tool (PCPT).

7.4.1.1.1 New Jersey Comprehensive Assessment Tool (NJ CAT)

The NJ CAT is comprised of the Functional Criteria Assessment (FCA) and the Developmental Disabilities

Resource Tool (DDRT).

The FCA is the assessment tool utilized to assess whether newly entering individuals meet the functional criteria to

be eligible for the Division or not. This tool assesses individual competencies in the following areas: sensory/motor,

cognitive abilities, communication, social interaction and sociability, self-direction, self-care/independent living

skills, special behaviors, health, school experience, and employment and determines relative need for services and

supports.

The DDRT has a long history of use with individuals with intellectual or developmental disabilities in NJ for

assessing individual support needs and determining relative need for services. The DDRT assesses individual

competencies and assists in determining who needs more support and ensures that those with like needs receive a

similar level of support.

The Support Coordinator will review the NJ CAT with the planning team, at a minimum, on an annual basis to

ensure that outcomes and services included in the ISP are warranted by assessed need.

7.4.1.1.2 Person-Centered Planning Tool (PCPT)

The Person-Centered Planning Tool (PCPT) is a mandatory discovery tool used to guide the person-centered

planning process and assist in the development of an individual’s Service Plan. The Support Coordinator will

facilitate the development of the PCPT with input and guidance from the identified team members. The PCPT can

be provided to the individual and/or their guardian, family, or other people as identified by the individual and/or

guardian prior to the planning meeting in order to assist them in becoming familiar with the PCPT and begin

thinking about information that will be provided to assist in completing the PCPT. Individuals may also have

participated in the person-centered planning process through other entities, such as their school. Information

gathered through these previous person-centered planning experiences can be very relevant to include in the PCPT,

too. Any information provided when an individual, family, etc. completes the PCPT prior to meeting with the

Support Coordinator will be discussed during the person-centered planning meeting(s) and used to inform the PCPT

completed by the Support Coordinator.

Information gathered through the PCPT informs the outcomes written into the ISP, should align with results of the

NJ CAT, and provides information related to service needs. The Support Coordinator writes the PCPT as part of

the initial plan and must review with the individual/guardian and planning team and update annually to identify

changes and inform the annual ISP. The PCPT must be updated annually and be comprehensive.

7.4.1.1.2.1 Components of the PCPT

7.4.1.1.2.1.1 Relationships

This section (sometimes referred to as a “circle of support” provides the opportunity for the individual and planning

team members to identify people that are loved, important, and/or relevant to the individual’s life. The relationship

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of each person included in this section – family, supporters at home and in the community, friends, and supporters

at work, school, day services – is included.

7.4.1.1.2.1.2 Strengths and Qualities

The individual’s positive qualities, achievements, areas that they like about themselves and others like about

them, and things the individual does well are documented here.

7.4.1.1.2.1.3 Important to the Individual

Routines, places to go, things to do, people to see, and recreational pursuits that are of importance to the individual

are provided in this section. Information provided here should include activities the individual enjoys doing with

their free time, hobbies, and things the individual misses when not around or available.

7.4.1.1.2.1.4 Hopes & Dreams

This section includes likes/dislikes, interests, short-term goals and aspirations, and long-term hopes and dreams.

Information about the ultimate destination for the individual. Information about how the individual sees

themselves having fun in the future, what they see themselves doing, where they want to be living, whether they

want to be added to the CCP Wait List, etc. would be included here.

7.4.1.1.2.1.5 Supporter Qualities

This section provides an explanation of what others – family, friends, staff, etc. – need to know in order to provide

the ideal support to the individual in a variety of settings under a variety of circumstances, and the skills, personality

characteristics, knowledge, etc. that someone providing supports for the individual would need or benefit from

having. Information in this section can be used to inform a job description for a Self-Directed Employee or for a

provider to know the qualities valued by the individual.

7.4.1.1.2.1.6 Community Integration

The information in this section will assist the people supporting the individual in accessing the community as fully

as possible. Previous experience in the community, interests, extent of interaction with people, and current activities

in the community are included in this section. Discussion on potential opportunities for community integration shall

occur.

7.4.1.1.2.1.7 Communication Styles

Information about how the individual communicates is captured in this section of the PCPT. Details about whether

or not the individual can read and/or write and the extent to which the individual can do so along with how the

individual will let someone know their emotions (happy, sad, excited, angry, etc.), health status (hungry, thirsty,

sick, in pain, etc.), wants/needs/choices, understanding, and lack of desire/interest are documented in this section.

7.4.1.1.2.1.8 Ideas/To Do List

This section provides the opportunity for the individual, planning team, and Support Coordinator to brainstorm

ideas of how the information gathered through the PCPT can be used to develop meaningful activities –

employment/career, education/learning, entertainment/fun, home life, responsibilities, and well-being – that are in

line with the individual’s interests, qualities, strengths, hopes/dreams, support needs, etc. This information then

leads to identification of outcomes in the ISP and the services and providers that can assist the individual in

accomplishing those outcomes.

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7.4.1.1.3 Annual Reviews/Discussions

7.4.1.1.3.1 Pathway to Employment

Provides an annual discussion to assist in determining where the individual is on their path to employment;

identifying potential barriers, concerns, fears, and reasons that the individual isn’t working or pursuing

employment; and establishing next steps in the employment process which become employment outcomes in the

ISP.

 Path 1: Already Employed – This path is completed when the individual is currently working

competitively in the general workforce. Answers to the questions in this section help determine the

individual’s satisfaction level with their current job and establish outcomes and service needs related to

maintaining their current job; finding a new or additional job; increasing hours, salary, or tasks; seeking a

promotion, etc.

 Path 2: Unemployed & Has Paid/Unpaid Experiences/Training – This path is completed when the

individual is not currently working but has worked, interned, job sampled, participated in work crews or

group placements (enclaves), had work-related training, etc. in the past. Answers to the questions in this

section help determine what is preventing the individual from using this experience and training to lead to

employment. Outcomes and service needs addressing these areas that have prevented the individual from

successfully finding and maintaining employment must be included in the ISP.

 Path 3: Unemployed & Has No Exposure to Paid/Unpaid Experiences/Training – This path is completed

when the individual is not currently working and has never worked, had work experiences or training, and

may never have considered employment as a viable option. Answers to the questions in this section help

the individual start discussing employment and the benefits of working and helps determine if the

individual is interested in pursuing employment at this time. This section can also provide ideas for

employment outcomes that can be developed for individuals who have medical or behavioral concerns

that prevent them from being able to pursue employment at this time.

 Path 4: Unemployed – Not Pursuing – This path is selected only if the individual has chosen to retire

because they are 65 or older or will not currently be pursuing employment due to medical

condition/behavioral issues precluding the individual from working at this time due to substantiated

concerns about harm to self or others which cannot be appropriately mitigated by supports/services.

7.4.1.1.3.2 Voting

This section provides questions used to guide a discussion with the individual about their right to vote and

determine interest level and support needs related to voting.

7.4.1.1.3.3 Mental Health Pre-Screening

The questions in this section are used to guide a discussion with the individual about any possible indicators that a

mental health evaluation may be necessary.

7.4.1.2 Optional Discovery Tools

Optional Discovery Tools are additional tools that can be utilized during the discovery process to inform the PCPT

and the Service Plan and provide potential caregivers, service providers, etc. with information essential to

supporting the individual. These tools can be completed by the individual and/or their guardian, family, or other

people as identified by the individual and/or guardian. Schools and other entities the individual was previously

associated with may also utilize person-centered planning to gather information leading to the development of the

Individualized Education Plan or other documents. If utilized, the Support Coordinator will compile information

from these tools and use it to assist in development of the PCPT and Service Plan.

Physical exams, psychological evaluations, etc., can also be utilized to inform the ISP. All individuals residing in

licensed residential settings are to receive an annual physical and dental examination as well as any follow-up care

directed by their treating physician. This is highly recommended for persons not interacting with those settings as

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well. Preventative care based on gender and age is also best practice. Support Coordinators are reminded to discuss

the importance of annual medical and dental exams on the SC planning/monitoring tool and to collect/upload these

documents to iRecord when they are available.

7.4.2 Planning Meetings

7.4.2.1 Notice of Planning Meetings

The Support Coordinator shall notify the planning team of team meetings. Written confirmation of scheduled

meetings is preferred. The date, time, and location of the meetings should be mutually convenient for the individual,

Support Coordinator, and other planning team members. The planning team should be notified at least five (5)

working days in advance of the meeting. The notification should include the time, date, and place of the meeting

and inform the planning team of the purpose of the meeting.

An initial meeting for newly assigned individuals should be arranged within ten (10) days of Support Coordination

Agency assignment in order to discuss the arrangements needed for the planning process.

7.4.2.2 Meeting Process

In cases when the individual is not fulfilling the role of meeting facilitator, the Support Coordinator shall coordinate

the planning team meeting, ensure all planning team members are introduced, explain each team member’s

responsibilities, and describe the purpose of the meeting. The Support Coordinator shall explain that the planning

team will operate as an interdisciplinary team and that every effort will be made to reach consensus, but that in the

event consensus cannot be achieved, deference should be paid to the individual’s thoughts, opinions, decisions,

preferences, and expressed needs first. In order to prevent delays in service provision, the areas in which consensus

has been met will be included in the plan if discussions are still continuing about other areas.

The Support Coordinator shall ensure that the individual is treated with respect and dignity during the meeting by

making sure that comments are directed to the individual in first person rather than third person language, sensitive

issues are discussed with respect for privacy and consideration for the individual’s dignity, etc. The Support

Coordinator shall also ensure that all participants are given an opportunity to provide input and that issues are

thoroughly discussed before decisions are reached. Decisions shall be guided by the individual, the Division’s

Mission and Core Principles, and the ISP Operating Principles.

The standard agenda for a meeting shall consist of the following:

 Review of PCPT;

 Review of the last ISP, if applicable;

 Review of professional evaluations and assessments, as needed;

 Discussion of the person’s current status, preferences, needs, and vision for the future;

 Development of long-term outcomes;

 Discussion of services needed to attain the long term outcomes;

 Discussion of other actions necessary to implement the services, achieve the outcomes, and meet the

individual’s needs;

 Discussion of other special considerations;

 Review of Medicaid status and the importance to comply with all correspondence including redetermination

requests and notify the SC of any expected changes in benefits (e.g., increase due to a parent retiring).

When special circumstances require a different agenda, the Support Coordinator shall communicate the revised

agenda to the team at the beginning of the meeting.

Individual as Facilitator – Prior to the facilitation of the planning meetings, the Support Coordinator should speak

with the individual to determine their desire to facilitate their own planning meetings. Every opportunity will be

provided for the individual to facilitate their planning meetings if they so desire. In circumstances where the

individual will be facilitating the meetings, the Support Coordinator will provide support as needed. If the

individual chooses not to facilitate the planning meetings, the Support Coordinator will fulfill this role.

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Frequency of Meetings – Face-to-face planning meetings/reviews are encouraged whenever possible. The ISP

shall be reviewed, as indicated on the Support Coordinator Monitoring Tool, during the Support Coordinator’s

monthly/quarterly/annual contacts, and more often if necessary, to ensure that the plan remains appropriate and that

the individual is making progress toward the outcomes specified in the plan. The planning team shall meet at least

annually – to review the current plan and develop a new annual ISP – and more often whenever there is a significant

change in the individual’s status.

Planning Process – The Support Coordinator has 30 days from the date an individual is enrolled into the Supports

Program or a new ISP is generated (due to annual ISP date, change in the individual budget, change in the

individual’s tier assignment, or enrollment on a different waiver) to complete the planning process resulting in an

approved ISP. The ISP is developed through a Person-Centered Planning Process. Once assigned, the Support

Coordinator will plan with the individual and their identified team members through regular contact and

communication that includes at least one face-to-face meeting in a mutually convenient location. Through the use

of information provided from the NJ Comprehensive Assessment Tool (NJ CAT), the Person-Centered Planning

Tool (PCPT), and any other discovery tools that have been utilized and can include past results of person-centered

planning, the Support Coordinator will begin to build an ISP that includes identification of the individual’s

strengths, preferences, and needs; builds upon the individual’s capacity to engage in activities and promote

community life; respects the individual’s preferences, choices, and abilities; and involves families, friends, and

professionals in the planning and delivery of services and supports as needed by the individual. Development of

the Service Plan drives the outcomes and services that will be implemented in order to meet the needs of the

individual.

In circumstances where time is needed to further explore service needs, research and confirm the appropriate service

providers, hire Self-Directed Employees (SDE), determine eligibility with other State agencies or funding sources

before determining the need for Division-funded services, etc., the ISP can include outcomes related to working on

these areas and still be approved within the 30-day timeframe without specifics about services and/or providers.

The services and providers that have already been identified and confirmed should be included in the ISP so services

and supports are not delayed while the Support Coordinator, individual, family, or other identified team members

are conducting this additional activity as noted in the ISP. However, individuals who have only received Support

Coordination services for 90 days may be subject to disenrollment from the Supports Program if it is determined,

upon further review by the Division, that Supports Program services are not needed at this time.

Extending 30-Day Timeframe for ISP Completion – the 30-day deadline for completing the ISP can be waived

if circumstances warrant additional time for completion. A written request specifying the reasons for the need for

an extension must be submitted to the SC Supervisor help desk. The written request as well as the approval/denial

of the request will be recorded in iRecord. The Support Coordination Agency will not receive payment for services

rendered until the ISP is completed and approved.

7.5 Components of the Individualized Service Plan (ISP)

The Individualized Service Plan (ISP) utilizes information gathered through the assessments/evaluations described

above to identify the individual’s needs; describe the needed services to be provided and outcomes to be attained;

direct the provision of safe, secure, and dependable support and assistance; and establish outcomes consistent with

full social inclusion, independence, and personal/economic well-being. The planning team shall identify and

document these areas in the ISP, and needs statements shall be functional statements oriented to the overall outcome

envisioned for and by the individual and developed with consideration of the person’s strengths and preferences.

Information comprising the ISP is entered directly into iRecord and includes the following areas:

7.5.1 Participant Information

Demographic information about the individual which includes DDD ID#, age, date of birth, county of residence,

program information, Medicaid ID and type, DDD eligibility status, contact information, diagnosis information,

Support Coordination Agency, guardianship information (if applicable), and medical contact information are all

indicated in this area of the ISP.

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7.5.2 Outcomes and Services

The ISP must indicate the individual’s outcomes and services based on assessed need.

7.5.2.1 Outcome

The outcome shall reflect the individual’s desired achievement based on strengths and preferences and shall be

developed without regard to the availability of services or funding sources. Outcomes change to reflect

accomplishments, life transitions, or changes in the individual’s status. Note that at least one outcome must relate

to the employment goals of the individual. There is no limit on the total number of outcomes in any service plan.

7.5.2.2 Service(s)

The service is identified to provide the assistance and supports an individual needs to reach the outcome. All

services, including those services that are not Division-funded, that are required to meet an assessed need must be

included within the ISP.

7.5.2.3 Payment Source

The payment source for the provider (Medicaid, FI, DVRS, natural, generic, etc.) is indicated here. Services funded

by the Division will be considered only when other resources and supports are insufficient or unavailable and do

not meet the needs of the individual and are attributable to the person’s disability.

7.5.2.4 Reference

The assessment tool from which the identified need was indicated is referenced in order to connect the need for

service to the individual. Assessment tools include mandated tools such as the PCPT and NJ CAT or optional

discovery tools used in the person-centered planning process.

7.5.2.5 Provider

The entity or individual who will provide the service(s) indicated in the ISP. Division-funded services can only be

provided by approved providers.

7.5.2.6 Procedure Code

The code is a series of letters and numbers used by Medicaid to identify the type of service that has been authorized.

The codes for each service are provided in Section 17 of this manual and within the Supports Program Services

Quick Reference Guide available in Appendix H.

7.5.2.7 Location

The location is where the service will be provided if applicable.

7.5.2.8 Start & End Dates

The dates between which the provider is prior authorized to provide services and receive funding.

7.5.2.9 Unit Type

The unit type is the predetermined interval of time that can be claimed for each particular service. Services that are

a one-time item, such as Environmental Modifications, will list “service(s)” as the unit type rather than a time

interval.

7.5.2.10 Frequency

The frequency is weekly since prior authorizations are provided on a weekly basis.

7.5.2.11 Rate

The rate is the cost per unit of a service provided. A list of the standardized rates for all services is available in the

Supports Program Services Quick Reference Guide in Appendix H.

7.5.2.12 Total Units

The approved increment of time, based on the assessed need, for the services that have been indicated on the ISP.

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7.5.2.13 Total Cost

The amount that will be provided from the individualized budget to fund this service.

7.5.3 Employment First

In an effort to address the issues of unemployment or underemployment for individuals with intellectual and

developmental disabilities and encourage discussions around employment for each individual served, every ISP

must contain at least one employment outcome even if the individual is not pursuing employment at the time of the

ISP.

These outcomes can fall into a wide range of areas from already employed and working toward further development

of a career, maintaining employment, unemployed but looking for employment, or unemployed and gaining or

improving upon skills, characteristics, behaviors, etc. that will assist the individual in successfully working.

The Support Coordinator will document the individual’s current employment status and employment plan based on

the Pathway to Employment discussion that is facilitated annually during development of the ISP. Based on the

individual’s employment status, the planning team will develop employment outcomes that make sense for the

individual. For example, for individuals who are already competitively employed, the outcome can relate to

maintaining their current employment or working toward further development of a career. For those individuals

that are unemployed or not competitively employed, the outcome can include finding competitive employment or

gaining, improving, and/or developing skills marketable or habilitative skills, characteristics, behaviors,

communication, etc. that will assist the individual in successfully working. As is the case with any outcome included

in the ISP, it is understood that employment outcomes may take years to achieve and involve lifelong skill

development.

Both DDD and non-DDD funded services can assist an individual in progressing toward their employment outcomes

identified in the plan. DDD services intended to support employment outcomes include, but are not limited to,

Career Planning, Day Habilitation, Pre-Vocational Training, and Supported Employment.

If employment is not being pursued at the time of the ISP, an explanation must be included in the ISP – these plans

will be further reviewed by the Division’s Support Coordination Quality Assurance Specialist to ensure that every

effort is being made to assist people in becoming employed.

7.5.4 Voting Plan

Information regarding the individual’s interest in voting and supports needed related to that is included here.

7.5.5 Health & Nutrition Needs

Information regarding allergies, dietary needs, health hazards/concerns, and self-care concerns as indicated through

the NJ CAT as well as the planning process will be identified within this section of the ISP.

7.5.6 Safety & Supports Needs

Information regarding behavior/sensory needs, mobility/adaptive equipment, communication, religious/cultural

information, and support settings based on information provided through the NJ CAT and the planning process will

be included in this section of the ISP.

7.5.7 Emergency Contacts

Information about emergency contacts (in preferred order of contact) and their contact information is provided in

this section of the ISP.

7.5.8 Medication

A list of medication, dosage, frequency, notes, and ability to self-medicate or not is provided in this section.

7.5.9 Authorizations & Signatures

Indications of all planning team members who participated in the planning process are identified here. Planning

team members must always include the individual and Support Coordinator at a minimum. Signatures from the

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individual/guardian/legal representative (as applicable) must all be included. The Support Coordinator must ensure

that the individual has been a full participant in the planning process and is aware of their rights and responsibilities

as documented in the “Participant Statement of Rights & Responsibilities” and indicated through the list of items

with which the individual’s signature attests to agreement. The ISP and Participants Statement of Rights and

Responsibilities form will be shared with all service providers indicated in the plan; however, sharing the

medications section of the ISP and/or the PCPT with service providers is up to the individual, as indicated in the

ISP.

7.5.9.1 Guidance on ISP Signature

In all cases, contact with the legal guardian is the very first contact made by the Support Coordinator once an

individual is assigned to a Support Coordination Agency.

Signature Not Obtained

1. If private or public guardian(s) has given verbal agreement to the ISP this can be documented in a case note

identifying the date of verbal approval and the ISP may be approved. The ISP Signature Page shall include

the physical signature or “mark” of the individual as well as the signature of the Support Coordinator. The

Support Coordinator will clearly note on the signature page the following: “Verbal permission from

[GUARDIAN NAME], legal guardian, was provided to me on [DATE] to move forward with plan approval.

Services outlined in plan are appropriate as per Planning Team.” Physical signature page from the guardian

shall be obtained as soon as practicable. NOTE: Verbal approval may ONLY be used in circumstances

where thoughtful planning has occurred but due to unforeseen circumstances approval is needed to avoid

lapse in service.

2. If private guardian (not applicable to public guardian) is unreachable (e.g. out of the country),

documentation of three separate attempts on varying dates and times over a two-week period to contact

them shall be made and memorialized in case notes. In this instance, as long as there is documented

approval of the planning team and individual, the individual may sign or mark the ISP for approval and the

ISP can be approved. The Support Coordinator will clearly note on the signature page the following: “I

have attempted to reach [GUARDIAN NAME], legal guardian, on [ENTER THREE DATES/TIMES] and

was unsuccessful. Services outlined in the plan are appropriate as per the Planning Team. Plan approval

moving forward.” Efforts to contact guardian must continue and proper documentation to include a

signature page obtained as soon as practicable. NOTE: ISP approval without guardian signature may

ONLY occur in unforeseen circumstances where approval is needed to avoid lapse in service.

3. If private guardian (not applicable to public guardian) is unable to sign (e.g. medically incapacitated or

deceased) this shall be documented in a case note. The Support Coordinator will also make efforts to obtain

a note from the treating physician documenting this issue whenever possible. As long as there is

documented approval of the planning team, the individual may sign or mark the ISP for approval. The

Support Coordinator will clearly note on the signature page the following: “[GUARDIAN NAME], legal

guardian, is medically incapacitated and unable to sign this ISP. Services outlined in the plan are

appropriate as per the planning team. Plan approval moving forward.” If there is an existing family

member who has started the legal process to become guardian (it may be an email stating that they are

interested in pursuing guardianship), that person’s input related to the ISP may be sought and their signature

added to the ISP as well. In this circumstance, a Substitute Guardianship referral must immediately be

submitted.**

**All referrals come through the guardianship liaison. The liaisons are familiar with the required

documents and track the guardianships that are in process. In the event that a medical emergency

arises, there are statutory provisions that permit the Division to provide consent in the absence of

a guardian.

7.5.9.2 Signature Page Upload

The signature page of the ISP may be uploaded as a separate document in circumstances that do not allow one

complete document to be obtained. This ISP signature page must have the plan version and date that corresponds

with the ISP. All attempts to upload the complete ISP along with the signature page should be made.

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7.6 Resolving Differences of Opinion among Planning Team Members

The planning team must seek to reach consensus in developing the ISP and in developing consistent and/or

complementary strategies and methods for implementing the plan. Efforts should be made during team meetings

to ensure that all points of view are heard. Differences of opinion can usually be resolved by a thorough discussion

of concerns and recommendations. If a team member feels that their point of view has not received a complete

hearing during a team meeting, they are encouraged to discuss their concerns privately with the Support

Coordinator, who may subsequently reconvene the planning team to readdress the issue.

The individual will indicate their agreement with and approval of the plan by signing the ISP “Authorizations &

Signatures” page.

In the event there is disagreement regarding the ISP, deference should be paid to the individual first. The areas in

which consensus has been met will be included in the plan so that there will not be a delay in the provision of

services related to those areas of consensus.

In circumstances where the individual or family disagree with information written into the ISP, the Support

Coordinator shall write a case note indicating the area(s) in which there is disagreement.

7.7 Service Plan Approval

All ISPs will be reviewed by the Support Coordination Supervisor and a copy signed by the individual/guardian

must be uploaded to iRecord prior to approval. The ISP Review Checklist for Support Coordination Supervisors

must be utilized to assist the Support Coordination Supervisor in reviewing the ISP for quality. The Support

Coordination Supervisor must sign and date the ISP Quality Review Checklist and upload the signed document to

iRecord.

Once a Support Coordination Agency has been authorized to approve the ISP without submitting it to the Division,

the Support Coordination Supervisor will be the approving party. If changes need to be made to the plan prior to

SC Supervisor approval, the SC Supervisor will communicate the need for revisions with the Support Coordinator

and approve the plan once the changes are made to their satisfaction.

For those agencies not authorized to approve their own plans, the SC Supervisor must submit all ISPs to the Division

for approval. The required method for submitting the plan to the Division for approval is changing the status of the

plan from “Review (R)” to “State Review (SR1)” in iRecord.

Upon review, the Division may require revisions to the plan prior to approval. These changes will be provided to

the SC Supervisor within seven (7) days and must be implemented and returned to the Division. If plan revisions

are significant (such as additions/deletions of outcomes, services, providers, etc.), signatures will need to be re-

obtained to ensure individual agreement with the plan changes. If the changes are minor (such as spelling/grammar

errors, word changes that don’t alter the meaning of an outcome or goal, etc.), the Support Coordinator must inform

the individual of these changes, but new signatures will not be needed to be obtained. A case note should record

when and how the individual was informed of these changes.

7.8 Service Approvals by the Division

The following services/items must be approved by the Division prior to being included in an approved ISP:

 Evaluations for Assistive Technology or Environmental Modifications (initiated in iRecord by selecting

“Evaluations” from the dropdown menu provided through the “Tools” tab and providing information related

to the need);

 Goods & Services (initiated in iRecord when “Goods & Services” is selected as a service);

 Services of Assistive Technology, Environmental Modifications, or Vehicle Modifications;

 Single Passenger Transportation (initiated in iRecord when selecting this service);

 Self-Directed Employee Rate above/below what is considered reasonable & customary (iRecord sends

notification for review when rate entered appears to be outside of the reasonable & customary range);

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 Individual Supports at the 15-minute rate when the individual is already receiving Individual Supports at

the daily rate by the same provider (CCP only);

 Community Inclusion Services when the individual is already receiving Individual Supports at the daily

rate;

 Retirement before the age of 65.

The Support Coordinator will follow instructions provided to initiate the review process with the Division and

Division staff will review the request(s) and provide a determination within 10 business days of receipt of request.

It is recommended that the Support Coordinator complete the ISP without the items in need of Division approval.

Once the ISP is approved, it can be revised to add the items in need of Division approval. Completing this process

in this order will expedite the ISP approval process without holding up services that are not in need of Division

approval.

7.9 Changes to the Service Plan

Revisions can be made to the Service Plan as needed, such as changes in services, provider choice, demographic

information, religious/cultural information, etc. It is not necessary to reconvene the planning team for all changes

to the ISP. Signatures and ISP approval must be obtained when there are changes/additions to outcomes, services,

providers, units, or start/end dates. To initiate the process, the individual will contact the Support Coordinator to

inform them of the change in need or provider. The Support Coordinator will make revisions to the plan as needed

and obtain signatures as described in Section 7.5.9. For service need changes, the Support Coordinator must end

the service to be revised in the current plan and add the new service with start date in the revised/new plan to ensure

there are no overlapping or duplicate services in the plan. This revised plan will be saved in iRecord as a version of

the plan that was revised.

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8 ACCESSING SERVICES

This section describes how the Support Coordinator arranges for and coordinates services, both within and external

to the Division, to meet the needs of eligible individuals as identified in the ISP. While this manual focuses on the

process for providing Division-funded services, the use of natural supports, community resources, and generic

services/supports is critical in order to meet all the needs of individuals eligible for the Division and extend the

individualized budget as far as possible. Services funded by the Division will be considered only when other

resources and supports are insufficient or unavailable and do not meet the needs of the individual and are attributable

to the person’s disability. Information about use of these non-Division services/supports can be found in Section

8.2.

8.1 Identification of Needed Services

The Support Coordinator utilizes information provided through the NJ CAT, PCPT, and other discovery and/or

assessment tools to identify service needs associated with the outcomes developed in collaboration with the

individual through the person-centered planning process and indicated in the ISP. These services, along with their

provider(s), are identified through the ISP. The ISP is developed by the Support Coordinator and must be developed

and approved within 30 days of Supports Program enrollment. The process for developing the ISP is explained in

Section 7.4.

8.2 Use of Community Resources and Non-Division-Funded Services

Once service needs have been identified, the Support Coordinator shall begin examining the services or other

assistance which may be provided through other State agencies, existing community resources, or family members.

8.2.1 Community Resources

Most communities offer an array of services that may meet the needs of people with developmental disabilities and

their families. The type and availability of services will vary, but utilizing these community resources can increase

the amount of services an individual receives and may provide services that are not available through the Division.

It is the Support Coordinator’s responsibility to be aware of community resource information and eligibility

requirements for these programs and agencies. Depending on the capabilities of the individual, either contact or

provide contact information to individuals and their families when it appears that these resources may benefit the

individual and family. Services through community resources may include, but are not limited to, advocacy,

adaptive and/or medical equipment, nutrition assistance, housing, legal assistance, recreation, transportation, and

utility assistance. Information on other resources is available on the Support Coordination information & Resources

website.

“New Jersey Resources,” www.njhelps.org, and www.nj211.org can be used to identify government, community

organizations, and professionals working to assist people with disabilities. NJ Resources can be accessed on the

Division of Disability Services (DDS) website at http://www.nj.gov/humanservices/dds/home/.

8.2.2 Coordination with Other State Programs and Agencies

The Support Coordinator is responsible for coordinating services and supports through other programs and entities

as appropriate. This can include a variety of programs and entities but requires at a minimum the following:

Managed Care Organizations (MCO) Care Managers

Every individual receiving Division services must be eligible for Medicaid and, as such, should have a Managed

Care Organization designated to provide services related to their acute and behavioral healthcare needs. The MCO

must assign a Care Manager to all individuals with developmental disabilities. The Support Coordinator should

identify and reach out to contact this MCO Care Manager to ensure coordination of health care

Does not preclude the individual/family from contacting the MCO Care Manager

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Division of Vocational Rehabilitation Services (DVRS)/Commission for the Blind & Visually Impaired

(CBVI)

Employment services must be sought through DVRS/CBVI prior to being made available through Division funding.

However, Long-Term Follow-Along (LTFA) services will be provided by the Division even in circumstances where

other employment supports were provided by DVRS/CBVI first. The DVRS/CBVI Counselor will indicate the

availability of DVRS/CBVI services by completing the Employment Determination Form (F3 form) and providing

it to the Support Coordinator. Employment services that are not available through DVRS/CBVI and are provided

by the Supports Program will be provided by the Division. If an individual is not seeking employment services, the

Support Coordinator will complete the Employment Non-Referral Form to DVRS or CBVI (F6 form). Individuals

are able to access DVRS/CBVI and Division services at the same time.

8.3 Accessing Division-Funded Services

The Support Coordinator will collaborate with the individual to identify Division-funded services that are needed.

The services available through the Supports Program are as follows:

 Assistive Technology

 Personal Emergency Response System (PERS)

 Behavioral Supports

 Physical Therapy

 Career Planning

 Prevocational Training

 Cognitive Rehabilitation

 Respite

 Community Based Supports

 Speech, Language, and Hearing Therapy

 Community Inclusion Services

 Support Coordination*

 Day Habilitation

 Supported Employment – Individual Employment Support

 Environmental Modifications

 Supported Employment – Small Group Employment Support

 Goods & Services

 Supports Brokerage

 Interpreter Services

 Transportation

 Natural Supports Training

 Vehicle Modification

 Occupational Therapy

*Please note – Support Coordination services are not direct services funded through the individualized budget

and are not included under “services” in the ISP.

Each Division-funded service the individual will be utilizing is written into the ISP. Once the ISP is approved by

the Support Coordination Supervisor (and Division in circumstances where the SCA has not been released to

approve their own plans or services need that additional step of approval), the ISP serves as prior authorization for

the services.

Each Division-funded service and the standards associated with it are further described in Section 17.

8.3.1 Utilizing a Service Provider

The individual selects each service provider they prefer to provide the services included in the ISP. The Division

encourages the individual to research service providers through phone calls, interviews, provider fairs, site visits,

word of mouth, marketing materials, etc. prior to selecting the service provider. To assist in this effort, the Division

has developed a provider search database that includes all Medicaid/DDD approved service providers. Service

providers can be identified through this database by county and/or services for which they are approved to provide

and can be accessed at https://irecord.dhs.state.nj.us/providersearch.

While the Support Coordinator cannot select the service providers or recommend any specific provider for the

individual, they shall assist the individual, as needed, in researching service providers, matching approved service

providers for the services that have been identified to meet the individual’s needs as indicated in the ISP. In addition,

the Support Coordinator is responsible for assisting the individual with identifying criteria that will help narrow the

list of available providers. The criteria are based on the needs and preferences of the individual. The Support

Coordinator shall contact potential service providers to help facilitate individual research through provider

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interviews, tours, meetings, etc.; schedule intake meetings; assist the individual/family in providing any referral

information required by the service provider; communicate with the service provider to ensure that they are capable

of meeting the strategies necessary to assist the individual in progressing toward the outcomes indicated in the ISP

and identify the service details (type of service, units, etc.); and determine availability of services unless the

individual/family has indicated that they prefer to do this research and schedule these meetings instead of the

Support Coordinator.

If a service provider cannot be located due to lack of capacity within the individual’s area, lack of ability to meet

the individual’s particular needs, lack of providers for a particular service, etc., the Support Coordinator must report

that information to their assigned Division SC Quality Assurance Specialist. The Division will track this

information in order to assure that adequacy of network is addressed.

8.3.1.1 Referral to the Selected Service Provider

Collaboration between the Support Coordinator and identified service provider(s) is necessary in order to ensure

that the service provider can effectively serve the individual by meeting their needs and providing services that will

help them progress toward their outcomes. As outlined below, the Support Coordinator must reach out to the

identified service provider(s) prior to beginning services in order to set up any required intake interviews, tours,

visits, etc., and provide any documentation that may be required in order for the service provider(s) to determine

whether the individual meets the criteria necessary for admission into their programs. In addition, the Support

Coordinator must remain in contact with the service provider(s) during development of the ISP in order to ensure

that everyone is in agreement about start dates, service provision, units, dates, etc. and provide a copy of the draft

ISP to the service provider(s) for review and agreement prior to delivery of services. This process will ensure

agreement across everyone involved and eliminate many errors that can occur when this collaboration is not

followed. Once the individual selects their preferred service provider, the following process will be implemented

in order to refer the individual to the provider and access services:

 The Support Coordinator must contact the potential provider to notify the provider of the individual’s

interest in accessing services through them and follow the intake/eligibility determination process that may

be required by the potential provider;

 The Support Coordinator must communicate applicable outcomes indicated in the ISP and discuss the

provider’s ability to assist the individual in progressing toward those outcomes. The Support Coordinator

shall describe the service needs of the individual, share the individual’s attributes, determine availability of

services; arrange intake/eligibility meetings; and/or identify any documents/information the service

provider requires as part of the referral process.

 When the service provider requires an intake interview, referral packet, tour, etc. in order to determine

individual eligibility, the Support Coordinator shall assist in meeting these requirements by scheduling

meetings and assisting the individual in providing the potential service provider with any

information/documentation that the service provider requires as part of the referral process;

 The service provider must inform the individual and/or Support Coordinator of their interest in delivering

services to the individual within five (5) working days of the initial contact;

 The Support Coordinator confirms that the potential service provider meets the individual’s needs and has

the capacity to provide services to the individual by the date on which the individual is in need of the

services. If the individual is assigned the acuity differentiated factor, the Addressing Enhanced Needs Form

(Appendix D) must be completed by the Support Coordinator and service provider as described in Section

3.4. This form is optional for Support Coordinators and service providers if the individual does not have

the acuity factor but may be helpful to address needs;

 The selected service provider indicates acceptance or denial into the service;

 The Support Coordinator selects the confirmed service provider(s), start dates, units of service, etc. in the

ISP;

 The Support Coordinator needs to be aware of items/documentation the service provider will need prior to

serving the individual and assist/ensure they are provided prior to the start of services;

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 The Support Coordinator sends a copy of the approved ISP (and any other relevant and consented to

discovery tools, evaluations, etc.) to all service providers identified in the ISP and receives confirmation of

its accuracy from the service provider;

 A prior authorization is distributed electronically to the confirmed service provider once the ISP is

approved;

 Services begin as per the start date, units, frequency, duration, etc. indicated in the prior authorization

8.3.2 Hiring a Self-Directed Employee (SDE) “Self-Hires”

Self-Directed Employees (SDE) are people who are recruited and offered employment directly by the individual

using the service or by the individual’s authorized representative. For purposes of this section, the term “individual”

is meant to encompass both the individual and authorized representative. In essence, the SDE is a staff person of

the individual and is hired to perform waiver services for which SDEs are qualified. Service qualifications and

limitations can be found in the service-specific descriptions in the Supports Program Services section of this manual

(Section 17).

An individual choosing to hire a self-directed employee is responsible to understand and comply with all applicable

federal and state labor, wage and employment laws, whether the individual is the employer of record (Vendor

Fiscal/Employer Agent model) or the co-employer (Agency with Choice). For more information on this, please

contact your selected fiscal intermediary. A self-directed employee may not be regularly scheduled to work more

than 16 consecutive hours in a 24-hour period.

The individual is responsible for creating the job description, setting the hours of employment, managing the SDE,

and determining the continuation or termination of employment. Assistance with these tasks and the overall

arranging, directing, and managing of services provided by a SDE can be obtained through Supports Brokerage if

needed. The Supports Brokerage service is funded through the individual budget and is further described in Section

17.20. As is the case with all services in both the Community Care Program and Supports Program, a prior

authorization must be obtained prior to delivery of services through the SDE in order for funding for those services

to be provided. Thus, if an individual negotiates with a SDE to work outside of what is prior authorized in the

Individualized Service Plan (ISP), the individual is responsible for payment and all employer-related functions.

Management of employment-related functions, including items such as timekeeping, payroll, tax withholding, and

compliance with applicable labor laws and regulations, is the responsibility of a Fiscal Intermediary (FI), a non-

governmental entity under contract with the State of New Jersey. FI management of SDE functions is limited to

services prior authorized in the ISP. FI policies and procedures and information will be maintained, updated, and

communicated by the appropriate FI through various methods which may include a manual, handbook, enrollment

packet, and website.

8.3.2.0.1 Establishing a Self-Directed Employee (SDE) Hourly Wage for Services Where the Direct

Support Professional Service Applies

The Division offers the choice for individuals to utilize Self-Directed Employees (SDEs) for several services. Some

of these services (Community Based Supports and Respite) are provided as a discrete service by Direct Support

Professionals (DSPs) employed by service providers. These services are denoted in Appendix H with the caption

DSP Service Applies. The Division supports comparable wages between SDEs and Direct Support Professionals

(DSPs) performing these services.

A Reasonable and Customary (R&C) wage range, as opposed to a static rate, has been adopted for SDEs performing

Community Based Supports and/or Respite to allow the ability to scale SDE wages based on DSP wages. The most

recent (at the time of this document’s publication) National Core Indicators State of the Workforce Survey reflects

data from 2022. It demonstrates (See Method II found on page 40 of that document) an average hourly DSP wage

of $17.94. Since that time, DSP wages in New Jersey have increased by about $1.25 on January 1, 2023 and an

additional $1.75 on January 1, 2024. This projects the current DSP average wage in New Jersey to be about $20.94

per hour.

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Using the above information and the data below, the established R&C wage range for an SDE shall be the prevailing

minimum wage up to $25.00 per hour for the services of Community Based Supports and/or Respite. An SDE may

not be paid a wage above $25.00 per hour unless they meet the standard for an Enhanced R&C wage set forth below.

The $25.00 per hour wage was arrived at by reviewing May 2023 (most recent data available at time of publication)

data from the U.S. Bureau of Labor Statistics for the State of New Jersey

(https://www.bls.gov/oes/current/oes_nj.htm). This data demonstrated a mean hourly wage for the following

occupations as listed below:

 Home Health and Personal Care Aides - $17.53 per hour

 Healthcare Support Workers, All Other - $23.27 per hour

 Personal Care and Service Workers, All Other - $23.71 per hour

An Enhanced R&C wage range of the prevailing minimum wage up to $35.00 per hour is available in certain

circumstances for certain professionals for the services of Community Based Supports and/or Respite. The

availability of the Enhanced R&C wage is not solely based on the presence, or lack of, an individual being assigned

an acuity. The $35.00 per hour wage was arrived at by reviewing May 2021 (most recent data available at time of

publication) data from the U.S. Bureau of Labor Statistics for the State of New Jersey

(https://www.bls.gov/oes/current/oes_nj.htm). This data demonstrated a mean wage for the following occupations

as listed below:

 Substance Abuse, Behavioral Disorder, and Mental Health Counselors - $32.33 per hour

 Licensed Practical and Licensed Vocational Nurses - $32.03 per hour

For SDEs who are a Registered Nurse, an Enhanced R&C wage range of the prevailing minimum wage up to $50.00

per hour is available in certain circumstances for the services of Community Based Supports and/or Respite. The

availability of the Enhanced R&C wage is not solely based on the presence or absence of an individual being

assigned an acuity. The $50.00 per hour wage was arrived at by reviewing May 2023 (most recent data available

at time of publication) data from the U.S. Bureau of Labor Statistics for the State of New Jersey

(https://www.bls.gov/oes/current/oes_nj.htm). This data demonstrated a mean wage for the following occupation

as listed below:

 Registered Nurses - $49.02 per hour

The Enhanced R&C wage range may be granted in the following circumstances:

 The individual has a documented enhanced medical care and/or enhanced behavioral care need as described

in the Enhanced Medical Care Need(s) and/or the Enhanced Behavioral Care Need(s) section below; AND

 The individual requires care provided by an SDE whose education comports with the SDE Education below

and this education is closely related to the documented enhanced medical and/or enhanced behavioral care

need of the individual.

Enhanced Medical Care Need(s):

 An enhanced medical care need is, as determined by the Division, one that cannot be supported without the

SDE possessing a higher level of education.

 Documentation of enhanced medical care need(s) must include any of the following that apply:

o The information contained within the Addressing Enhanced Needs Form (AENF);

o SDE shift notes/service documentation documenting the medical care provided to an individual;

o Support Coordination Monthly Monitoring Tools that contain discussion/documentation of care

need;

o As applicable, documentation (including but not limited to) of:

 Medically based hospitalizations;

 Significant increase and or/change in medical appointments/physician oversight;

 Whether the individual has been assessed for medical needs that require skilled nursing

care (Registered Nurse, Licensed Practical Nurse);

o Other information specific to the individual circumstance.

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Enhanced Behavioral Care Need(s):

 An enhanced behavioral care need is, as determined by the Division, one that cannot be supported without

the SDE possessing a higher level of education. In all circumstances, a current behavior support plan should

be in place as described in Section 17.2 – Behavior Supports – of this manual. The behavior support plan

may require an SDE to complete regular data tracking, consistently implement the individual’s behavior

support plan, etc.

 Documentation of enhanced behavioral care need(s) must include any of the following that apply:

o The information contained within the Addressing Enhanced Needs Form (AENF);

o SDE shift notes/service documentation documenting the care provided to an individual;

o Support Coordination Monthly Monitoring Tools;

o As applicable, documentation (Including but not limited to) of:

 Emergency Room/Mental Health Screening;

 Hospitalization(s) of the individual for reasons related to their behavioral health needs;

 Property damage resulting from behaviors engaged in by the individual;

 Aggression by the individual towards self/others, including staff, which have resulted in

injury;

 Elopement by the individual;

 Legal involvement.

o Other information specific to the individual circumstance.

Enhanced Wage SDE Education Requirements:

To receive an Enhanced R&C wage, the SDE must possess a matriculated degree/advanced degree in a medical

and/or behavioral subject area closely related to the identified enhanced need of the individual. Years of

experience may not be used as an equivalent to a matriculated/advanced degree.

Documentation is required and must include one or more of the following: Official copies of educational

transcript(s); Certification(s); or License(s).

Establishing Enhanced R&C Wage

Eligibility for the Enhanced R&C wage must be determined by the Division before it can be offered to an SDE.

This consists of:

1. The Division verifying that there is documentation of an enhanced medical and/or behavioral need; and

2. The Division determining that the SDE meets the required Education/Credentialing Factors as described

in this section.

Individuals/guardians who believe their identified SDE meets the criteria for an enhanced wage should work with

their Support Coordinator to submit the Enhanced Reasonable and Customary Wage Request Form. They should

indicate Combined Approval as the request type in Section 1 and complete the entire form. Upon receipt of a

sufficiently detailed submission, the Division will review and render a determination within seven (7) business days.

The Division recognizes that there may be instances where approval for the Enhanced R&C wage range may be

needed in order to identify an SDE. In these circumstances, please indicate Pre-Approval as the request type in

Section 1 and follow the corresponding instructions completing sections 1, 2 and 3. Upon receipt of a sufficiently

detailed submission, the Division will review and render a determination within seven (7) business days.

Once Pre-Approval is obtained, the individual/guardian may then solicit an SDE using the Enhanced R&C wage

range and assume the Enhanced R&C wage will be granted contingent on the selected SDE meeting the SDE

Education requirements as determined by the Division.

Upon selection of an SDE, re-submission of the Enhanced Reasonable and Customary Wage Request Form for

Final Approval will need to occur so that the Division can verify that SDE possesses the required education. Upon

receipt of a sufficiently detailed submission, the Division will review and render an expedited determination.

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Salary Increases

Salary increases above the maximum standard(s) listed in this section will not be granted. For this reason, it is

recommended that individuals/families not establish an hourly wage at the maximum amount so that they have the

ability to provide pay increases over time within the established wage range.

8.3.2.0.2 Establishing a Self-Directed Employee (SDE) Hourly Wage for Services Where the Direct

Support Professional Service Does Not Apply

The Division offers the choice for individuals to utilize Self-Directed Employees (SDEs) for several services. Some

of these services (Interpreter Services, Supports Brokerage, and Transportation) are not provided as a discrete

service by Direct Support Professionals (DSPs) employed by service providers. For these services, the following

shall be used to establish the hourly wage for the corresponding service:

Interpreter Services – This service has an established rate for American Sign Language (ASL) and Other – Non-

ASL (Please see Interpreter Services Definition and Appendix H) and is not provided as a discrete service by a

DSP. Therefore, the SDE wage shall not exceed the established Interpreter Services rate.

Supports Brokerage – This service has an established base rate (see Supports Brokerage Service Definition and

Appendix H) and is not provided as a discrete service by a DSP. Therefore, the SDE wage shall not exceed the

established Supports Brokerage rate.

Transportation – This service, when used for an SDE, reimburses the SDE for their time providing transportation

as well as their mileage (Please see Transportation Service Definition and Appendix H). It is not offered in the

same way to DSPs as they are reimbursed for mileage only. Therefore, the SDE wage for Transportation shall be

negotiated on a case-by-case basis. The approved wage for Transportation may be lower than the established SDE

wage for another service as a result.

8.3.2.1 Selecting SDE Service Delivery

If an individual is in need of one of the services that is available through an SDE (Community Based Supports,

Interpreter Services, Respite, Supports Brokerage, or Transportation), the Support Coordinator will present the

options of utilizing a SDE or a provider agency. The Support Coordinator will also explain the two SDE models

available – Vendor Fiscal/Employer Agent or Agency with Choice, as outlined in the documentation developed

and maintained by the FI for each of these models. Information about these options can also be found at

https://nj.gov/humanservices/ddd/individuals/community/selfdirected/.

Selecting the Vendor Fiscal/Employer Agent SDE Model

In the Vendor Fiscal/Employer Agent SDE model, the individual must enroll as the employer of record or identify

someone else (typically a family member or friend) to enroll as the employer of record. If the individual elects to

use the Vendor Fiscal/Employer Agent SDE model, the Support Coordinator, individual and family (as applicable)

will conduct a preliminary review to confirm that a SDE will be able to sufficiently meet the needs of the individual

and provide the service in accordance with the service description, limitations, and standards. The Support

Coordinator will submit an Individual Referral through iRecord to the FI for the Vendor Fiscal/Employer Agent

SDE model. Upon receipt of the Individual Referral, the FI will initiate the employer of record and SDE enrollment

processes and register the individual and any authorized representatives for the FI-developed orientation. The

following major areas will be covered by the orientation curriculum:

 A description of the services offered by and the roles and responsibilities of the FI;

 Process for ensuring the SDE meets qualifications to deliver the service;

 Roles, responsibilities, and rights of the individual;

 Roles, responsibilities, and rights of the SDE; and

 Required documentation.

The individual will receive an employer enrollment packet from the FI. This packet will contain the forms necessary

for the individual to enroll as the employer of record and appoint the FI as the agent for employment-related matters.

The FI will assist the individual in completing these forms. In circumstances when the individual has a SDE

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candidate in mind, the SDE candidate will receive an employee enrollment packet. The FI will collect and process

the documents with the appropriate federal and New Jersey agencies to enroll the SDE.

In circumstances when the individual does not have a particular SDE candidate in mind, the individual is responsible

for recruitment of candidates. If needed, the Support Coordinator will assist the individual in obtaining Supports

Brokerage services to provide assistance with or undertake the search for a SDE.

Please note that in this model one Employer Identification Number (EIN) is used. If an individual accesses services

through the Personal Preference Program (PPP), administered by the Division of Medical Assistance and Health

Services (DMAHS), an additional EIN is required.

Wages and Benefits in the Vendor Fiscal/Employer Agent SDE Model

The SDE’s hourly wage is determined by the individual, subject to minimum-wage laws, at a rate that is considered

reasonable and customary for the service being delivered. In the Vendor Fiscal/Employer Agent SDE model, the

FI will mark up the identified hourly wage to cover the cost of employer-related taxes and will use the marked-up

wage to calculate the Fee-for-Service billable rate. The wage and the mark-up for employer-related taxes are funded

through the individual budget. The FI will verify that hourly wages are in compliance with federal and NJ

Department of Labor and Workforce Development (NJ DLWD) rules and compute standard payroll deductions that

will be applied to the SDE’s paycheck. Employer-sponsored health benefits are not available to SDEs in the Vendor

Fiscal/Employer Agent model. However, the individual can choose to include within the hourly wage an amount

that may enable the SDE to purchase healthcare or health benefits privately or through a government-run, and

potentially subsidized, exchange.

The SDE can only receive payment for rendering services that have been prior authorized through an approved ISP.

Any services, including overtime, exceeding those indicated in the ISP will not be reimbursed through the

individual’s budget. One SDE cannot provide more than 40 hours of service for an individual per week. If an

individual requires services that will go beyond those 40 hours in a week, another SDE or a provider agency must

be utilized to deliver those additional hours of service. It is the individual’s responsibility, along with the Support

Coordinator and Supports Broker when utilized, to ensure that SDE schedules do not require payment of overtime.

Individuals who are receiving services from an SDE in the Vendor Fiscal/Employer Agent SDE model must pay an

annual fee to maintain a workers’ compensation policy. This annual fee (determined by the NJ Compensation Rating

and Inspection Bureau) is deducted from the individual budget at the time the initial SDE-delivered service is added

to the plan or at the time a plan that includes an SDE-delivered service renews.

SDE Hiring in the Vendor Fiscal/Employer Agent SDE Model

Once the FI is notified of SDE selection, it will assist the SDE with obtaining, completing, and submitting the

required forms with the intent to complete the process to become approved to provide that service within two (2)

weeks of referral. The required information, forms, and instructions that will be distributed to SDEs include but

are not limited to the following:

 Introductory letter;

 Worker checklist;

 Employment application;

 I.R.S. Form W-4 Withholding Allowance Certificate;

 U.S. BCIS Form I-9 Employment Eligibility Verification Form;

 DHS PDS 1006 Worker Agreement or PDS 1008 for Goods and Services (considered the Medicaid

agreement);

 Permission for pre-employment checks of criminal background and the Central Registry of Offenders

Against Individuals with Developmental Disabilities;

 Worker timesheets, instructions, due dates, and pay schedule;

 New Jersey New Hire Reporting form;

 Form for determination of tax exemptions;

 Notice of direct deposit and debit card payment options and sign-up instructions.

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The FI will provide the forms within one (1) business day of receipt of the Individual Referral from the Support

Coordinator and will process the completed forms within two (2) business days of receipt. The FI will process the

background checks required for the service (using the forms and process supplied by the Division) and will also

ensure that SDEs complete the mandated staff training applicable to the service(s) being delivered (as explained for

each specific service in Section 17 and referenced in the Quick Reference Guide to Mandated Staff Training and

Professional Development in Appendix E), including providing instructions for accessing trainings through the

College of Direct Support. Through the duration of the SDE’s employment, the FI will repeat background checks

as required or requested by the Division or individual.

Once it is confirmed that service delivery qualifications/requirements are met and the individual and SDE forms are

processed, the FI will notify the Support Coordinator that the SDE can begin work, and will provide the Support

Coordinator with the Fee-for-Service billable rate (wage plus mark-up for employment-related taxes). The Support

Coordinator will enter the SDE information and the FFS billable rate into the ISP and a prior authorization will be

generated and emailed to the FI upon the ISP approval. The Support Coordinator will notify the individual of plan

approval.

The FI will maintain adequate records for each individual as well as all the SDE-specific employment records (e.g.

timekeeping, payroll, tax withholding). This will include the determination of appropriate tax withholding and

payroll deductions.

Self-directed employees may be members of a participant’s family provided that the family member has met the

same standards as providers who are unrelated to the individual.

SDE Termination in the Vendor Fiscal/Employer Agent SDE Model

The individual may terminate the SDE any time by notifying the SDE and Support Coordinator. The Support

Coordinator will revise the ISP to reflect the change to another SDE or to a service provider or end services if they

are no longer required. In the Vendor Fiscal/Employer Agent SDE model, it is the responsibility of the employer

of record to inform the SDE of termination. The Support Coordinator will notify the FI within two (2) business

days so the FI can complete the NJ DLWD Reason for Separation Notice within ten (10) calendar days, and process

and deposit final payments, etc.

If the individual has decided to no longer utilize SDEs and will no longer be acting as an employer, the Support

Coordinator will notify the FI and the FI will take the necessary steps to close the employer record in the FI’s

system, process and deposit final tax payments, and terminate the workers’ compensation policy (the annual fee for

the workers’ compensation policy is not refundable). The FI cannot close an Employer Identification Number (EIN)

business account on behalf of an individual. To close an EIN business account with the Internal Revenue Service

(IRS), the individual must write a letter to the IRS requesting to close the EIN business account (see www.irs.gov).

The Division reserves the right to suspend or terminate the ability to use SDEs by any individual/ authorized

representative or the ability of someone to serve as a SDE at any time due to non-compliance with roles and

responsibilities, CCP standards and qualifications as contained in this manual, or other waiver documentation; fraud

and abuse; or failure to continue meeting the service standards and qualifications, including background checks. If

the Division initiates suspension or termination, the Division will immediately notify the individual, Support

Coordinator (SC), and FI and the SC or Division will revise the ISP as necessary to end prior authorization as

appropriate.

Payroll Processing in the Vendor Fiscal/Employer Agent SDE Model

Timesheets and instructions for their completion will be developed, distributed, collected, verified, and processed

by the FI. Copies of timesheets and associated payroll documents will be maintained by the FI. The FI will process

payroll checks biweekly, within five (5) business days after receipt of the timesheet for the relevant period and will

make payment directly to the SDE via check, electronic deposit or debit card. This process includes the processing

and distributing of all federal and New Jersey payroll, employment, and withholding taxes and reports (e.g. federal

and State income tax withholding, Medicare, Social Security, unemployment, temporary disability, family leave).

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Payments to SDEs will include a remittance advice showing gross wages and net wages following withholdings

and other deductions.

The FI is responsible for managing improperly cashed or issued payroll checks, stopping payment on checks, and

re-issuance of lost, stolen or improperly cashed checks. The FI will also process all judgment, garnishments, tax

levies or related holds on SDE pay that may be required by federal or New Jersey law. This includes researching,

investigating, and resolving all tax notice from the I.R.S., NJ DLWD, and NJ Division of Revenue and Enterprise

Services. The individual or SDE impacted should contact the FI directly using the provided contact information if

any of these issues arise.

The FI is required to pay SDEs for every hour worked pursuant to the Division’s prior authorization. FI services are

procured by the State for use by participants for processing and recordkeeping functions related solely to State-

authorized services. State funding for services is limited to the hours and rates authorized in the ISP and will be

prior authorized each week. Participants are not permitted to approve more hours than the Division has prior

authorized for the relevant time period without a change to the ISP that has been submitted by the Support

Coordinator and approved. If the SDE’s timesheet is submitted to the FI with hours exceeding those authorized, it

will be considered invalid and will not be paid. The FI will notify the employer of record and SDE within one (1)

day of receiving the timesheet. An individual or SDE involved in multiple overages within a one-year period will

be barred from participation. In the event that a SDE is overpaid, the FI will identify the overage and institute

recovery proceedings.

Employees in the Vendor Fiscal/Employer Agent model receive paid sick leave. Please contact the FI for more

information related to accrual, maximum hours earned, etc.

Selecting the Agency with Choice SDE Model

If the individual utilizing an SDE elects to use the Agency with Choice model, the Support Coordinator will conduct

a preliminary review with the individual and family (as applicable) to confirm that a SDE will be able to sufficiently

meet the needs of the individual and provide the service in accordance with the service description, limitations, and

standards. The Support Coordinator will also confirm that the individual’s budget can support the projected per-

member per-month (PMPM) fee needed to participate in the Agency with Choice SDE model. The PMPM fee is

based on whether and how many of an individual’s SDEs elect employer-sponsored health benefits. An Individual

Referral should not be made to the Agency with Choice SDE model unless/until a SDE candidate has been

identified. Please see Appendix P for PMPM information.

The Support Coordinator will submit an Individual Referral through iRecord to the FI for the Agency with Choice

SDE model. Upon receipt of the Individual Referral from the Support Coordinator, the FI will initiate the enrollment

process and register the individual and any authorized representatives for the FI-developed orientation. The

following major areas will be covered by the FI orientation curriculum:

 A description of the services offered by and the roles and responsibilities of the FI;

 Process for ensuring the SDE meets qualifications to deliver the service;

 Roles, responsibilities, and rights of the individual;

 Roles, responsibilities, and rights of the SDE; and

 Required documentation.

The individual will receive an enrollment packet. This packet will contain the forms necessary for the individual

to enroll. The FI will assist the individual in completing these forms. The SDE candidate will receive a separate

enrollment packet. The FI will collect and process the documents with the appropriate federal and New Jersey

agencies to enroll the SDE.

If needed, the Support Coordinator will assist the individual in obtaining Supports Brokerage services to provide

assistance with or undertake the search for an SDE.

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8.3.2.2 Wages and Benefits in the Agency with Choice SDE Model

Wages are determined by the individual, subject to minimum-wage laws, at a rate that is considered reasonable and

customary for the service being delivered. In the Agency with Choice SDE model, the FI will mark up the identified

hourly wage to cover the cost of employer-related taxes and workers’ compensation insurance. It will use the

marked-up wage to calculate the Fee-for-Service billable rate. The wage and the mark-up for employer-related taxes

and workers’ compensation are funded through the individual budget. The FI will verify that hourly wages are in

compliance with federal and NJ Department of Labor and Workforce Development (NJ DLWD) rules and compute

standard payroll deductions that will be applied to the SDEs paycheck. All components of the wage come from the

budget assigned to the individual. Employer-sponsored health benefits and paid time off are available to SDEs in

the Agency with Choice SDE model. The per-member, per-month fee deducted from the individual’s budget to

participate in the Agency with Choice SDE model covers all the costs associated with these benefits and is based

on whether and how many of an individual’s SDEs elect employer-sponsored health benefits.

The SDE can only receive payment for rendering services that have been prior authorized through an approved ISP.

Any services, including overtime, exceeding those indicated in the ISP will not be reimbursed through the State.

One SDE cannot provide more than 40 hours of service for an individual per week. If an individual requires services

that will go beyond those 40 hours in a week, another SDE or a provider agency must be utilized to deliver those

additional hours of service. It is the individual’s responsibility, along with the Support Coordinator, to ensure that

SDE schedules do not require payment of overtime.

SDE Hiring in the Agency with Choice SDE Model

Once the FI is notified of SDE selection, it will assist the SDE with obtaining, completing, and submitting the

required forms with the intent to complete the process to become approved to provide that service within two (2)

weeks of referral. The required information, forms, and instructions that will be distributed to SDEs include but

are not limited to the following:

 Introductory letter;

 Worker checklist;

 Employment application;

 I.R.S. Form W-4 Withholding Allowance Certificate;

 U.S. BCIS Form I-9 Employment Eligibility Verification Form;

 DHS PDS 1006 Worker Agreement or PDS 1008 for Goods and Services (considered the Medicaid

agreement);

 Permission for pre-employment checks of criminal background, Child Abuse Registry Information (CARI),

and the Central Registry of Offenders Against Individuals with Developmental Disabilities;

 Worker timesheets, instructions, due dates, and pay schedule;

 New Jersey New Hire Reporting form;

 Form for determination of tax exemptions; and

 Notice of direct deposit and debit card payment options and sign-up instructions.

The FI will provide the forms within one (1) business day of notification by the Support Coordinator and will

process the completed forms within two (2) business days of receipt. The FI will process the background checks

required by the service (using the forms and process supplied by the Division) and will also ensure that SDEs

complete the mandated staff training applicable to the service(s) being delivered (as explained for each specific

service in Section 17 and referenced in the Quick Reference Guide to Mandated Staff Training and Professional

Development in Appendix E), including providing access to training provided through the College of Direct

Support. Through the duration of the SDE’s employment, the FI will repeat background checks as required or

requested by the Division or individual.

Once it is confirmed that service delivery qualifications/requirements are met and the individual and SDE forms are

processed, the FI will notify the Support Coordinator that the SDE can begin work and will provide the Support

Coordinator with the Fee-for-Service billable rate. The Support Coordinator will enter the SDE information and

the FFS billable rate into the ISP and a prior authorization will be generated and emailed to the FI upon the ISP

approval. The Support Coordinator will enter the SDE information and the FFS billable rate into the ISP and a

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prior authorization will be generated and emailed to the FI upon the ISP approval. The Support Coordinator will

notify the individual of plan approval.

The FI will maintain adequate records for each individual as well as all the SDE-specific employment records (e.g.

timekeeping, payroll, tax withholding). This will include the determination of appropriate tax withholding and

payroll deductions.

Self-Directed employees may be members of a participant’s family provided the family member has met the same

standards as providers who are unrelated to the individual.

8.3.2.4 SDE Termination in the Agency with Choice SDE Model

The individual may terminate the SDE any time by notifying the SDE and Support Coordinator. The Support

Coordinator will revise the ISP to reflect the change to another SDE or to a service provider or end services if they

are no longer required. In the Agency with Choice SDE model, the individual may inform the SDE that they no

longer wish to receive services from the SDE. It is the responsibility of the FI/employer of record to inform the

SDE of termination. The Support Coordinator will notify the FI within two (2) business days so the FI can complete

the NJ DLWD Reason for Separation Notice within ten (10) calendar days, and process and deposit final payments,

etc.

If the individual has decided to no longer utilize SDEs, the Support Coordinator will notify the FI and the FI will

take the necessary steps to close the individual’s record, and process and deposit final tax payments.

The Division reserves the right to suspend or terminate the ability to use SDEs by any individual/ authorized

representative or the ability of someone to serve as an SDE at any time due to non-compliance with roles and

responsibilities, CCP standards and qualifications as contained in this manual, or other waiver documentation; fraud

and abuse; or failure to continue meeting the service standards and qualifications, including background checks. If

the Division initiates suspension or termination, the Division will immediately notify the individual, Support

Coordinator (SC), FI, and the SC or Division will revise the ISP as necessary to end prior authorization as

appropriate.

8.3.2.5 Payroll Processing in the Agency with Choice SDE Model

Timesheets and instructions for their completion will be developed, distributed, collected, verified, and processed

by the FI. Copies of timesheets and associated payroll documents will be maintained by the FI. In the Agency with

Choice SDE model, timesheets are submitted weekly and payroll is processed biweekly, within five (5) business

days after receipt of the second week’s timesheet for the relevant period. The FI will make payment directly to the

SDE via electronic deposit or pay card. This process includes the withholding, processing and distributing of all

federal and New Jersey payroll, employment, and other required deductions and reports (e.g. federal and State

income tax withholding, Medicare, Social Security, unemployment, temporary disability, family leave). Payments

to SDEs will include a remittance advice showing gross wages and net wages following withholdings and other

deductions.

The FI will also process all judgment, garnishments, tax levies or related holds on SDE pay that may be required

by federal or New Jersey law. This includes researching, investigating, and resolving all tax notices from the I.R.S.,

NJ DLWD, and NJ Division of Revenue and Enterprise Services. The individual or SDE impacted should contact

the FI directly using the provided contact information if any of these issues arise.

The FI is required to pay SDEs for every hour worked pursuant to the Division’s authorization. FI services are

procured by the State for use by participants for processing and recordkeeping functions related solely to State-

authorized services. State funding for services is limited to the hours and rates authorized in the ISP and will be

prior authorized each week. Participants are not permitted to approve more hours than the Division has prior

authorized for the relevant time period without a change to the ISP that has been submitted by the Support

Coordinator and approved. If the SDE’s timesheet is submitted to the FI with hours exceeding those authorized, it

will be considered invalid and will not be paid. The FI will notify the employer of record and SDE within one (1)

day of receiving the timesheet. An individual or SDE involved in multiple overages within a one-year period will

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be barred from participation. In the event an SDE is overpaid, the FI will identify the overage and institute recovery

proceedings. Employees in the Agency with Choice model are eligible for paid time off depending on the number

of hours worked per week and the number of years worked for the employer of record. Please contact the FI for

more information.

8.3.2.6 Mandated SDE Training

The SDE shall comply with any relevant licensing and/or certification standards required for the service they are

providing. The individual may be compensated for the time spent completing the training and payment for those

courses that require a fee will be covered by the Division. A non-computer based version of the training provided

through the College of Direct Support (CDS) will be made available to the SDE upon request. All SDEs shall

complete the following training:

8.3.2.6.1 DDD System Mandatory Training Bundle – Within six months of hire

The following training is available through the College of Direct Support (CDS). Additional information about

CDS is available in Section 11.4.1.

 DDD Shifting Expectations: Changes in Perception, Life Experience, & Services

 Prevention of Abuse, Neglect, & Exploitation Module

o CDS Maltreatment Prevention and Response: Lesson 1: The Direct Supports Professional Role

o CDS Maltreatment Prevention and Response: Lesson 3: What is Abuse?

o CDS Maltreatment Preventions and Response: Lesson 4: What is Neglect?

o CDS Maltreatment Prevention and Response: Lesson 5: What is Exploitation?

o CDS Maltreatment Prevention and Response: Lesson 7: The Ethical Role of the DSP

 DDD Life Threatening Emergencies (Danielle’s Law)

8.3.2.6.2 Individual/Family Developed Orientation – Within six months of hire

Topics covered should assist the SDE in getting to know the individual and may include the following suggestions:

 Great things about the individual;

 Areas of importance to the individual;

 Best ways to support the individual;

 Information about how the individual communicates;

 Individual rights;

 Working with families;

 Incident reporting.

8.3.2.6.3 Medication (unless medications are not being distributed) – Prior to administering medications

The following training is available through the College of Direct Support (CDS). Additional information about

CDS is available in Section 11.4.1.

 Introduction;

 An Overview of Direct Support Roles in Medication Support;

 Medication Basics;

 Working with Medications;

 Administration of Medications and Treatments;

 Follow-up, Communication, and Documentation of Medications.

8.3.2.6.4 Medication Practicum (unless medications are not being distributed) – Prior to administering

medications

 On-site competency assessment conducted by the individual/family.

8.3.2.6.5 Cardiopulmonary Resuscitation (CPR) and Standard First Aid – Within six months of hire

Must be from a nationally certified training program for CPR and for Standard First Aid following the guidelines

provided in Section 11.4.2.

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8.3.2.6.6 CPR and Standard First Aid Recertification – Every two years

Staff shall submit documentation of successful completion of recertification in CPR and Standard First Aid in

accordance with the recertification timeframes established by the certified training program and following the

guidelines provided in Section 11.4.2.

8.3.2.6.7 Specialized Staff Training – Within six months of hire, as needed

Staff that work with individuals with medical restrictions, special instructions, or specialized needs shall receive

training to meet those needs. Topics in this area shall be addressed to meet the individual’s needs and may include

but are not limited to the following:

 Specialized diets/mealtime needs – including eating techniques, consistency of foods, nutritional

supplements, food thickeners, the use of prescribed equipment, chair positioning, the level of supervision

needed, etc.;

 Mobility procedures and safe use of mobility devices;

 Seizure management and support;

 Assistance, care, and support for individuals with identified specific needs related to physical and/or

medical conditions;

 Assistance, care, and support for individuals with identified mental health and/or behavioral needs (must

comply with relevant Division policies).

8.3.2.6.8 Behavior Plan (if applicable because the SDE is working with individual(s) who have a behavior

plan) – Within six months of hire

8.3.3 Accessing/Continuing Needed Services upon 21

Birthday

Services and supports are primarily covered through the school district until the individual exhausts their

educational entitlement upon graduation after their 21

birthday. However, some additional services that are not

provided by school districts (respite or private duty nursing, for example) are sometimes provided through the

Department of Children & Families (DCF) Children’s System of Care (CSOC) or other entities until the individual’s

birthday. At that time, the Division can continue some of these services provided through CSOC and other

entities as long as the individual is eligible for the Division of Developmental Disabilities. To access services upon

the 21

birthday, the individual should contact the Intake Unit at his/her Division Community Services Office to

inform the Division that they are turning 21 in a month or two and will need to continue accessing respite services,

for example. If the individual is already eligible for Division services, the intake worker will provide the Support

Coordination Agency Selection Form and instruction in order for the individual to be assigned to a Support

Coordination Agency up to 60 days prior to their 21

birthday. Upon assignment, the Support Coordinator will

begin developing the ISP in order to ensure that the continued service is available through Division funding, if

needed, upon the individual’s 21

birthday. Please note that the Division cannot provide funding for any services

that should be provided through the school district until the educational entitlement has been exhausted (at

graduation after the 21

birthday). If the individual is not eligible for Division services, the intake worker will

provide information on the eligibility determination process as described in Section 3.

8.4 Prior Authorization of Services

To ensure the service provider or SDE can receive payment for the services they are providing, a prior authorization

must be obtained BEFORE the service is delivered. Services begun or provided without prior authorization or

outside of the scope of the prior authorization will not be reimbursed. Medicaid must receive a prior authorization

from the Division before they will remit payment for a claim. Prior authorizations are created upon approval (or

modification) of the ISP and automatically generated for each week of service. A secure email containing the

approved ISP and a Service Detail Report detailing the start/end dates, number of units, and procedure codes for

services prior authorized for delivery is automatically generated to all identified service providers and/or the FI in

circumstances when the individual is utilizing a SDE or accessing a waiver service through a vendor that is not a

Medicaid provider.

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Medicaid sends a letter to providers whenever a prior authorization is created, changed, or revoked. The most recent

prior authorization supersedes any previous prior authorizations. Without a prior authorization, it is possible that a

claim will not be paid.

8.4.1 Rounding of Service Units

Providers must comply with Newsletter Volume 28 No. 01 released in February 2018 and found in Appendix L of

this manual.

CCP providers are allowed to add non-continuous units of billable sessions together. This requires careful

documentation supporting the time the individual sessions were provided. These times may not be estimated. The

provider may then add non-continuous units together to reach a total. Since units are 15 minutes in length, the initial

unit of service less than 15 minutes may be billed as one unit. Beyond the initial unit, service times less than half

of the unit shall be rounded down while service times equal to or greater than half shall be rounded up.

For example, 53 minutes would consist of three full 15-minute units and a partial unit of 8 minutes. Eight minutes

is greater than half of the 15-minute unit. This total may be rounded up to four full units. A total of 52 minutes

would consist of three full 15-minute units and a partial unit of 7 minutes. Seven minutes is less than half of the

unit. This total would be rounded down to three full units. The total used for rounding may only include services

provided that calendar day.

The Division of Medical Assistance and Health Services anticipates proposing regulations to address these issues.

8.4.2 Unit Accumulation

Prior authorized units of service that have not been utilized can carry over for future use within the ISP plan year

as long as the service and provider that were prior authorized remain the same. If prior authorized units of service

are not utilized, due to an unscheduled absence, unexpected program closure, lack of need for that service that

particular week, etc., the service provider or SDE remains prior authorized to provide those carry-over units at any

time within the ISP plan year. For example, if 40 units of Supported Employment – Individual Employment Support

are prior authorized for 2/21/2016 through 2/27/2016, but only 32 units are utilized that week, the individual can

use the 8 carry-over units for Supported Employment – Individual Employment Support (as long as it is with the

same provider) at any time throughout the remainder of the ISP.

Service providers and SDEs must track units used compared to units authorized in order to ensure payment for all

services rendered. An individual may decide to include additional units at the start of a service in order to create

flexibility in their schedule or account for an unexpected change in service needs from week to week. For example,

someone attending a program that provides Community Inclusion Services, Prevocational Training, and Day

Habilitation may need flexibility to account for their preferences in activities from day to day. This individual may

include a few additional units for each of these services so they can use carry over units of Prevocational Training

(i.e. to switch from one service to another when they are not interested in participating in certain waiver activities).

Another example would be someone including some additional units for Supported Employment – Individual

Employment Support to cover a future need for additional units of service in a week when they are learning a new

job task or gets a new supervisor.

Carry-over units cannot be edited after the week in which they were originally assigned has passed so the individual

and Support Coordinator should be cautious about frontloading units that won’t be able to be used in the future if

the individual changes services (from Supported Employment to Day Habilitation, for example) or providers, or is

in need of additional units of service in another area.

8.4.3 Back-Up SDEs

Individuals may prior authorize more than one SDE – at the same pay rate – to be called in as a back-up in

circumstances where the scheduled SDE is unexpectedly unable to provide the service (due to illness, for example)

by including the names of multiple SDEs in the same ISP. Multiple SDEs can continue to be utilized at different

pay rates when they are scheduled separately to provide that particular service (for example, the back-up SDE fills

in during a week when the primary SDE is on vacation. This change is known ahead of time and included in the

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ISP so the back-up SDE may be receiving a lower pay rate than the SDE used more frequently, with more

experience, etc.).

8.5 Delivery of Services

Services will be delivered and documented in accordance with the standards described in Section 11 Service

Provision and specific to each service as described in Section 17.

8.6 Duplicative Services

The State cannot provide funding for duplicative services so adjustments must be made to the Employment/Day

Services component of individual budgets in situations where funding is being provided for day services through

other State Agencies. Examples of these programs include but are not limited to Medical Day programs, Extended

Employment programs, or Mental Health Partial Day Programs. In circumstances where an individual is accessing

these duplicative services, the percentage of time – based on a 30 hour week – they are spending in the program

that is not funded by the Division will be deducted from the employment/day component of the individual budget.

For example, if someone is attending a Medical Day program for 15 hours per week, 50% of the employment/day

component of their budget will be deducted. The remaining budget can be utilized to fund additional services as

needed.

8.7 Retirement

An individual enrolled in the Supports Program can retire at the age of 65 if they choose. There are two potential

areas of retirement. Individuals who are competitively employed in the general workforce may choose to retire

from work but continue participating in their other day services/activities (Day Habilitation, Community Based

Supports, classes through Goods & Services, etc.) or choose to retire from all types of day activities. Individuals

who are not competitively employed in the general workforce may choose to retire from all day activities. Of

course, individuals may continue working and/or accessing day activities past the age of 65 and for as long as they

choose, as long as they remain eligible for DDD services.

8.7.1 Retirement from Employment

If the individual who is 65 or older is competitively employed in the general workforce and wishes to retire from

working, the Support Coordinator will change the individual’s status within the Employment Pathway Assessment

to “Unemployed – Not Pursuing” and select “retirement” as the reason for not (or in this case no longer) pursuing

employment. When this selection is made, an employment outcome will no longer be required in the ISP, but there

will not be any additional changes to the planning process or the individual budget. Other day activities the

individual may be experiencing with DDD services would continue, could increase to replace time the individual

was working, etc.

8.7.2 Retirement from Employment/Day Services

If the individual who is 65 or older has chosen to retire from all day activities, the Support Coordinator will check

the “retirement” box within the “More Info” tile under the “Personal” tab in iRecord. The individual will continue

to access their full individual budget (including the portion previously utilized for employment and day habilitation

services) to provide funding for alternative services and supports. The Division recognizes that these services are

likely to shift to in-home services and supports at this point. If the individual seeking retirement is not yet 65 years

of age, the Support Coordinator will be directed to follow the early retirement procedure upon selection of the

retirement box. This process includes submitting the “Request for Retirement Form” to

DDD.EmploymentHelpdesk@dhs.nj.gov to provide details regarding the reason for retirement to the Division for

review and approval.

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9 PROVIDER ENROLLMENT

The Supports Program is implemented using a Medicaid based, Fee-for-Service model. Acceptance of applications

to become an approved provider for Supports Program services is ongoing and open. To deliver services available

through the Supports Program, the provider must meet all the qualifications and standards associated with the

particular service(s) the provider wishes to offer. These qualifications and standards are described for each service

in Section 17. Once approved to deliver services, the provider will receive compensation through a Fee-for-Service

model. It is the provider’s responsibility to market to potential participants and their families. The Division does

not guarantee participants.

9.1 Prior to Submitting an Application to Become a Medicaid/DDD Approved Provider

 Review the Supports Program Service Descriptions, Limitations, and Qualifications available in

Section 17 Supports Program Services. It is critical that all service providers are familiar with and

understand the definitions, limitations, and qualifications for the service(s) they are interested in providing

in order to ensure that they are within the guidelines of the waiver.

 Review the Supports Program Policies & Procedures Manual

Approved service providers must assure Medicaid and the Division that they will follow the policies and

procedures governing the Supports Program as described in this manual. In addition, provision of services

within the Supports Program must meet any Division standards specific to a particular service as described

in Section 17 of this manual.

 Review additional informational materials and resources

Information on a variety of topics, including becoming a provider, is available on the Division’s website.

The steps to becoming a provider are included on the Apply to Become a Provider page of the Division’s

website.

9.2 Submitting an Application to Become a Medicaid/DDD Approved Provider

An organization/agency/provider that is primarily in business to provide social/human services and supports to a

segment of the population (in this case, individuals with intellectual and developmental disabilities) will become

Medicaid approved providers and claim directly through Medicaid. The Combined Application (Medicaid/DDD)

and the process for becoming an approved service provider are available on the Apply to Become a Provider page.

9.2.1 Application Process

 Apply for a National Provider Identifier (NPI) for the administrative location of the provider as well as each

location from which services are delivered. If services are delivered in the community, the administrative

NPI will be utilized. This process goes quickly when applying through the National Plan and Provider

Enumeration System (NPPES) website at https://nppes.cms.hhs.gov.

 Complete the Combined Application (Medicaid/Division) available on the Apply to Become a Provider

page. This single application serves the purposes of (1) applying to become an approved Medicaid provider

and (2) applying to become approved for the specific services the agency or individual plans to provide.

The application can be completed online but must be printed and mailed to Gainwell Technologies Provider

Enrollment Unit at P.O. Box 4804, Trenton, NJ 08650-4804.

 Keep a copy of the original completed Combined Application for ease of processing service or location

additions/addendums.

An application packet consists of the following information:

 Application Cover Letter - (DDD-SP-ACL 3-25-2013);

 Request for National Provider Identifier (NPI);

 Signature Authorization Form;

 Provider Start Date Form;

 Provider Application - (FD-20);

 DDD Provider Agreement - (DDD-SP-PA 3-25-2013);

 Disclosure of Ownership and Control Interest Statement (06/19/2012);

 W-9 Tax Form;

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 Notice to Enrollee;

 Affirmative Action Survey;

 Authorization for Automatic Payments & Deposits;

 Agreement of Understanding;

 DDD Statement of Intent (DDD-SP-SOI 03-25-2013) form including an accurate verification code from

the Division’s website https://nj.gov/humanservices/ddd/providers/apply/;

 Business Associate Agreement (HIPAA 200-B);

 Additional required documents indicated on the “Required Documents list” generated when the potential

provider selects the services for which they would like to become approved to provide.

9.2.2 Adding Services

A service provider can apply to become approved to offer additional services at any time by submitting the

Combined Application indicating the new services they would like to offer.

9.2.3 Adding Service Locations

The Combined Application must be completed and submitted in order to add a new location.

9.2.5 Adding Service Locations

The Division maintains a publicly available web-based Provider Search database found at

https://irecord.dhs.state.nj.us/providersearch. Provider Search is a tool used by individuals, families, Support

Coordinators and other stakeholders to locate providers who are DDD/Medicaid-approved to render services. To

ensure that Provider Search is a helpful tool, it is important that DDD/Medicaid approved service providers keep

their information updated – especially noting services that they may be approved to render but are not providing.

The Division recommends service providers update their information at least every six months.

Below are the steps that a service provider is to use to update their information:

 Go to Provider Search located at https://irecord.dhs.state.nj.us/providersearch. A service provider can

search for their agency to access the current information available, if needed;

 Download the Provider Data Spreadsheet found under Message of the Day (Top right corner of page);

 Open the Provider Data Spreadsheet and enter the updated description for the service provider. Please note

there is a 570-character limit.

 Save the Provider Search Spreadsheet and email it to DDD.Prov[email protected]j.gov.

 DDD Provider Helpdesk staff will update the narrative within five business days.

9.3 Business Entity/Individual Practitioner

An organization or enterprising entity engaged in commercial, industrial, or professional activities that are offered

to the general public, or an individual who offers a skilled service for which they have received education and/or

licensing, as appropriate, will receive payment for services that utilize a “reasonable & customary rate” instead of

standardized rates through the Fiscal Intermediary and does not need to submit a Medicaid/DDD application at this

time. SDEs should follow the process outlined in Section 8.3.2 of this manual. Approval of other business entities

or individual practitioners to receive payment for services will be conducted by the Support Coordinator, Support

Coordination Supervisor, Fiscal Intermediary, and/or Division staff at the time in which the individual is requesting

the service. This process will be based on criteria specific to each service as described in Section 17.

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10 FISCAL INTERMEDIARY (FI)

Fiscal Intermediary (FI) services for the Supports Program serves two main functions. The FI manages the financial

aspects of the Supports Program on behalf of an individual choosing to direct their services through an SDE. In

addition, the FI acts as a conduit for an organization or enterprising entity that is not a Medicaid provider but engages

in commercial, industrial, or professional activities that are offered to the general public and will be available to

individuals enrolled in the SP.

10.1 Vendor Fiscal/Employer Agent Model

The current Fiscal Intermediary providing the Vendor Fiscal/Employer Agent Model for the Department of Human

Services is Public Partnerships LLC (PPL).

In the Vendor Fiscal/Employer Agent Model, the individual or a designee is the common law employer of record

and must have an Employment Information Number (EIN). The FI will provide administrative services which

include but are not limited to procurement of workers’ compensation; withholding state income and employment

taxes; collecting, verifying, and processing worker time sheets; and preparing and distributing payroll checks to the

SDE.

Please refer to Section 8.3.2 for additional information about the FI as it relates to utilizing SDEs.

10.2 Agency with Choice Model

The current Fiscal Intermediary providing the Agency with Choice Model for the Department of Human Services

is Easterseals New Jersey.

The Agency with Choice Model allows the individual or designee to recruit their own employees who are, in turn,

employed by the FI (Easterseals New Jersey in this case). It is a joint employment arrangement in which the

individual or designee is responsible for managing the staff and the FI’s responsibilities include but are not limited

to handling the employment-related finances, benefits (as applicable), and paperwork. A per-member per-month

(PMPM) fee is required to participate in the Agency with Choice Model which is paid from the individual budget.

Please refer to Section 8.3.2 for additional information about the FI as it relates to utilizing SDEs.

10.3 Fiscal Intermediary as Fiscal Conduit

In addition to providing services associated with Self-Directed Employees, the FI acts as a fiscal conduit making

non-routine, non-payroll purchase transactions for services (for example, Goods & Services, Environmental

Modifications, Transportation, and Vehicle Modifications) that can be provided by vendors that are not

Medicaid/DDD approved.

If the individual is not utilizing any SDEs to render services, the FI will be PPL. If the individual is utilizing SDEs

to provide services, the FI will be the same as the one chosen by the individual or designee – PPL if the individual

has selected the Vendor Fiscal/Employer Agent Model and Easterseals NJ if the individual has selected the Agency

with Choice Model.

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11 ADDITIONAL PROVIDER REQUIREMENTS

11.1 Policies & Procedures Manual

All approved service providers must develop, maintain, implement, and be able to produce for Division review at

any time, a Policies & Procedures Manual governing their organization. These policies and procedures shall be

designed in accordance with the Supports Program and Community Care Program (CCP) Policy & Procedures

Manuals and applicable Division Circulars.

Policies & Procedures should be internally consistent, include procedures that are specific, detailed, and include

assignment of responsibilities, timeframes and other important details. They should be easy to read, understand and

follow. Policies & Procedures should be reviewed at least annually and updated as needed to reflect current state

and federal requirements.

To assist providers in developing/maintaining their Policies & Procedures Manual, the following areas have been

identified in connection to the Community Care Program and Supports Program Policies & Procedures Manuals

and applicable Division Circulars and must be addressed as applicable to the provider. This applies to:

DDD/Medicaid-approved Support Coordination Agencies and service providers that deliver direct care services,

including: Behavioral Supports; Career Planning; Community Based Supports; Community Inclusion Services; Day

Habilitation; Prevocational Training (Individual and Group); Respite; and Supported Employment (Individual and

Group).

 Organizational Governance – Outlines the business classification/structure, illustrates the table of

organization inclusive of job descriptions for all titles and clearly denotes how the business will ensure

conflict free operations at the agency level and at the staff level (which may include the use of outside

activity documentation or other documentation from employees); see Section 11.2 Organizational

Governance Policy;

 Personnel – Addresses how the agency will verify, hire and train personnel in accordance with all Division,

state, and federal requirements. Policies will define method for conducting required background checks

(initial and ongoing), identification of CDS administrator (at least 2), compliance with Komnino’s Law (2-

hour notification, drug testing, etc.), criminal history, central registry, Child Abuse Registry Information

(CARI), federal exclusion check (See Appendix I), NJ Treasurer’s exclusion database check, NJ Division

of Community Affairs (if applicable), NJ Department of Health (if applicable), State Debarment check (See

Appendix I), driver’s abstract, system ensuring completion of initial and ongoing mandated training

including IR, method for verifying staff qualifications;

 Admission – Outlines the criteria for acceptance, method to establish level of supervision, appeal process

/ grievance procedure, waiting list for admission, communication of necessary information to prospective

individual, and denotes title/role responsible for actions;

 Suspension – Outlines the process for making determination (determining reasons are met, warning

process, etc.), reason for suspension, timeline and process for return to services, appeal process / grievance

procedure and denotes title/role responsible for actions;

 Discharge – Describes the potential reason for discharge; process for making the determination

(determining that reasons are met, warning process, etc.); notification to individual, caregiver, Support

Coordinator, the Division, etc.; appeal process / grievance procedure and denotes title/role responsible for

actions;

 Reporting Incidents (Division Circular #14) – Adopting standardized policy and agency defines training

staff on procedure, notifications necessary, steps to record and report the incident, follow up on incident

when required and denotes title/role responsible for actions;

 Complaint/Grievance Resolution or Appeals Process – Outlines the steps to file a complaint/grievance,

two levels of appeal for complaint/grievance, one level to involve the executive director, documentation

completed when process is followed and denotes title/role responsible for actions;

 Complaint Investigation (Division Circular #15) – Describes staff that are responsible for investigation,

process to interview staff, reporting requirements once investigation is complete, time frames involved with

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investigation, process for disciplinary action due to results of investigation and denotes title/role responsible

for actions;

 HIPAA & Protected Health information (PHI) – Establishes a uniform system to implement the

requirements of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 as it relates to

Privacy Practices and consistent with Division Circulars and denotes title/role responsible for actions;

 Emergency Procedure – Addresses Life Threatening Emergencies (Division Circular #20) Policy and

Procedure; staff training, recording incident, etc.; notification practices (the Division, administration, other

staff, family, guardians, etc.); evacuation process (if applicable); mechanism to ensure everyone is

evacuated and accounted for; staff roles and responsibilities; mechanism to ensure everyone has been

moved to a safe location and is accounted for (shelter in place policy, if applicable); completion of IR and

denotes title/role responsible for actions;

 Medication Administration (if medication is distributed while rendering service) – Details the process to

store on/off site, procedure for administration of medication, prescribed/OTC medications documentation,

staff responsibilities (training requirements / storage), notification if necessary (reporting of errors /

definition of errors / IR completion), notification of administration of PRN/OTC medication, staff training

to include practicum; denotes title/role responsible for direct administration, training, and Quality

Assurance oversight;

 Reporting Medicaid Fraud/Waste/Abuse (Division Circular #54) – Adopting standardized policy that

addresses definition of Medicaid Fraud/Waste/Abuse, staff roles and responsibilities, process to identify

concerns, staff designated to receive all reports of concern, system to report to required entity, notification

that should be made, addressing annual training requirement and denotes title/role responsible;

 Human Rights (Division Circular #5) – Addresses whether the provider will create its own internal Human

Rights Committee (HRC) or utilize Division HRC, outline system to review concerns regarding an

individual’s rights, system to review Behavior Support Plans (as necessary), staff roles and responsibilities,

documentation needed, notification needed and addresses agency’s assurance of protecting Individual

Rights across all operations aspects consistent with Home and Community Based Settings rules and denotes

title/role responsible;

 Financial Management and Billing – Outlines the operational steps for conducting Internal Controls for

claim submission, billing process, oversight of recordkeeping, monitoring expenditure controls and

addressing Internal Financial controls that help ensure fiscal sustainability, financial reporting, audit

requirements and monitoring fiscal sustainability criteria, and clearly defines staff roles and responsibilities;

 Quality Management Plan – Outlines system for continuously assessing and improving service delivery,

inclusive of internal and external process to measure customer satisfaction, method to evaluate areas for

improvement / goals for the year, plan for improvement via Quality Management Report (additional

information can be found in Section 15.4).

Providers of indirect or Allied Health professional services that do not provide additional direct care services must

follow the modified requirements outlined in Appendix S of this manual. These services include: Assistive

Technology; Cognitive Rehabilitation; Environmental Modifications; Goods & Services; Interpreter Services;

Natural Supports Training; Occupational Therapy; Personal Emergency Response System; Physical Therapy;

Speech, Language, and Hearing Therapy; Transportation; and Vehicle Modifications.

Please refer to Appendix S – Quick Guide to Required Content Areas for Provider Policy and Procedure Manuals

for additional detail on content requirements.

11.2 Organizational Governance Policy

All DDD/Medicaid-approved service providers, regardless of their designation as for-profit or not-for-profit, must:

1. Maintain and be able to produce for Division review at any time, document(s) that outline the organization’s

governance that oversees the operations of the organization in such manner as will assure effective and

ethical management;

2. If requested, disclose and make public all Board member/stockholder names, affiliations, and any potential

conflicts of interest. This must include the requirement that, at a minimum, all board member/stockholder

names be made publicly available on the organization’s website;

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3. Demonstrate compliance with all legislation and regulations of corporate governance and financial practices

as prescribed by the organization’s corporate designation (profit, non-profit).

Providers found at any time to be in violation of their Board Policies, including but not limited to all the above

requirements, and background check requirements for Board Members described in 15.1.2, may be dis-enrolled as

an approved provider of Division services.

11.3 Documentation of Qualifications

All approved service providers must maintain documentation that can be provided at the request of the Division to

demonstrate continued compliance with qualification requirements. Personnel files that include relevant licenses,

certifications, proof of completion of mandated training, etc. shall be maintained and available for Division review

at any time.

In addition, all approved service providers must adhere to documentation requirements specific to each service, as

detailed in Section 17, and maintain participant files for each individual receiving services (these files can be

maintained with an electronic health record).

Providers using an electronic health record (EHR) or other electronic systems will remain in compliance if all

information required in documents is captured somewhere and can be shown/reviewed during an audit.

11.4 Staff Orientation, Training, and Professional Development

Providers must comply, at a minimum, with the service specific mandatory training and professional development

indicated in Section 17 and Appendix E. It is the provider’s responsibility to ensure that their employees understand

the mandatory training and provide additional training and/or enhancements to the mandatory training as needed.

Service providers are expected to provide employees with orientation that includes but is not limited to an overview

of the organization’s mission, philosophy, goals, services, and practices, personnel policies of the provider agency,

understanding the ISP and using information documented in it to individualize strategies and services,

documentation and recordkeeping, and training relevant to health and safety.

11.4.1 Accessing Training through the College of Direct Support (CDS)

The College of Direct Support (CDS) is an online training and learner management system. The Division uses the

CDS to provide and track training. The CDS contains more than 30 online training modules designed for use by

direct support professionals, frontline supervisors, and other disability service professionals. Providers are given

access to CDS after enrollment with the Division.

Approved service providers must have a CDS Agency Administrator. Each agency shall have two CDS

Administrators to account for vacation and turnover. Each provider may have a maximum of four CDS

Administrators. All Agency CDS Administrators are required to complete training offered through The Boggs

Center on how to use the system and must follow the procedures as described in the CDS Administrator Manual

and training related policies set forth by the Division. Technical Assistance is provided to Agency CDS

Administrators through contacting cdsta@rutgers.edu. Additional information on using the College of Direct

Support including: Learner Manual, instructional webinars, Agency Guide: Using the CDS for Pre-Service

Training, the NJ Career Path, etc. can be found on The Boggs Center Workforce Development webpage.

11.4.2 CPR and First Aid Training Entities

For services that mandate CPR and/or First Aid training, providers may choose a training entity that meets current

Emergency Cardiovascular Care (ECC) guidelines, through which certification in Standard First Aid and CPR is

obtained. The ECC Guidelines provide recommendations regarding how to resuscitate victims in the event of a

cardiovascular emergency.

Providers shall obtain, and make available for inspections and/or audits, documentation that the training entity

utilizes a curriculum in compliance with the ECC guidelines. The documentation shall be a statement, on the entity

letter head, that their training content/curriculum meets the ECC Guidelines.

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Additionally, providers shall ensure staff competency through the successful completion of a standard First Aid and

CPR course which shall include:

 In-person course with a certified instructor; on-line certifications are not acceptable; and

 Successful completion of a skills test/practicum.

Re-certification every two (2) years to include skills and competency assessment

11.5 Health Insurance Portability and Accountability Act (HIPAA)

Service providers must be in compliance with HIPAA and ensure their staff is trained on HIPAA and all

documentation is HIPAA compliant. For example, paper documents/case records must be stored securely with

appropriate safeguards, and the individual’s written authorization for release of information must be obtained before

any protected health information can be shared.

11.6 Return of Client Records

Service providers must maintain and retain individual client records in accordance with Division Circular #30,

Records Confidentiality. When a service provider type other than Support Coordination needs to return records to

the Division, the provider shall contact its agency liaison within the Provider Performance and Monitoring Unit

(PPMU). If an agency is unsure of who their PPMU liaison is they should contact DD[email protected].

A Support Coordination Agency (SCA) needing to return records to the Division shall contact its Quality Assurance

Specialist (QAS) assigned by the Division. This includes previously assigned SCAs that have not uploaded

documentation to iRecord or are otherwise dis-enrolling. Documentation should be sent to the assigned QAS within

three business days. If a Support Coordination Agency is unsure who their assigned QAS is they should contact

DDD.SCHelpdesk@dhs.nj.gov.

11.7 Home and Community Based Services (HCBS) Settings Compliance

All waiver services funded by the Division are Home and Community Based Services (HCBS) made possible by

New Jersey’s participation in the Comprehensive Medicaid Waiver. In accordance with the Home and Community

Based Services (HCBS) Settings Final Rule and 42 CFR § 441.301 all HCBS must be delivered in settings that are

integrated in, and support full access to, their community. This section is a summary of the HCBS Settings Final

Rule.

The following Home and Community Based Services Requirements apply to all settings (Day and Residential)

where HCBS services are delivered:

 The setting is integrated in and supports full access of individuals receiving Medicaid HCBS to the greater

community, including opportunities to seek employment and work in competitive integrated settings,

engage in community life, control personal resources, and receive services in the community, to the same

degree of access as individuals not receiving Medicaid HCBS.

 The setting is selected by the individual from among setting options including non-disability specific

settings and an option for a private unit in a residential setting. The setting options are identified and

documented in the person-centered service plan (i.e. ISP) and are based on the individual's needs,

preferences, and, for residential settings, resources available for room and board.

 Ensures an individual's rights of privacy, dignity and respect, and freedom from coercion and restraint.

 The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making

life choices, including but not limited to, daily activities, physical environment, and with whom to interact.

 The setting facilitates individual choice regarding services and supports, and who provides them.

In addition to the above qualities, the following additional conditions must be met in provider-owned, managed or

controlled residential settings:

 The unit or dwelling is a specific physical place that can be owned, rented, or occupied under a legally

enforceable agreement by the individual receiving services, and the individual has, at a minimum, the same

responsibilities and protections from eviction that tenants have under the landlord/tenant law of the State,

county, city, or other designated entity. For settings in which landlord tenant laws do not apply, the State

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must ensure that a lease, residency agreement or other form of written agreement will be in place for each

HCBS participant, and that the document provides protections that address eviction processes and appeals

comparable to those provided under the jurisdiction's landlord tenant law.

 Each individual has privacy in their sleeping or living unit.

 Units have entrance doors lockable by the individual, with only appropriate staff having keys to doors.

 Individuals sharing units have a choice of roommates in that setting.

 Individuals have the freedom to furnish and decorate their sleeping or living units within the lease or other

agreement.

 Individuals have the freedom and support to control their own schedules and activities, and have access to

food at any time.

 Individuals are able to have visitors of their choosing at any time.

 The setting is physically accessible to the individual.

Any modification of the additional conditions must be supported by a specific assessed need and justified in the

person-centered service plan (i.e. ISP). The following requirements must be documented in the person-centered

service plan (i.e. ISP):

 Identify a specific and individualized assessed need; Document the positive interventions and supports used

prior to any modifications to the person-centered service plan; Document less intrusive methods of meeting

the need that have been tried but did not work; Include a clear description of the condition that is directly

proportionate to the specific assessed need; Include regular collection and review of data to measure the

ongoing effectiveness of the modification; Include established time limits for periodic reviews to determine

if the modification is still necessary or can be terminated; Include the informed consent of the individual;

Include an assurance that interventions and supports will cause no harm to the individual.

Home and community-based settings do not include the following:

 A nursing facility; an institution for people with mental illness; an intermediate care facility for individuals

with intellectual disabilities; a hospital; or

 Any other locations that have qualities of an institutional setting. This includes:

o Any setting that is located in a building that is also a publicly or privately operated facility that

provides inpatient institutional treatment;

o Any setting that is located in a building on the grounds of, or immediately adjacent to, a public

institution; or

o Any other setting that has the effect of isolating individuals receiving Medicaid Waiver HCBS from

the broader community of individuals not receiving Medicaid HCBS.

Should an individual or interested party feel that the setting where Division funded services are received is not

compliant with the Home and Community Based Services (HCBS) Settings Final Rule, please contact the Division

at DDD.HCBShelpdesk@dhs.nj.gov and/or notify the individual’s Support Coordinator/Case Manager. Non-

compliance with the HCBS Settings Rule can also be reported by calling the Division at 1 (800) 832-9173. The

Division will review the submission and contact the service provider to address areas of non-compliance.

11.8 Emergency Preparedness and Response Plan (EPRP)

In accordance with P.L. 2021, Chapter 292, the NJ Department of Human Services (DHS) provides an Emergency

Preparedness and Response Plan for Licensed Providers of Services to Individuals with Intellectual and

Developmental Disabilities (EPRP). A Licensed Service Provider is any entity licensed, certified, or otherwise

authorized by DHS to provide services to individuals with intellectual and developmental disabilities and

encompasses all service types.

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The EPRP was created in consultation with the NJ Department of Health (DOH), Ombudsman for Individuals with

Intellectual or Developmental Disabilities and Their Families, Licensed Service Providers (LSPs), and the State

Office of Emergency Management.

The EPRP:

 Establishes guidelines and best practices for the general and specific operations, activities, and procedures

that are to be undertaken or implemented by LSPs during a public emergency;

 To the extent feasible, identifies the means, methods, and channels through which licensed service providers

may obtain personal protective equipment (PPE) and other equipment or services that are critical to the

maintenance of ongoing operations during the course of a public emergency;

 Addresses various possible public emergency scenarios and provides for the application of differing

standards and best practices for each, as appropriate, while highlighting the standards, best practices, and

resource sourcing methods that are applicable for the purposes of any currently declared public emergency;

and

 Is consistent with, and incorporates, any relevant guidance that is published by the U.S. Department of

Health and Human Services, the federal Centers for Disease Control and Prevention, and any other federal

agencies that are involved in the remediation of public emergencies.

DHS shall revise the plan and post on its website, at a minimum, every two years from date of publication and as

soon as possible/needed following the declaration of any new public emergency in the State. A new public

emergency in the State is defined as one that is officially recognized and declared by the Governor of New Jersey

or by the President of the United States. All LSPs must also continue to be in compliance with any other applicable

state or federal requirements, including but not limited to, DHS Licensing requirements.

All providers funded by the Division should ensure that they have plans in place for more uncommon emergencies

like cyber-attacks, hurricanes, tornadoes, etc. so that they have continuity in operations, etc. as well as an emergency

plan for unexpected staff losses.

Please review the following for more information:

 Emergency Preparedness and Response Plan for Licensed Providers of Services to Individuals with

Intellectual and Developmental Disabilities (EPRP)

 EPRP Presentation (Slides)

 EPRP Presentation (Recording)

11.9 Infection Control and Prevention

All DDD/Medicaid approved service providers must follow the most current infection prevention and control

information/guidance from the Centers for Disease Control and Prevention (CDC), Occupational Safety and Health

Administration (OSHA), and New Jersey Department of Health (NJ DOH) on health issues that impact the

population(s) they serve. This includes, but is not limited to: COVID-19, Influenza, etc. In all circumstances,

DDD/Medicaid approved providers shall cooperate with Federal, State, and Local health officials.

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12 SERVICE PROVISION

12.1 Service Provider Responsibilities

 Develop and maintain a Policy and Procedure Manual that complies with the requirements outlined in the

SP/CCP manuals, Division directives, policies, circulars, and procedures.

 Develop strategies in collaboration with the individual receiving services to assist the individual in reaching

their outcomes.

 Complete and maintain documentation as required to support Medicaid billing and Division requirements.

 Claim for services according to Medicaid (Gainwell Technologies) standards and guidance.

 Provide services and supports within the parameters indicated in the ISP and the Service Detail Report.

 Become familiar with the individual’s vision, outcomes, needs, etc. and provide services and supports

accordingly.

 Participate as a member of the Planning Team.

 Complete, maintain, and submit reporting documents as required.

 Be responsive to Division needs/requests as they relate to special projects.

 Comply with monitoring, auditing, and quality assurance measures conducted by the Division and/or

Medicaid/Gainwell Technologies.

 Comply with provider qualifications, policies, standards, procedures and training requirements specific to

the service being provided as described for each service in Section 17.

12.2 Documenting Progress toward ISP Outcomes

At least one personally defined outcome will be provided within the ISP for each service the individual is going to

receive. The service provider must collaborate with the individual to develop strategies used to progress toward

reaching the outcome(s) related to the service(s) they are providing and maintain documentation of the individual’s

progress using Division required service delivery documentation. This documentation is unique to the service and

further described in Section 17 and Appendix D.

12.3 Claim Submission

The following factors must be in place prior to claim submission for Medicaid service:

 Compliance with the requirements outlined in Section 12 of this manual;

 Proper documentation of service delivery of service along with any deliverable documents necessary to

substantiate the claim in the case of an audit. Services may have specific deliverable documents (such as

strategies, time sheets, behavior plans) relevant to delivery of that service. Details about these documents

are provided in Section 17;

 The service that was provided has a valid prior authorization;

 The claim must include participant information and service information (such as Medicaid ID, diagnosis,

procedure code, rate etc.) which can be found within the service plan and service detail report;

 Staff are properly trained, vetted, and credentialed to deliver services rendered.

** Claims submitted without adherence to standards outlined in this manual will require Medicaid

repayment**

Service providers may submit claims for payment through the NJMMIS site (www.njmmis.com) or through a

software solution which can perform bulk electronic claim submission.

Training on how to submit claims and track their status through the NJMMIS site can be provided by Gainwell

Technologies. Gainwell Technologies provider services can be reached by calling 800-776-6334 or on the NJMMIS

website through the option “Contact Provider Services”.

12.4 Subcontracting Services

The use of sub-contracting by a Medicaid/DDD approved provider is precluded unless the provider is contracting

with a qualified temporary employment agency for temporary staff to provide behavioral supports, community

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based supports (SP), day habilitation, individual supports (CCP), interpreter services, occupational therapy, physical

therapy, and/or speech, language, & hearing therapy services in order to ensure compliance with staffing

requirements. In this case the provider and subcontractor must follow Newsletter Volume 30 No. 19 included in

Appendix P.

A qualified temporary employment agency that will provide one or more of the identified services for a provider

must submit the combined Medicaid/DDD provider application to Gainwell Technologies for approval. The

temporary employment agency shall be screened and assigned a NJFC Medicaid Provider ID Number by Gainwell

Technologies. The Medicaid/DDD approved agency providing temporary employees (acting as a subcontractor)

shall maintain a vendor contract with the Medicaid/DDD enrolled provider that has requested the temporary staffing

services (acting as a contractor). This contract shall outline that the contractor shall complete the GAINWELL

TECHNOLOGIES billing in exchange for the required services from the subcontractor. The contract shall also

outline reimbursement rates, contain a description of needed staff profiles and attestation to assure continuous

vetting of current employees to ensure minimum requirements continue to be met. At no time shall that contract

violate Medicaid/DDD requirements. The contract shall be subject to review by DDD and DMAHS.

The subcontractor is responsible for ensuring that any individuals under contract and temporarily employed for

staffing purposes fully satisfy all applicable State, federal, and any other licensure and certification requirements,

including those regulations incorporated within the Medicaid/DDD combined application. Failure to assure that all

such requirements are met, which are consistent with N.J.A.C. 10:49-9.8(d), may result in either or both actions

listed below:

1. DMAHS may recover from the enrolled contractor the NJFC Medicaid reimbursement paid by the Program

to the provider for any service rendered by an employee not meeting such requirements; and/or

2. The contractor or subcontractor may be subject to any applicable civil or criminal sanctions and/or

penalties.

If a DDD provider has any questions concerning this Newsletter, please contact DDD at 609-633-1482. For

questions related to provider enrollment, please contact the Gainwell Technologies Provider Enrollment Unit at

609-588-6036.

12.5 Discontinuing Services

In order for a provider to discontinue services with an individual, the following steps must occur:

 The service provider must notify the individual, guardian, family of their intention to end services;

 The service provider must provide the reasons for which they can no longer serve the individual – these

reasons should align with the provider’s Policies & Procedures related to discharge;

 The service provider must notify the individual’s Support Coordinator at least 30 days prior to discontinuing

services so the Support Coordinator can assist the individual in accessing a replacement provider(s) and/or

service(s) as needed and revise the ISP; and

 The service provider will continue to support the individual until they find services to replace those that

will discontinued and find a new service provider(s) that meets the individual’s needs and can coordinate

services beginning with that new provider(s).

12.5.2 Provider Ready Directory

The Provider Ready Directory (PRD) is a listing of providers who have indicated a willingness to take over

operation of a day setting when the current provider is unable to do so. Qualified DDD/Medicaid Approved

Providers can request to be added to the PRD by submitting a Letter of Interest following the process outlined here

(Please note that application to the directory may be submitted at any time). The PRD provides a mechanism to

preserve operation of service locations so continuity of services can be maintained and personal choice of

individuals served is respected. Many factors impact the ability to exercise the Provider Ready Directory including

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asset ownership, corporate structure, availability of a willing Alternate Provider, the number of impacted programs,

the needs of persons served, etc.

In the event that a DDD/Medicaid Approved provider operates a Day Services Program (Certified Day Habilitation

program or Pre-Vocational program) and intends on closing one or more service locations they are required to notify

the Division Assistant Commissioner and Provider Performance and Monitoring Unit (PPMU) in writing before

any changes occur, including the relocation of persons served. This shall be provided on agency letterhead at least

60 (sixty) days before any changes occur. This correspondence shall be sent by email to DDD-

CO.LAPO@dhs.nj.gov and DD[email protected]j.gov. A physical copy of the letter shall be mailed to:

Assistant Commissioner

Division of Developmental Disabilities

PO Box 726

Trenton, NJ 08625-0726

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13 MONITORING (Participant)

This section provides information regarding individual monitoring requirements and mandatory reporting of cases

of suspected abuse and neglect. In addition, information regarding a service provider’s responsibility to report

quality assurance issues to the Division is provided.

The individual should notify the Division if they and/or their family or caregiver have not received contact from

his/her Support Coordinator monthly or had the opportunity to meet with their Support Coordinator.

13.1 Mandatory Monitoring

As an enrolled participant in the Supports Program, the individual must participate in monthly phone contacts and

quarterly visits with the Support Coordinator and understand that these visits are mandatory and may occur in the

home, day program, place of employment, etc. as agreed upon with the Support Coordinator and that, annually, at

least one of these quarterly visits must take place in the home. If the individual needs assistance in participating in

this monitoring and the guardian or parents are not always available, a designee familiar with the individual and

their services can fill this role. The Support Coordinator is responsible for conducting ongoing monitoring of all

individuals on their caseload. At a minimum the following monitoring must occur:

 Monthly Contact – must be conducted within the next calendar month from the date of the ISP approval

and within every calendar month thereafter. The Support Coordinator must have, at a minimum, contact

with the individual once per calendar month. Face-to-face contact is preferable but contact via the telephone

or HIPAA compliant video conferencing is acceptable. Email, texting, or other methods of communication

are not acceptable to meet the mandatory minimum monitoring requirements. However, email can be

utilized to gather information prior to the monthly contact in order to streamline the process. Email must

remain confidential and HIPAA compliant and be documented through case notes in iRecord. Information

gathered/observed during this contact must be documented in the Support Coordinator Monitoring Tool

and uploaded in iRecord no later than the last day of the following month. Claiming should not occur before

the deliverable, contact, and documentation that fulfills the requirement of a Support Coordinator

Deliverable, have all been met. The Support Coordinator must document any additional contact beyond

the required monthly through case notes. Follow-up that has occurred based on the monthly contact can be

documented in case notes or subsequent Support Coordinator Monitoring Tools. The ISP must be revised

as necessary.

 Quarterly Face-to-Face Contact – must be conducted during the third calendar month from the date of

the ISP approval and every three months thereafter. The Support Coordinator must have, at a minimum,

one quarterly face-to-face visit with the individual. These quarterly contacts shall include at least one home

visit annually and at least one visit to the location in which an individual is receiving a particular service

for more than 16 hours per week on a regular basis. The Support Coordinator must contact the provider to

schedule the quarterly visit ahead of time. Information gathered and observed during this contact must be

documented in the Support Coordinator Monitoring Tool and uploaded in iRecord no later than the last day

of the following month. Claiming should not occur before the deliverable, contact, and documentation that

fulfills the requirement of a Support Coordinator Deliverable, have all been met. The Support Coordinator

must document any additional contact beyond the required quarterly contact through case notes. Follow-

up that has occurred based on the quarterly contact can be documented in case notes and/or subsequent

Support Coordinator Monitoring Tools. The ISP must be revised as necessary.

 Annual Face-to-Face Home Visit – must be conducted any time within one year from the date of the ISP

approval. Information gathered and observed during this contact must be documented in the Support

Coordinator Monitoring Tool and uploaded in iRecord no later than the last day of the following

month. Claiming should not occur before the deliverable, contact, and documentation that fulfills the

requirement of a Support Coordinator Deliverable, have all been met. The Support Coordinator must

document any additional contact beyond the required annual home visit through case notes. Follow-up that

has occurred based on the annual home visit can be documented in case notes and/or subsequent Support

Coordinator Monitoring Tools. The ISP must be revised a necessary.

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 Annual ISP – All individuals who are eligible for Division services and programs shall have, at a minimum,

a new ISP annually. The Support Coordinator shall facilitate the person-centered planning process with the

planning team, continually update and revise the ISP if service needs have changed during the course of the

year, and write a new ISP annually. Information gathered and documented in case notes and/or on the

Support Coordinator Monitoring Tool throughout the year must be considered in reviewing, revising, and

writing new ISPs. If the monthly and quarterly minimal requirements have already been met (including the

annual home visit), a Support Coordinator Monitoring Tool does not need to be completed in the same

month as the annual ISP.

13.2 Plan Review Elements

The following applicable elements must be addressed by the Support Coordinator whenever the planning team

reviews the ISP or services:

 Review the individual’s current services and ISP to determine the type, recommended amount, received

amount, and cost of each service.

 Review the NJ CAT and all progress reports, evaluations, assessments, recommendations, nursing reports,

incident reports, and monitoring records received to determine if services are being provided appropriately.

 Gather information obtained in circumstances in which interaction with or assessment/observation of

individual services was done.

 Assess, in conjunction with the individual, the services being provided, progress toward outcomes, and any

problems or service needs from the individual’s perspective. Discuss satisfaction with services and

providers, including service gaps and the back-up plan where appropriate.

o Support Coordinators should develop an emergency back-up plan with individuals and families in

the event that current supports are no longer available. Emergency back-up plans can be

documented on the ISP form or included in the demographic section of iRecord. Emergency back-

up plans should consider support needs as well as the need for proxy decision-makers, if

appropriate.

 Discuss new or previously identified risks and the prevention of those risks.

 Discuss with the individual, provider/other team member’s progress toward outcomes and any concerns.

Review the data on outcomes to assess the individual’s progress and identify any barriers to achievement

of those outcomes.

 Discuss changes in the individual’s medical/functional status including any behavioral health needs. If

necessary, contact the Managed Care Organization’s (MCO) care management to discuss any changes in

the individual’s health.

 Discuss services the individual is receiving from entities other than the Division (i.e. DVRS, DDS, MCO,

etc.). Coordinate care with these entities as appropriate.

 If the Support Coordinator’s assessment indicates changes to the current ISP or services are necessary,

discuss the changes and the rationale for the changes with the individual. This discussion is especially

critical if the changes may result in a reduction or termination of service.

13.3 Service Provider’s Quality Assurance Responsibilities

Service providers – including Support Coordinators – may become aware of quality assurance issues during the

course of their work, e.g. licensing standards that are out of compliance, inappropriate implementation of programs,

serious incidents not being reported, or billing/claim irregularities. The service provider must report problems to

the Division and document these concerns in a case note and/or the Support Coordinator Monitoring Tool.

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14 PROVIDER FISCAL SUSTAINABILITY

The Division is responsible for ensuring that each provider agency is in compliance with the terms and conditions

of program participation. Financial measurements complement and inform Division action taken around quality

metrics, as well as potentially providing a leading indicator of program performance. Although financial success

alone is not an indicator of program quality, the fee-for-service reimbursement model renders it a necessary

condition for sustainable and high-quality service delivery.

The requirements in this section are finance specific. Program compliance and performance are addressed in other

auditing and reporting requirements.

14.1 Financial Reporting Requirements

Fee-for-service payments for Community Care Program (CCP) and Supports Program (SP) services are not deemed

to be Federal awards for federal audit purposes. The Uniform Administrative Requirements, Cost Principles, and

Audit Requirements for Federal Awards (Uniform Guidance), 2 CFR §200.502(i) states that: “Medicaid payments

to a sub-recipient for providing patient care services to Medicaid eligible individuals are not considered Federal

awards expended under this part unless a state requires the funds to be treated as Federal awards expended because

reimbursement is on a cost reimbursement basis.”

Claims made by provider agencies for CCP and SP services are paid at a fixed rate by the State’s Medicaid Fiscal

Agent according to prior authorizations generated by individual service plans. In contrast, payments to provider

agencies under a DHS Third-Party contract continue to be governed by the DHS Contract Policy and Information

Manual and the Contract Reimbursement Manual (CRM).

Audited Financial Statements

All provider agencies that claim $100,000 or more in combined reimbursement for Community Care Program and

Supports Program services within their fiscal year must have annual financial statement audits performed in

accordance with Generally Accepted Auditing Standards (GAAS). All provider agencies that expend $100,000

through DHS Third-Party contracts must continue to have annual financial statement audits performed in

accordance with Generally Accepted Government Auditing Standards (GAGAS) pursuant to DHS Contract Manual

and DHS Policy Circular P7.06.

All provider agencies that claim less than $100,000 in combined reimbursement for Community Care Program and

Supports Program services and, or expend less than $100,000 through cost reimbursement contracts within their

fiscal year are subject to audit by the Department of Human Services or its representatives at DHS’ discretion.

All provider agencies remain subject to audit by federal, DHS and state partner or oversight agencies regardless of

reimbursement or expenditure totals.

Audited financial statements include a balance sheet as of the close of the fiscal year, as well as an income statement

and cash flow statement for the fiscal year. Detailed and explanatory notes in the financial statements should be

consistent with industry standard and be accompanied by a report by independent certified public accountants.

Audited financial statements must be made available to the Division upon request.

14.2 Notifications

The Provider Agency shall notify the DHS Office of Auditing by email at DHSOffice.OfAuditing@dhs.nj.gov and

DDD Provider Helpdesk by email at DDD.ProviderHelpdesk@dhs.nj.gov within five business days of receiving a

draft or final audit report that contains a qualified option or an exception to an unqualified opinion (e.g., going

concern, scope limitation, disagreement with management, GAAP compliance).

The Provider Agency shall notify the Division within five business days of the occurrence of any event that it

reasonably anticipates will materially impact the business, assets, liabilities, financial condition or prospects of the

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Provider Agency. This notice shall specify the nature and duration of the event and what action the Provider Agency

intends to take to maintain operations and service delivery.

The Provider Agency shall notify the Division within five business days of the occurrence of any default or event

of default on any financial instrument or other obligation. This notice shall specify the nature and duration of the

default and what action the Provider Agency intends to take to remedy the default.

The Provider Agency shall notify the Division within five business days of the occurrence of any material change

in the amounts available through insurance policies or self-insurance reserves to cover risk and liabilities that are

typical to service providers of a similar size and scope in the industry. This notice shall specify the nature and

duration of the change and what action the Provider Agency intends to take to mitigate the risk.

The Provider Agency shall notify the Division within five business days of the occurrence of the filing, or threat or

intent to file, of any actions, suits or proceedings, including audit and tax findings, against the Provider Agency that

(a) relate to services provided to the Division pursuant to this manual, (b) relate to tangible or intangible property,

including real estate, necessary for the delivery of services to the Division, or (c) are reasonably likely to be

determined adversely to the Provider Agency, and, if so adversely determined, could reasonably be expected to

have a material impact on operations and service delivery. This notice shall specify the nature of the occurrence and

what action the Provider Agency intends to take to mitigate the risk.

14.3 Fiscal Sustainability Criteria

The below calculations must be submitted annually by all provider agencies with more than $100,000 in annual

combined billing to DDD. This includes all revenue received from DDD through Medicaid Fee-for-Service

Billings, support coordination, and any contract revenue.

Agencies must utilize the DDD Fiscal Sustainability Template when submitting these criteria. The criteria shall be

submitted to DDD.WaiverFinancia[email protected]j.gov.

Deadlines for Submission

Provider agencies are required to submit Financial Sustainability Criteria at the end of each State Fiscal Year. The

deadline for submission is 120 calendar days after the close of a given State Fiscal Year (June 30). For agencies

whose fiscal years do not align with the State Fiscal Year (July 1 through June 30), submissions are due 120 calendar

days after the agency’s specific fiscal year has ended, beginning with the agency specific fiscal year occurring after

June 30, 2019.

Provider agencies are encouraged to develop their own internal metrics and are permitted to submit these as

supplements to the required reports.

Operations

Primary Reserve Ratio = Expendable net assets / Total expenses

Measures liquid resources in relation to overall expenses, effectively indicating a provider agency’s ability to

withstand adverse changes in the business climate without selling assets or borrowing. A ratio of .4 or higher is

advisable (expendable net assets would cover about five months of expenses).

Operating Reliance Ratio = Program revenues / Total expenses

Measures how effectively the organization could pay all expenses from program revenues alone. Ratios will vary

across provider agencies depending on the number of unique funding sourcing a provider agency has. A ratio of

“1” is a good outcome, but the Division recognizes that many provider agencies may use other revenue to maintain

operations.

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Liquidity & Activity

Quick Ratio = (Cash + Accounts receivable + Short-term investments) / Current liabilities

Demonstrates if short-term assets are sufficient to pay current liabilities. A ratio of “1” or higher indicates that a

business is able to meet its short-term liabilities.

Average Collection Period = Days in period * Average claims receivable / Total claims

Calculates the approximate amount of time it takes for the provider agency to receive payments owed. Typically,

this calculation is performed by businesses that sell on credit. Within the context of CCP fiscal reporting, this metric

is referring specifically to fee-for-service claims for waiver services. Given that claims can be submitted daily and

will be paid bi-weekly this figure should be under 30 days unless the provider agency has substantial reserves or is

experiencing problems with claim processing.

Financing

Debt Ratio = Total debt / Total assets

Reflects the proportion of assets funded by debt. Ratios will vary across provider agencies depending on the mix of

services provided. The Division recognizes that certain types of services require more intensive capital investment

and thus may result in higher debt levels. Analysis of this measurement should also take into account the volatility

of a provider agency’s cash flows.

Interest Coverage Ratio = EBIT / Interest expense

Calculates how many times the provider agency’s earnings before interest and taxes (EBIT) could cover its debt

expense. A ratio of “1.5” or higher indicates that the business should have sufficient earnings to service its debt.

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15 QUALITY ASSURANCE, TECHNICAL ASSISTANCE, & AUDITING

15.1 Service Provider Quality Management

Quality management in a service provider agency requires a comprehensive strategy that includes planning,

implementing, evaluating, and improving on systems and agency practices that lead to enhanced outcomes for

individuals served. The Division of Developmental Disabilities expects that all service providers will be able to

demonstrate a comprehensive quality management system in the agency that includes employee development and

training; background and exclusion checks; auditing and fraud detection; incident and risk management; adherence

to human rights standards; performance and outcomes measurements for service improvement; and an annual

quality management plan that details the agency’s goals and quality improvement practices.

15.1.1 Employee Development & Training

Supported and well-trained staff in service provider agencies are essential to positive outcomes obtained by

individuals with developmental disabilities. Employee development includes strategies to recruit and retain staff

and to enhance the professional and personal growth of staff. This can include methods such as ongoing learning

and skill development, implementing motivating strategies, and increasing supervisory support and coaching on the

job. Focus on career development, increased skills, and reducing staff turnover are core elements of employee

development programs. While employee development programs should include more than just minimum standards,

the Division requires all staff to complete mandated training topics and to obtain a minimum amount of ongoing

training per year. Mandated training will be hosted through the College of Direct Support (CDS). See training

requirements under services in Section 17. In addition, agencies will be required to collect and monitor data related

to staff turnover and retention rates.

15.1.2 Mandated Background & Exclusion Checks

Service providers are required to check that staff hired, Board of Directors, and contracted vendors utilized are not

excluded from working with individuals with developmental disabilities or within a Medicaid provider agency in

accordance with the newsletter found in Appendix I. For services provided through the Fiscal Intermediary (FI),

such as SDEs providing Community-Based Supports or vendors providing Assistive Technology, the FI will be

responsible for checking all applicable federal and State databases.

Initial and on-going Criminal History Background Checks (State and Federal) must comport with Division Circular

#40 – Background Checks (N.J.A.C. 10:48A).

15.2 Incident Reporting & Risk Management

When an unusual incident occurs, the primary responsibility is to provide protection to the individual. If emergency

medical care is needed, or if the person is in a life threatening emergency, call 911. See Division Circular 20A for

details.

In addition, anyone providing services to individuals eligible for Division services must report incidents within the

required timeframes and cooperate with investigations and follow-up to incidents. N.J.S.A. 30:6D-73 et seq., known

as the Central Registry of Offenders Against Individuals with Developmental Disabilities, stipulates that failure to

immediately report allegations of abuse, neglect, or exploitation is considered a disorderly person’s offense and can

result in a fine of $350 for each day that the abuse, neglect, or exploitation is not reported. For complete details on

the Division’s full policy, a chart of incident categories and incident codes, incident and follow up reporting forms,

and instructions, see Division Circular 14.

15.2.1 Reporting Incidents

Sufficient information about the incident must be gathered to complete an initial incident report. However, if all

information is not available, reporting of the incident should not be delayed. The missing information should

be submitted as soon as possible in a follow-up report. Staff of the IR Units may ask Support Coordinators and

Service Providers for more information in order to fully understand the nature of an incident. Alleged incidents of

abuse, neglect, or exploitation remain allegations unless substantiated by investigation. See below for additional

information about investigations.

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15.2.1.1 Individuals/Families

Individuals and their families may report incidents to their Support Coordinator. Support Coordinators and

service providers are mandated to notify the Division immediately of all known or alleged reports of abuse,

neglect, and exploitation. Definitions of abuse, neglect, and exploitation are as follows:

 Abuse – physical, sexual, or verbal acts against a person served that cause pain, physical or emotional harm,

mental distress, injury, anguish, and/or suffering. 

 Neglect – the failure of a caregiver to provide the needed services and supports to ensure the health, safety,

and welfare of the service recipient.

 Exploitation – any willful, unjust, or improper use of a service recipient or their property/funds, for the

benefit or advantage of another, condoning and/or encouraging the exploitation of a service recipient by

another person.

If an individual or family member does not want to report an incident to a Support Coordinator, they may utilize

the Abuse and Neglect Hotline at 1-800-832-9173. The Hotline is staffed with Office of Risk Management

personnel familiar with incident reporting.

15.2.1.2 Support Coordination Agencies

The below provides the processes to be followed by Support Coordinators in reporting incidents. In any case,

Support Coordinators are required to write a case note summarizing the incident in iRecord and categorizing it as a

IR note.

15.2.1.2.1 Incident is Unrelated to the Service Provider

If a family or individual reports an incident to the Support Coordinator and the incident is unrelated to the Service

Provider, the Support Coordinator must complete a typed incident report form and follow-up reports associated

with Division Circular #14 and send them to the Incident Reporting (IR) unit that corresponds to the county where

the individual resides. There are two means by which an incident report can be submitted to an IR unit:

 UPDOC – a web-based application that is the preferred means for sending an incident report to the

appropriate IR unit, listed below. The instructions for UPDOC are available at

http://www.state.nj.us/humanservices/ddd/documents/ddd%20web%20current/CIRCULARS/DC14/uir_u

pdoc_instructions_and_ra_assignments.pdf.

 Faxing the incident report to the appropriate IR Unit, as follows:

o Mays Landing IR Unit (Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester,

and Salem counties): 609-341-2340.

o Plainfield IR Unit (Bergen, Essex, Hudson, Passaic, Somerset, and Union counties): 609-341-

2342.

o Trenton IR Unit (Hunterdon, Mercer, Middlesex, Monmouth, Ocean, Sussex, and Warren

counties): 609-341-2343.

o ORM Central Office (out-of-state IRs): DDD-CO[email protected]j.gov

In addition to reporting to the IR unit, the Support Coordinator must also report allegations of abuse, neglect, or

exploitation of an individual that occur in the person’s home and do not involve a service provider to Adult

Protective Services (APS) as soon as they become aware. There is an APS office in every county. Information

about Adult Protective Services, including contact information is available at:

http://www.state.nj.us/humanservices/doas/documents/APS%20flyer.pdf.

15.2.1.2.2 Incident is Related to or Reported by the Service Provider

If a service provider reports an incident to the Support Coordinator, the Support Coordinator is not required to

complete an incident report (IR) as that is the responsibility of the service provider. However, Support Coordinators

are required to notify the applicable IR unit of such incidents so that the IR unit can ensure the service provider

reports the incident as required.

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15.2.1.3 Service Provider

Service Providers are required to report incidents to an applicable IR unit using the incident report forms associated

with Division Circular 14 and to notify the guardian, HIPAA authorized family, and the Support Coordinator.

Service providers are encouraged to use UPDOC to submit incident report forms and follow up reports; they may

fax the form to the appropriate IR unit if they are unable to use UPDOC. Instructions for UPDOC are available at

http://www.state.nj.us/humanservices/ddd/documents/ddd%20web%20current/CIRCULARS/DC14/uir_updoc_in

structions_and_ra_assignments.pdf and see above for related fax numbers.

15.2.2 Investigations and Follow Up

Investigations of unusual incidents will occur in accordance with DHS policies and procedures, including the

involvement of the Office of Investigation (OI) or Critical Incident Management Unit (CIMU) as appropriate. The

Office of Investigation directly investigates the most serious allegations of abuse, neglect, and exploitation as well

as several types of incidents related to major injuries and deaths. The Critical Incident Management Unit conducts

administrative review of investigations conducted by service providers and Support Coordination Agencies (SCAs).

Any incident of abuse, neglect, or exploitation that occurs in connection with the delivery of services by a service

provider or SCA must be investigated by the respective service provider or SCA unless otherwise advised by the

Office of Investigation or the Critical Incident Management Unit. The IR unit to which the incident of abuse,

neglect, or exploitation was reported will advise the service provider or SCA where and how to send its investigation

report, either to the Office of Investigation or to the Critical Incident Management Unit.

Regardless of the type of incident, follow up is required. The objectives of a follow-up to an incident are to

document the actions taken to protect the individual and to reduce the likelihood of the incident occurring again.

Sometimes actions taken at the time of the incident will be sufficient to achieve that objective and the incident can

be closed when it is reported. In some situations, follow-up actions may be planned immediately but implemented

at a later date. Documentation of the completion of those actions may be necessary to close the incident. The IR

unit to which the incident was reported will determine additional information and/or follow-up needed based on the

specifics of the incident, and will advise the service provider or SCA accordingly.

Any and all documents and materials related to a pending or closed investigation are not public and can only be

released upon judicial order. This includes, but is not limited to: Investigations of unusual incidents; Initial Unusual

Incident Reports; and Unusual Incident Follow-Up Reports.

15.2.2.1 Role of Adult Protective Services

Allegations of abuse, neglect, or exploitation of an individual that occur in the person’s home and do not involve a

Service Provider must be reported to Adult Protective Services (APS) by the Support Coordinator and/or Service

Provider as well as to the IR unit, as soon as they become aware. The IR staff will notify the Support Coordinator

if the Service Provider has reported an allegation to APS and has not made that notification.

15.2.2.2 Law Enforcement Notification

Refer to the chart of incident categories and codes available in Division Circular 14 for a list of what types of

incidents require law enforcement notification. If assistance is needed in notifying law enforcement for these types

of incidents, Support Coordinators and service providers may call the IR unit that corresponds to the county in

which the individual lives.

15.2.3 Assistance with Unusual Incident Reporting

IR Coordinators are available in each Region to provide technical assistance with recording of incidents (including

forms, timeframes, types of incidents, role of the Support Coordinator, etc.). IR Coordinators review all available

information and determine whether remedial action is needed or was already taken. Use the following telephone

numbers corresponding to the county in which the individual lives, and ask to speak to an IR Coordinator.

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County of Residence

IR Unit Phone Number

Hunterdon, Mercer, Middlesex, Monmouth, Ocean

(609) 292-1903

Bergen, Hudson, Morris, Passaic, Sussex, Warren

(973) 927-2111

Atlantic, Camden, Burlington, Cape May, Cumberland, Salem, Gloucester

(609) 476-5080

Essex, Somerset, Union

(908) 561-4587

15.3 Performance & Outcome Measures

15.3.1 Quality Focus Groups

As part of formulating a comprehensive quality management strategy for the Division in accordance with the CMS

Quality Framework, a series of focus groups were held with stakeholders representing individuals with disabilities,

their family members, and service providers. These groups helped to provide a forum for voicing what individuals

with disabilities want in their lives, what they need from service providers, and how the Division should measure

and use quality data gathered from the service system. After collating data obtained from the quality focus groups,

an online survey was distributed to capture additional feedback from stakeholders in these same areas. A summary

report compiled by The Boggs Center on Developmental Disabilities with the results of the quality focus groups

and survey results, as well as next steps in the development of the Division’s quality management strategy, was

released in late Summer 2015.

www.state.nj.us/humanservices/ddd/documents/stakeholder_input_report_on_quality_improvement.pdf

15.3.2 National Core Indicators

Since 2007, the Division has worked with the National Core Indicators Project (NCI). Sponsored by the National

Association of State Directors of Developmental Disabilities Services (NASDDDS) and managed by the Human

Services Research Institute (HSRI), the National Core Indicators will serve as the basis of a systems performance

measurement system for the Division. The Quality Improvement Unit is responsible for managing and staffing the

NCI project. Division staff conduct information gathering activities including face-to-face interviews and

emailed/mailed surveys. NCI performance indicators include approximately 100 individual, family, systemic, cost,

and health and safety outcomes - outcomes that are important to understanding the overall health of developmental

disabilities agencies. Many of the individual NCI data elements have potential implications for discovery,

remediation, and improvement regarding service planning and delivery. Sources of information include individual

survey (e.g. empowerment and choice issues), and family surveys (e.g. satisfaction with supports. The core

indicators also provide information for many of the desired outcomes identified in the Home and Community Based

Services Quality Framework. The NCI surveys have been expanded, and service providers are expected to cooperate

with Division staff conducting surveys.

15.3.3 Customer Satisfaction Measures

Service providers are required to design and implement customer satisfaction measures with results reported to the

Division on at least an annual basis. Measures may include surveys, complaint and grievance resolution, or other

evidence.

Customer satisfaction measures must be in line with the CMS Home & Community Based Services (HCBS) Quality

Framework, which includes the following seven broad areas:

 Participant access;

 Participant-centered service planning and delivery;

 Provider capacity and capabilities;

 Participant safeguards;

 Participant rights and responsibilities;

 Participant outcomes and satisfaction;

 System performance.

For more information, see

https://www.nasddds.org/wp-content/uploads/2021/03/HCBSQualityFrameworkrev06-05-1.pdf

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Support Coordination Agencies may utilize “Evaluating Your Support Coordination Services: A Tool for People

with Disabilities” to identify useful measures to include in their own surveys. This document is available at

http://rwjms.rutgers.edu/boggscenter/projects/documents/AToolForEvaluatingSupportCoordinationServicesFinal.

pdf.

As the Division continues to develop an overall quality management strategy, examples and additional elements

may be provided as necessary to measure common elements across agencies.

15.4 Quality Management Plan

The Division requires an annual Quality Management Plan for each service provider detailing goals for the year,

implementation strategies, evaluation of strategies, and indicators of systemic improvements made as a result of

analysis. This includes detailing quality improvement strategies used in the agency, including staff training, policy

updates, and service process improvements. As the Division continues to develop its own overall quality

management strategy, examples and additional elements may be provided as necessary to measure common

elements across agencies.

15.4.1 Data Collection & Reporting

Data from agency incident reports should be collected and a trend analysis conducted on at least an annual basis.

Additional areas for data collection and reporting related to the agency’s Quality Management Plan are required.

15.5 Division Oversight & Quality Monitoring

The Division is required to implement oversight and monitoring of Division approved service providers. As such,

agencies will be subject to audits and formal reviews of fiscal and programmatic functions. The Division will

evaluate services and require corrective action when necessary. Evaluative strategies and actions by the Division

will include, but are not limited to:

 Monitoring and addressing characteristics and behaviors affecting the health and safety of individuals

 Monitoring the use of restrictive interventions and unusual incidents

 Monitoring and preventing instances of abuse, neglect, and exploitation of individuals

 Evaluating appropriate level of care and access to services

 Monitoring of deliverables and related documentation required by service type

 Monitoring of credentialing requirements by service type

 Monitoring training requirements

 Monitoring of service plans, including assessed needs met and revisions made when necessary

 Monitoring service delivery in accordance with service plans

 Monitoring individual choice and trends in referrals by support coordination agencies

 Monitoring individual and family satisfaction with services

 Monitoring individual outcomes and goal attainment

 Trend analysis of issues identified on monitoring tools and required follow-up

 Involuntary capacity closure for services not being rendered in compliance with Division standards

 Monitoring and auditing Medicaid claims data

 Monitoring service provider Quality Management Plans and required data reporting

Provider agencies should ensure that agency documents meet requirements and be prepared to submit to the

Division upon request. Documents may include, but are not limited to the following: Quality Management Plan,

Quality Management Meeting Minutes, Quality Management Annual Report, Customer Satisfaction Surveys,

Customer Satisfaction Survey results and action plan and any other applicable document.

See also Provider Disenrollment in Section 16.

 
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15.5.1 Auditing 
Ongoing evaluation of service providers will occur to ensure compliance with Division standards and Medicaid 
claiming through routine audits or other methods. This includes monitoring compliance with mandated background 
and exclusion checks (see Section 15.1.2) as well as personnel and training standard as indicated in this manual (see 
Section 17).  Monitoring for criminal history background checks will be in accordance with regulation 10:48A-3.6 
(Background Checks – Monitoring).  Methods of monitoring may include on-site visits, interviews with staff or 
contractors, questionnaires, DHS/DDD Licensing and Certification inspections, reviews of policies and procedures, 
trend analysis or other methods as deemed appropriate by the Division’s Quality Improvement Office. All service 
providers will be subject to both fiscal and programmatic reviews and audits on a regular basis by both Medicaid 
and the Division or the Division’s designee (external auditing firms, etc.).  
 
Day Habilitation programs must be certified, which will require formal reviews and on-site inspections. See Section 
17.7.3 for detailed information. 
 
Residential  programs  will  continue  to  be  licensed  and  subject  to  published  licensing  regulations.  Current 
requirements can be found at: https://www.state.nj.us/humanservices/providers/rulefees/regs/.  
15.5.2 Fraud Detection 
Division Policy on Fraud, Waste, & Abuse includes sanctions for providers when fraudulent claims are made as 
well as whistleblower protections for staff reporting:  
http://www.state.nj.us/humanservices/ddd/documents/ddd%20web%20current/CIRCULARS/DC54.pdf  
 
Division Policy on Fraud, Waste, & Abuse includes sanctions for providers when fraudulent claims are made as 
well  as  whistleblower  protections  for  staff  reporting: 
https://nj.gov/humanservices/ddd/assets/documents/circulars/DC54.pdf.  Agencies where potential fraud is detected 
will be subject to Medicaid Fraud & Abuse investigations and policies as well as the Provider Disenrollment Policy, 
found in Section 16. While NJ Medicaid providers are not currently required to implement Compliance programs, 
the Medicaid Fraud Division strongly encourages providers whose payments from the Medicaid program exceed 
$100,000  per  year  to  implement  a  compliance  program.    Please  go  to  the  following  websites  for  additional 
information: 
 
  Medicaid Fraud Division information: https://www.nj.gov/comptroller/about/work/medicaid/  
  Provider Compliance Program information: NJ Office of the State Comptroller  
 
15.5.3 Human Rights Committee (HRC) 
The Division requires an objective review of Issues that may infringe upon human or civil rights of individuals with 
intellectual and/or developmental disabilities through a Human Rights Committee review.  Approved providers can 
opt to develop an internal HRC or utilize the Division’s established Human Rights Committee.  
 
Internal  HRCs  must  align  with  the  requirements  outlined  in  Division  Circular  #5 
https://www.nj.gov/humanservices/ddd/assets/documents/circulars/DC5.pdf  and  be  identified  in  the  agency’s 
approved Behavior Policy and Procedure Manual. All minutes from HRC meetings are required to be submitted to 
DDD.HR[email protected] for review. 
 
The referral form for Division HRC can be found at: 
https://www.nj.gov/humanservices/ddd/assets/documents/providers/human-rights-committee-referral.docx.  
Questions about this requirement can be sent to DDD.HRC@dhs.nj.gov. 
15.6 Technical Assistance 
The Division is committed to providing quality services to individuals with developmental disabilities and therefore 
will provide technical assistance to service providers to improve performance. Service providers may be moved to 

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the Provider Disenrollment process for poor performance or lack of improvement in core areas. See policy in Section

16 for details.

Division staff will be assigned to agencies based on area of technical assistance required. Areas may include

Employment, Day Habilitation, Behavior Policy & Planning, Human Rights, Service Plan Development, Quality

Improvement, Compliance/Fiscal Auditing, or other core areas as identified in reviews or audits.

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16 PROVIDER DISENROLLMENT

The Division of Developmental Disabilities (Division) reserves the right to dis-enroll any provider in its entirety or

any one or more of its services in the event the provider does not meet or is in violation of any of the Division’s

policies, standards, and/or requirements. When warranted, the Division may impose sanctions, such as limiting the

location of service, including expansion, as well as the acuity level of individuals served. The Division will dis-

enroll providers in accordance with NJAC 10:49-11 concerning suspension, debarment, and disqualification of

providers. Additional details about this process can be found in the Medicaid Administrative Manual available at

http://www.lexisnexis.com/hottopics/njcode/.

Providers may be immediately dis-enrolled, including additional sanctions, whenever it is determined that the

agency has:

 Jeopardized the safety and welfare of the program participants;

 Materially failed to comply with the terms and conditions of the Provider Agreement;

 Compromised the fiscal or programmatic integrity of the Provider Agreement, including evidence of

fraudulent activity reportable to the Medicaid Fraud and Abuse Unit;

 Impeded or failed to cooperate with State or federal investigation(s).

The provider is responsible for complying with all Division standards during the disenrollment process, whether

voluntary or involuntary. Failure to do so could result in a report to Medicaid Fraud and Abuse for neglect of duties.

16.1 Voluntary Provider Disenrollment – Provider Initiated

1. Providers of all services other than residential who wish to dis-enroll as a Division-approved provider must

notify the Assistant Commissioner, Division of Developmental Disabilities, in writing, with a copy to the

designated staff coordinating agency approvals. This notification must include the number of people served,

the service location(s), and a plan to transfer services and supports. This transfer plan includes but is not

limited to information such as timeframes, notification of Support Coordinators, process for transferring

information to newly selected providers, etc. The dis-enrolling provider does not select or identify the

provider to which individuals served will transfer. This process will be conducted by the individuals’

Support Coordinators with assistance from the Division as needed.

2. The Assistant Commissioner or designee will review the transfer plan and will approve or negotiate an

acceptable plan within ten (10) business days of the notification to the Division.

3. Once the transfer plan is approved by the Assistant Commissioner or designee, the provider will begin the

transfer, with a transition period lasting at least 60 days from plan approval. Certain circumstances,

including where an agency serves more than 50 individuals, may require a longer timeframe for transition.

16.1.1 Provider & Support Coordinator Transition Responsibilities

1. The provider is required to follow through on the transfer plan approved by the Division to ensure

participant health, welfare, and safety. This plan must include transfer of individual files to new providers

as identified.

2. The provider is responsible to make arrangements to ensure continuity of care prior to closure. This includes

notification to the individual’s Support Coordinator in writing of an agency closure including timeframes.

3. The Support Coordinator will notify the individual and family/guardian, as applicable, and assist with

coordination of a new service provider.

4. The provider must follow up with individuals/families to ensure they have made contact with the Support

Coordinator and are actively being assisted with the transition to a new provider.

a. If the agency to close is a Support Coordination Agency (SCA), the Division will provide the

individuals/families with the SCA Agency Selection Form and assist with identifying a new

agency.

5. Failure by the service provider or Support Coordination agency to comply with any of the above

requirements could result in a report to Medicaid Fraud and Abuse for neglect of duties.

6. At least 30 days prior to the disenrollment date, the provider will fill out the online disenrollment paperwork

and forward to the designated staff coordinating agency approvals.

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7. The designated staff coordinating agency approvals will transfer the paperwork to the Office of Provider

Enrollment, Division of Medical Assistance & Health Services (DMAHS), at least 15 days before the

disenrollment date.

16.2 Involuntary Provider Disenrollment – System Initiated

Providers may be subject to sanctions or exclusionary actions in addition to disenrollment based on the severity of

the circumstance in the event of any of the following occurrences or for the reasons stated in N.J.A.C. 10:49-11.1:

 Corrective action is not implemented in a timely manner or to the satisfaction of the Division;

 Issues identified during suspension are not satisfactorily addressed;

 Failure to comply with the terms and conditions of the Provider Agreements (DMAHS and DDD), any

relevant Division Policy & Procedure Manuals, and federal and state law;

 Failure to provide or maintain quality services to Medicaid beneficiaries within accepted practice standards

of the Division;

 A record of failure to perform or of unsatisfactory performance in accordance with the quality oversight

process and/or licensing statutes;

 Criminal activity on the part of the approved provider agency, its officers, board members, or employees

subject to offenses listed in NJAC 10:49-11.1;

 Submission of fraudulent claims, submission of false information, or disregard to timely submission of

claims;

 Sanctions or financial actions taken by third parties against the approved provider agency that jeopardize

the intent or fulfillment of the Provider Agreement;

 Failure to submit reports, records, and audits either upon request or in the event of an incomplete

submission; and/or

 Disqualification by some other department/agency within the State of New Jersey or exclusion from

participation in any Medicaid program of another state.

The provider may be immediately dis-enrolled and excluded from rendering supports and services to individuals,

without the opportunity for corrective action, whenever it is determined that the provider agency has:

 Jeopardized the safety and welfare of the program participants;

 Materially failed to comply with the terms and conditions of the Provider Agreement;

 Compromised the fiscal or programmatic integrity of the Provider Agreement, including evidence of

fraudulent activity reportable to the Medicaid Fraud and Abuse Unit; and/or

 Impeded or failed to cooperate with State or federal investigation(s).

16.2.1 Technical Assistance & Remediation

 The Division may provide technical assistance to a provider to correct issues identified before initiating the

involuntary provider disenrollment process unless fraudulent activity or other serious issue is discovered.

 The technical assistance and expected remediation will be at the discretion of the Division and will be

targeted for 30 days, with extended timeframes in extenuating circumstances. Corrective action required by

the Division may include a temporary capacity closure to new individuals until the remediation is complete

to the satisfaction of the Division.

 If the issue warrants immediate corrective action or issues still exist after the identified timeframe for the

technical assistance, the Division will initiate the involuntary provider disenrollment process.

16.2.1.2 Involuntary Provider Disenrollment Process

The involuntary provider disenrollment process begins with the opportunity for corrective action unless fraudulent

activity or serious issues are discovered, in which case the provider may be moved to immediate sanctions and

disenrollment.

16.2.1.2.1 Corrective Action

1. The Division will advise the provider of any deficiencies in writing and a corrective action response from

the provider is due within 10 business days of receipt.

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2. A copy of the deficiency notice will be forwarded to the Office of Provider Enrollment, Division of Medical

Assistance and Health Services (DMAHS). DMAHS will forward a letter to the provider notifying them

that their provider number is in jeopardy.

3. The provider will be given up to 90 days to implement the corrective action response. The Division will

document all verbal communication during this time period and all decisions, direction, and mandates will

be documented via written communication.

4. If the provider fails to implement the corrective action plan either timely, or to the satisfaction of the

Division, the Director of the Waiver and Quality Unit (DDD) and the Office of Provider Enrollment

(DMAHS) will be notified in writing by the Division designated staff coordinating agency approvals and

the decision to move the provider to suspension and/or disenrollment will be made.

5. Providers that do not comply with timeline requirements and Corrective Action requirements should expect

sanctions, up to and including, Division recommendation for closure.

16.2.1.2.2 Sanctions

1. Sanctions to the provider may include limiting the location of service, including any expansion; limiting

the acuity level of individuals served; a reduction of census; and/or suspension of claiming ability for all or

particular services.

2. Providers are expected to continue to provide services to individuals unless the Division or Medicaid

determines otherwise. In situations where services will cease during the provider’s sanction, the individual’s

Support Coordinator will be notified by the Division to assist in transitioning to a new provider.

3. The Division will sanction a provider via written notice within ten (10) days of the effective date.

16.2.1.2.2.1 Suspensions

 Notices for suspension of payments will advise the following:

a) Effective date suspension is imposed;

b) Reasons for the suspension or a statement declining to give such reasons and setting forth the

Division’s position regarding the suspension;

c) State that the suspension is for a temporary period pending the completion of an investigation and

any legal proceedings that may ensue; and

d) An opportunity for a hearing if so requested.

 If legal proceedings do not commence or the suspension is not removed within 60 days of the date of notice,

the provider will be given a statement with the above information for continuation of the suspension. Where

a suspension by one Division has been the basis for suspension by another Division, the latter shall note

that fact as a reason for its suspension.

 A suspension shall not continue beyond 18 months from its effective date unless civil or criminal action

regarding the alleged violation has been initiated within that period, or unless disenrollment action has been

initiated. The suspension may continue until the legal proceedings are completed.

 A suspension may include all known affiliates of a provider, provided that each decision to include an

affiliate is made on a case-by-case basis after giving due regard to all relevant facts and circumstances.

 The Division will notify the Office of Provider Enrollment, DMAHS, of the suspension and whether the

intent is to also impose pre-pay status for the course of the suspension or some other determined time-

period. Pre-pay status allows for submission of claims during the suspension time with retroactive payments

once the outcome of the provider is determined.

16.2.1.2.3 Disenrollment

1. The provider will be advised by the Office of Provider Enrollment, DMAHS, of the following in a notice

for disenrollment:

a) Reason for the disenrollment;

b) Provider’s right to request an appeal with timeframes and procedures;

c) Effective date of the impending disenrollment; and/or

d) That a request for an appeal of the decision for disenrollment does not preclude the determined

disenrollment from being implemented.

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2. The provider may be required to participate in a plan for transition of services – including return of

individual files – as defined by the Division, and once the transfer is complete, Medicaid will close the

provider number.

3. The Office of Provider Enrollment at DMAHS will copy the Division on the notice for the provider

disenrollment and terms.

16.2.1.3 Appeals & Reinstatement

16.2.1.3.1 Appeals Process

1. A provider may be granted a hearing because of the denial of a prior authorization request or issues

involving the provider’s status, for example, suspension, disenrollment, and other status, as described in

NJAC 10:49-11.1, or issues arising out of the claims payment process (NJAC 10:49-9.14).

2. The Office of Provider Enrollment, DMAHS, will notify the provider in writing of the disenrollment stating

the reason and referencing the violation as stated in either of the Provider Agreements or state regulation

and a copy will be sent to the Division. In the case of suspension, the Division will notify the provider in

writing.

3. The provider has 20 days from the date of the letter to contact the Office of Legal & Regulatory Affairs by

certified and regular mail of their intent to appeal. The address for the Office of Legal & Regulatory Affairs

is included in the disenrollment notice.

16.2.1.3.2 Reinstatement

1. Reinstatement of a provider will occur per Medicaid policies and procedures.

2. If reinstated, the provider may receive retroactive payment for services provided per Medicaid decision.

16.3 Disenrollment Communication

During a time of disenrollment transition, whether voluntary or involuntary, or under a corrective action plan,

providers must agree to the following:

 The service provider or Support Coordination Agency may not notify individuals served or send letters,

notification, or other communication without prior authorization from the Division. This excludes

communication related to individual monitoring, plan development/revisions, service plan specifics, or the

individual’s health or safety. Any communication regarding the presence or status of corrective action plans

or potential disenrollment of the agency is strictly prohibited.

 Due to the stricter provisions of conflict-free requirements for Support Coordination Agencies, an

individual’s information may not be shared with other Support Coordination Agencies for the express

purpose of marketing or referral of services, even with the individual’s consent. In addition, Support

Coordination Agencies in the process of disenrollment are prohibited from involvement in the new Support

Coordination Agency selection process for the individuals affected. The Division will provide all

communication regarding disenrollment, choice of agency, and process to individuals and/or families

directly.

 In the event of service providers who communicate service options to individuals upon disenrollment,

individuals must always be notified of choice of agency in any communication.

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17 SUPPORTS PROGRAM SERVICES

The services available through the Supports Program are as follows:

 Assistive Technology

 Personal Emergency Response System (PERS)

 Behavioral Supports

 Physical Therapy

 Career Planning

 Prevocational Training

 Cognitive Rehabilitation

 Respite

 Community Based Supports

 Speech, Language, and Hearing Therapy

 Community Inclusion Services

 Support Coordination*

 Day Habilitation

 Supported Employment – Individual Employment Support

 Environmental Modifications

 Supported Employment – Small Group Employment Support

 Goods & Services

 Supports Brokerage

 Interpreter Services

 Transportation

 Natural Supports Training

 Vehicle Modification

 Occupational Therapy

*Please note – Support Coordination services are administrative in nature and are not funded through the

individualized budget. They are not included under “services” in the ISP.

This section provides service descriptions, limitations, qualifications, and standards for each service.

Services typically are delivered one at a time and cannot be delivered concurrently (during the same period of time).

For a list of exceptions where certain services are permitted to be delivered and claimed for concurrently, please

see Appendix K: Quick Reference Guide to Overlapping Claims for Supports Program Services. As with all CCP

services, the need for the overlapping service must be a documented need of the individual, memorialized in the

ISP, prior authorized and related to an ISP outcome.

A Direct Support Professional and/or Self-Directed Employee may not to be regularly scheduled to work more than

16 consecutive hours in a 24-hour period.

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17.1 Assistive Technology

Procedure

Codes

Units

Additional Descriptor

Budget Component

T2028HI

Single

Evaluation

Individual/Family Supports

T2028HI22

Single

Purchase, Customize, Repair,

Replace, Train

Individual/Family Supports

T2029HI

Single

Remote Monitoring

Individual/Family Supports

Please refer to Appendix H for current rates.

17.1.1 Description

Assistive technology device means an item, piece of equipment, or product system, whether acquired commercially,

modified, or customized, that is used to increase, maintain, or improve functional capabilities of participants.

Assistive technology service means a service that directly assists a participant in the selection, acquisition, or use

of an assistive technology device. Assistive technology includes: (A) the evaluation of the assistive technology

needs of a participant, including a functional evaluation of the impact of the provision of appropriate assistive

technology and appropriate services to the participant in the customary environment of the participant; (B) services

consisting of purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices for

participants; (C) services consisting of selecting, designing, fitting, customizing, adapting, applying, maintaining,

repairing, or replacing assistive technology devices; (D) ongoing maintenance fees to utilize the assistive technology

(e.g., remote monitoring devices); (E) coordination and use of necessary therapies, interventions, or services with

assistive technology devices, such as therapies, interventions, or services associated with other services in the

Service Plan; (F) training or technical assistance for the participant, or, where appropriate, the family members,

guardians, advocates, or authorized representatives of the participant; and (G) training or technical assistance for

professionals or other individuals who provide services to, or who are employed by participants.

17.1.2 Service Limits

All Assistive Technology services and devices shall meet applicable standards of manufacture, design and

installation and are subject to prior approval on an individual basis by the Division. Prior approval will be based on

the functional evaluation as described above. Items covered by the Medicaid State Plan cannot be purchased through

this service.

17.1.3 Provider Qualifications

All providers of Assistive Technology services must comply with the standards set forth in this manual.

In addition, AT providers must meet at least one of the following:

 Occupational Therapists must be licensed per N.J.A.C. 13:44K -OR-

 Physical Therapists must be licensed per N.J.A.C. 13:39A -OR-

 Speech/Language Pathologist must be licensed per N.J.A.C. 13:44C -OR-

 Assistive Technology Specialist, bachelor’s degree in technical services or rehabilitation services related

field and a minimum of 1-year working with individuals with ID/DD and is certified by the Rehabilitation

Engineering and Assistive Technology Society of North America (RESNA)

In addition AT Vendors/Business Entities must:

 Be an established business as a medical supplier or assistive technology supplier in New Jersey -or-

 Have license, certification, registration, or authorization from the New Jersey Department of Consumer

Affairs or any other endorsing entity and Liability Insurance -or-

 Be an out-of-state medical or assistive technology supplier who is an approved Medicaid provider in their

state of residence

17.1.4 Examples of Assistive Technology Activities

*Please note that examples are not all inclusive of everything that can be funded through this service

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 Evaluation of AT or environmental modification needs

 Purchasing, leasing, acquiring AT

 Designing, fitting, customizing devices

 Repairing or replacing devices

 Ongoing maintenance fees

 Training or technical assistance for the individual, family, guardians, professionals, etc. to use the

technology

17.1.5 Assistive Technology Policies/Standards

In addition to the standards set forth in this manual, the service provider and staff must comply with relevant

licensing and/or certification standards.

17.1.5.1 Need for Service and Process for Choice of Provider

The need for Assistive Technology will be identified through the NJ Comprehensive Assessment Tool (NJ CAT)

and the person-centered planning process documented in the Person-Centered Planning Tool (PCPT). In addition,

the following steps must be completed in order to access Assistive Technology:

 The Support Coordinator will assist the individual in identifying an approved Assistive Technology

provider to conduct an evaluation;

 The Support Coordinator will submit a request to conduct the Assistive Technology evaluation through

iRecord for Division review and approval;

 If an AT evaluation has already been conducted (through school, for example), the Support Coordinator

should include that information within the details of the submitted request and upload the evaluation into

the “Documents” tab;

 The Division will review the evaluation request and provide a determination. The determination may be to

skip the evaluation if needed information is already available (through a previous evaluation, for example).

 If “approved,” by the Division, the Support Coordinator will add Assistive Technology to the ISP and utilize

the Assistive Technology Evaluation procedure code (T2028HI).

 Upon approval of the ISP, the Assistive Technology provider conducts the evaluation as prior authorized

and submits the completed evaluation and supporting documents to the Support Coordinator.

 Once the evaluation has been completed (or if the evaluation step has been skipped as approved by the

Division), the Support Coordinator will submit a request for the Division to review and approve the

Assistive Technology itself.

 Once the Assistive Technology is approved, the Support Coordinator will add Assistive Technology to the

ISP using procedure code T2028HI22 (purchase, customize, repair, train).

 The Assistive Technology provider will render services as prior authorized by the approved ISP and claim

to Medicaid (if a Medicaid provider) or submit an invoice to the Fiscal Intermediary (if not a Medicaid

provider).

Questions or concerns that are related to this process can be directed to the Service Approval Help Desk at

DDD.ServiceApprovalHelpdesk@dhs.nj.gov.

17.1.5.2 Documentation & Recordkeeping

Documentation of the delivery of service must be maintained to substantiate claims. This documentation should

include the date, start and end times, and number of units of the delivered service for each individual and must align

with the prior authorization received for the provision of services.

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17.2 Behavioral Supports

Procedure

Codes

Units

Additional Descriptor

Budget Component

H0004HI22

15 minutes

Assessment/Plan Development

Either

H0004HI

15 minutes

Monitoring

Either

Please refer to Appendix H for current rates.

17.2.1 Description

Individual and/or group counseling, behavioral interventions, diagnostic evaluations or consultations related to the

individual’s developmental disability and necessary for the individual to acquire or maintain appropriate

interactions with others provided by the Behavior Supports provider at the Assessment/Plan Development rate.

Intervention modalities must relate to an identified challenging behavioral need of the individual. Specific criteria

for remediation of the behavior shall be established. The provider(s) shall be identified in the Service Plan and shall

have the minimum qualification level necessary to achieve the specific criteria for remediation. Behavioral Supports

includes a complete assessment of the challenging behavior(s), development of a structured behavioral modification

plan, implementation of the plan, ongoing training and supervision of caregivers and behavioral aides, and periodic

reassessment of the plan.

17.2.2 Service Limits

Behavioral Supports services are offered in addition to and do not replace treatment services for behavioral health

conditions that can be accessed through the State Plan/MBHO and mental health service system. Individuals with

co-occurring diagnoses of developmental disabilities and mental health conditions shall have identified needs met

by each of the appropriate systems without duplication but with coordination to obtain the best outcome for the

individual.

17.2.3 Provider Qualifications

All providers of Behavioral Supports services must comply with the standards set forth in this manual. In addition,

Behavioral Supports providers shall complete State/Federal Criminal Background checks, Central Registry checks

for all staff, drug tests as applicable under Stephen Komninos’ Law, and ensure that all staff successfully completes

the training described in Section 17.2.5.3.

In addition, staff conducting assessments, developing behavior support plans, and evaluating their

effectiveness must:

 Have demonstrated experience in positive behavior support and/or applied behavior analysis -AND-

 1 year working with people with developmental disabilities -AND-

 Meet or be under the supervision of at least one of the following:

o Board Certified Behavior Analyst – Doctoral (BCBA-D) -OR-

o Board Certified Behavior Analyst (BCBA) -OR-

o With 1 year of supervised experience working with individuals with developmental disabilities

involving behavioral assessment and the development of behavior support plans:

 Master’s degree and the completion of requisite coursework from a BACB approved course

sequence program -OR-

 Clinician holding NADD Clinical certification -OR-

 Master’s or Bachelor’s degree in applied behavioral analysis, psychology, special

education, social work, public health counseling, or a similar degree AND under the

supervision of a BCBA-D or BCBA.

In addition, staff responsible for monitoring the implementation of the behavior support plan and

training/supervising caregivers must have demonstrated experience in positive behavior support and/or

applied behavior analysis and 1 year working with people with developmental disabilities and meet the

following criteria or be under the supervision of someone that does:

 Board Certified Assistant Behavior Analyst (BCaBA) in accordance with BACB standards -OR-

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 Registered Behavior Technician (RBT) in accordance with BACB standards -OR-

 Direct Support Professional (DSP) holding NADD DSP Certification -OR-

 Bachelor’s degree in applied behavior analysis, psychology, special education, social work, public health,

or a similar degree

17.2.4 Examples of Behavioral Supports Activities

*Please note that examples are not all inclusive of everything that can be funded through this service

17.2.4.1 Examples of Assessment/Plan Development Activities

 Behavioral assessment

 Development of behavior support plan

 Dissemination of plan

 Initial training and supervision of caregivers

 Training, oversight, and coordination with staff performing monitoring activities

 Periodic re-training and supervision of caregivers

 Review of raw and/or aggregated data associated with plan

 Periodic reassessment of behavioral support plan

 Revision of plan when required

17.2.4.2 Examples of Monitoring Activities

 Monitoring the implementation of plan by caregivers

 Incidental correction and re-training of caregivers

 Review data collection practices for integrity

17.2.4.3 Need for Human Rights Committee (HRC) Review

The Division requires an objective review of issues that may infringe upon human or civil rights of individuals with

intellectual and/or developmental disabilities through a Human Rights Committee review as outlined in Section

15.5.3 of this manual. Questions regarding this requirement can be sent to DDD.HR[email protected].

17.2.5 Behavioral Supports Policies/Standards

In addition to the standards set forth in this manual, the service provider and staff must comply with relevant

licensing and/or certification standards as well the requirements outlined in Division Circulars 5, 18, 19, 20, and

34.

17.2.5.1 Need for Service and Process for Choice of Provider

The need for Behavior Supports will typically be identified through the NJ Comprehensive Assessment Tool (NJ

CAT) and the person-centered planning process documented in the Person-Centered Planning Tool (PCPT). Once

this need is identified, an outcome related to the result(s) expected through the participation in Behavioral Supports

will be included in the Individual Service Plan (ISP) and the Behavioral Supports provider will develop strategies

to assist the individual in reaching the desired outcome(s). Individuals and families are encouraged to include the

Behavioral Supports provider, as practicable, in the planning process to assist in identifying and developing

applicable outcomes.

The Behavioral Supports provider can require/request referral information that will assist the provider in offering

quality services. Once the Support Coordinator has informed the provider that the individual has selected them to

provide Behavioral Supports, the provider has five (5) working days to contact the individual and/or Support

Coordinator to express interest in delivering services.

Prior to service provision, consistent with Division Circular #34, providers are required to have a Division-approved

Behavior Supports Policy and Procedure. The Policy should be submitted to DDD.Behaviorals[email protected]j.gov

for approval.

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The agency identified to provide this service along with details regarding the extent of the service hours, duration,

frequency, etc. will be noted in the ISP providing prior authorization for the identified service provider to perform

this service. A copy of the approved ISP and Service Detail Report will be provided to the identified service

provider.

17.2.5.2 Minimum Staff Qualifications

The service provider shall meet the minimum staff qualifications and training set forth in this manual. Qualifications

and training shall be documented either in the employment application, resume, reference check, or other personnel

document(s).

17.2.5.3 Mandated Staff Training & Professional Development

The service provider shall comply with any relevant licensing and/or certification standards. Agency Trainers must

have a minimum of 1 year experience in the field or 1 year experience in training. In addition, all staff providing

Behavioral Supports shall successfully complete the training outlined in Appendix E: Quick Reference Guide to

Mandated Staff Training.

17.2.5.4 Documentation and Reporting

Demonstration of completion of all mandated staff training must be documented through certificates of

attendance/completion; sign-in sheets from the training entity, provider, or trainer; information maintained through

the College of Direct Support, etc. and made available upon request of the Division.

Documentation of the delivery of service must be maintained to substantiate claims. This documentation should

include the date, start and end times, and number of units of the delivered service for each individual and must align

with the prior authorization received for the provision of services.

17.2.5.5 Medication Standards

If the provider is distributing medications while delivering this service, the “Medication” standards described under

Day Habilitation Section 17.7.5.8 or Prevocational Training Section 17.15.5.7 (these standards are the same for

both services) shall be followed.

17.2.5.6 Quality Assurance/Monitoring

The Division will conduct quality assurance and monitoring of Behavioral Supports providers in accordance with

the requirements of the Supports Program Quality Plan.

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17.3 Career Planning

Procedure

Codes

Units

Additional Descriptor

Budget Component

H2014HI

15 minutes

Either (DSP Service applies)

Please refer to Appendix H for current rates.

17.3.1 Description

Career planning is a person-centered, comprehensive employment planning and support service that provides

assistance for program participants to obtain, maintain or advance in competitive employment or self-employment.

It is a focused, time-limited service engaging a participant in identifying a career direction and developing a plan

for achieving competitive, integrated employment at or above the state’s minimum wage. The outcome of this

service is documentation of the participant’s stated career objective and a career plan used to guide individual

employment support. If a participant is employed and receiving supported employment services, career planning

may be used to find other competitive employment more consistent with the person’s skills and interests or to

explore advancement opportunities in their chosen career.

17.3.2 Service Limits

This service is available to participants in accordance with the DDD Supports Program Policies & Procedures

Manual and as authorized in their Service Plan. This service is available to participants at a maximum of 80 hours

per Service Plan year. If the participant is eligible for services from the State’s Division of Vocational Rehabilitation

Services, these services must be exhausted before Career Planning can be offered to the participant.

17.3.3 Provider Qualifications

All providers of Career Planning services must comply with the standards set forth in this manual. In addition, all

staff providing Career Planning services must be a Certified Rehabilitation Counselor (CRC), Professional

Vocational Evaluator (PVE), Certified Vocational Evaluator (CVE) or Employment Specialist that has successfully

completed all Division-approved training mandated for an employment specialist/job coach as further described in

Section 17.3.5.5. Career Planning providers shall complete State/Federal Criminal Background checks, Central

Registry checks for all staff, drug tests as applicable under Stephen Komninos’ Law, and ensure staff are a minimum

of 20 years of age and possess a valid driver’s license and abstract (not to exceed 5 points) if driving is required.

17.3.4 Examples of Career Planning Activities

*Please note that examples are not all inclusive of everything that can be funded through this service

 Determination of career direction through interest inventories, situational assessments, etc.

 Development of a plan that states the career objective and guides individual employment support

17.3.5 Career Planning Policies/Standards

In addition to the standards set forth in this manual, the service provider and staff must comply with relevant

licensing, regulatory, and/or certification standards.

17.3.5.1 Career Planning Overview

The career planning process utilizes the individual’s dreams, outcomes, personal preferences, interests, and needs

to help the individual figure out the types of employment they want to pursue and develop a plan to assist them in

getting there. The focus of the career planning process is on identifying what the job seeker wants to do rather than

a lack of skills or limitations that they may have. Upon identification of the desired employment outcome, the

career plan will identify support needs necessary toward reaching that outcome. Each individual’s career planning

service is unique to that individual’s plan and demonstrates increasing involvement in the employment market,

development of community connections, and continued movement toward inclusive settings and community

employment.

The goals of Career Planning services include:

 Developing a career path that leads to maintained employment in the general workforce

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 Furthering an individual’s career through increased wages earned, receipt of employment benefits,

increased working hours, promotions, etc.

 Increasing an individual’s satisfaction with their career direction in circumstances where the individual is

unsatisfied with their current job

17.3.5.2 Best Practices in Career Planning

 Utilizing a person-centered approach to discover the individual’s likes/dislikes, job preference goals,

strengths/skills, and support needs in order to develop a career plan;

 Partnering with the individual and people they already know to identify creative methods leading to the end

result of employment within the career path of choice;

 Identifying a network of people/connections who can provide assistance, leads, support, etc. to accomplish

employment within the career path of choice;

 Developing a written plan that will guide the individual in negotiating/meeting their needs;

 Finding a new approach to the individual’s career path; and/or

 Connecting to the individual’s community and discovering additional resources.

17.3.5.3 Need for Service and Process for Choice of Provider

Career Planning services can be provided to anyone who is unable to identify a desired career path or job and has

expressed an interest to work competitively in the general workforce. The need for Career Planning services will

typically be identified through the Pathway to Employment discussion that takes place annually during the person-

centered planning process and is documented in iRecord and in the ISP. Once this need is identified, an outcome

related to exploring career options and developing a path to competitive employment in the general workforce will

be included in the Individual Service Plan (ISP) and the Career Planning provider will develop a career plan that

must include, at a minimum, indication of the individual’s career goal, a detailed description/outline of how the

individual is going to achieve that goal, and identification of areas where employment support may be needed.

This service can only be accessed through the Division if it is not available through the Division of Vocational

Rehabilitation Services (DVRS) or Commission for the Blind & Visually Impaired (CBVI) – as documented on the

Employment Determination Form - (F3) (Appendix D).

It is recommended that the individual research potential service providers through phone calls, meetings, office

visits, etc. to select the service provider that will best meet their needs.

The Career Planning service provider can require/request referral information that will assist the provider in offering

quality services. Once the Support Coordinator has informed the provider that the individual has selected them to

provide Career Planning, the provider has five (5) working days to contact the individual and/or Support

Coordinator to express interest in delivering services.

The agency identified to provide this service along with details regarding the extent of the service hours, duration,

frequency, etc. will be noted in the ISP providing prior authorization for the identified service provider to perform

this service. A copy of the approved ISP and the Service Detail Report will be provided to the identified service

provider.

17.3.5.4 Minimum Staff Qualifications

The service provider shall meet the minimum staff qualifications and training set forth in this manual. Qualifications

and training shall be documented either in the employment application, resume, reference check, or other personnel

document(s).

17.3.5.4.1 All Staff

 Minimum 20 years of age; – AND –

 Complete State/Federal Criminal Background checks and Central Registry checks;

 Valid driver’s license and abstract (not to exceed 5 points) if driving is required.

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17.3.5.4.2 Executive Director or Equivalent

 Bachelor’s Degree; - OR -

 High school diploma and 5 years’ experience working with people with developmental disabilities, two of

which shall have been supervisory in nature.

17.3.5.4.3 Program Management Staff/Supervisors

 Graduated from an accredited college or university with a Bachelor’s degree, or higher, in Education, Social

Work, Psychology or related field, plus one (1) year of successful experience in human services or

employment services, or

 Graduated from an accredited college with an Associate’s degree, plus two (2) years of successful

experience in human services, or

 Graduated with a high school diploma or equivalent and five (5) years of experience in occupational areas

similar to those being offered at the program. A combination of college or technical school may be

substituted for experience on a year for year basis.

 Have a clear understanding of the demands and expectations in business and industry.

17.3.5.4.4 Certified Rehabilitation Counselors (CRC), Professional Vocational Evaluator (PVE), Certified

Vocational Evaluator (CVE), or Employment Specialist

 Education level necessary to maintain CRC, PVE, or CVE status;

 Have an Associate’s degree or higher in a related field from an accredited college or university or have a

high school diploma or equivalent with three (3) years of related experience;

 Be familiar with the demands and expectations of business and industry.

17.3.5.5 Mandated Staff Training & Professional Development

The service provider shall comply with any relevant licensing and/or certification standards. Agency Trainers must

have a minimum of 1 year experience in the field or 1 year experience in training. All staff providing Career

Planning services shall successfully complete the training outlined in Appendix E: Quick Reference Guide to

Mandated Staff Training.

17.3.5.6 Documentation & Reporting

Demonstration of completion of all mandated staff training must be documented through certificates of

attendance/completion; sign-in sheets from the training entity, provider, or trainer; information maintained through

the College of Direct Support, etc. and made available upon request of the Division.

Documentation of the delivery of service must be maintained to substantiate claims. This documentation should

include the date, start and end times, and number of units of the delivered service for each individual and must align

with the prior authorization received for the provision of services.

Career Planning services must result in an individualized written career plan. The Career Planning provider can

develop the preferred format for this plan but must include, at a minimum, indication of the individual’s career goal,

a detailed description/outline of how the individual is going to achieve that goal, and identification of areas where

employment support may be needed.

17.3.5.7 Medication Standards

If the provider is distributing medications while delivering this service, the “Medication” standards described under

Day Habilitation Section 17.7.5.8 or Prevocational Training Section 17.15.5.7 (these standards are the same for

both services) shall be followed.

17.3.5.8 Quality Assurance and Monitoring

The Division will conduct quality assurance and monitoring of Career Planning providers in accordance with the

requirements of the Supports Program Quality Plan.

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17.4 Cognitive Rehabilitation

Procedure

Codes

Units

Additional Descriptor

Budget Component

97532HI

15 minutes

Individual/Family Supports

Please refer to Appendix H for current rates.

17.4.1 Description

A systematic, functionally-oriented service of therapeutic cognitive activities, based on an assessment and

understanding of the person’s brain behavior deficits. Services are directed to achieve functional changes: by (1)

reinforcing, strengthening or re-establishing previously learned patterns of behavior, or (2) establishing new patterns

of cognitive activity or compensatory mechanisms for impaired neurological systems. Therapeutic interventions

include but are not limited to direct retraining, use of compensatory strategies, use of cognitive orthotics and

prostheses. Activity type and frequency are determined by assessment of the participant, the development of a

treatment plan based on recognized deficits, and periodic reassessments. Cognitive therapy can be provided in the

individual’s home or community settings.

17.4.2 Service Limits

Daily limits as delineated by the participant’s Service Plan. Frequency and duration of service must be supported

by assessment and included in the participant’s Service Plan. CRT may be provided on an individual basis or in

groups. A group session is limited to one therapist with maximum of five participants. Both group and individual

sessions may not exceed 60 minutes in length. The therapist must record the time the therapy session started and

when it ended in the participant's clinical record. This service must be coordinated and overseen by a CRT provider

holding at least a master’s degree. All individuals who provide or supervise the CRT service must complete six

hours of relevant ongoing training in CRT and or brain injury rehabilitation. Training may include, but is not limited

to, participation in seminars, workshops, conferences, and in-services.

17.4.3 Provider Qualifications

All providers of Cognitive Rehabilitation services must comply with the standards set forth in this manual. In

addition, Cognitive Rehabilitation providers shall complete State/Federal Criminal Background checks and Central

Registry checks for all staff, drug tests as applicable under Stephen Komninos’ Law, and ensure that all staff

successfully completes the Division mandated training.

In addition, staff providing Cognitive Rehabilitation services must meet the following:

 Certified Brain Injury Specialist (CBIS) through the Academy of Certified Brain Injury Specialists

(ACBIS) – AND –

 Complete 6 hours of relevant ongoing training on Cognitive Rehabilitation Therapy or brain injury

rehabilitation - AND - at least one of the following:

o Master’s degree in an allied health field from an accredited institution where the degree is a

prerequisite for licensure or certification

o Bachelor’s degree in an *allied rehabilitation field from an accredited institution where the degree

is sufficient for licensure, certification or registration

o Master’s or Bachelor’s degree in an *allied rehabilitation field from an accredited institution where

the degree is insufficient for licensure, certification, or registration or when such is not available

must be supervised by a qualified professional

*Applicable allied rehabilitation degree programs include: counseling, education, medicine,

neuropsychology, OT, PT, psychology, recreation therapy, social work, special education and speech-

language pathology.

Supervisors of Cognitive Rehabilitation Services must meet at least one of the following:

 Cognitive Rehabilitation Therapy providers holding at least a Master’s degree

 Certification by the Society for Cognitive Rehabilitation

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 Rehabilitation professional that is licensed or certified

17.4.4 Examples of Cognitive Rehabilitation Activities

*Please note that examples are not all inclusive of everything that can be funded through this service

 Direct retraining

 Compensatory strategies

 Cognitive orthotics and prostheses

17.4.5 Cognitive Rehabilitation policies/standards

In addition to the standards set forth in this manual, Cognitive Rehabilitative services must be performed under the

guidelines described in the New Jersey practice arts for occupational and physical therapists

17.4.5.1 Need for Service and Process for Choice of Provider

To access Cognitive Rehabilitation services, the NJ Comprehensive Assessment Tool (NJ CAT) must indicate that

the individual has an acquired non-degenerative or traumatic brain injury and an appropriate medical prescription

must be obtained. In addition, the following steps must be completed in order to access Cognitive Rehabilitation:

 The Support Coordinator uploads a copy of the medical prescription to iRecord

 The individual/family reaches out to the primary insurance carrier to request Cognitive Rehabilitation

therapy

 If the primary insurance carrier approves the Cognitive Rehabilitation, the individual will access this

therapy through their primary insurer and follow the process required by that insurer

 If the primary insurer denies the Cognitive Rehabilitation therapy, the individual will receive (or must

request) a denial letter or Explanation of Benefits (EOB) document

 The individual will submit the primary insurer’s denial letter or EOB to the Support Coordinator

 The Support Coordinator will upload the denial letter or EOB to iRecord and assist the individual in

identifying providers of Cognitive Rehabilitation therapy

 The Support Coordinator will include Cognitive Rehabilitation in the ISP as is done for other services

 When the ISP is approved, the prior authorization will be emailed to the provider and the Support

Coordinator will submit the denial letter or EOB from the primary carrier to the service provider that has

been identified in the ISP to provide Cognitive Rehabilitation

 The prior authorized service provider (identified in the ISP) will request the “Bypass Letter Request

Form” from [email protected]j.gov

 The service provider completes the Bypass Letter Request Form, attaches the explanation of benefits

(EOB) for the denied service (either for exhausted benefits or non-coverage), and submits the documents

to the OSC

 Staff at the OSC will review the information and issue a Bypass Letter if appropriate

 The service provider will submit claims for rendered services along with the Bypass Letter to Gainwell

Technologies for payment

17.4.5.2 Documentation & Recordkeeping

Documentation of the delivery of service must be maintained to substantiate claims. This documentation should

include the date, start and end times, and number of units of the delivered service for each individual and must align

with the prior authorization received for the provision of services.

17.4.5.3 Medication Standards

If the provider is distributing medications while delivering this service, the “Medication” standards described under

Day Habilitation Section 17.7.5.8 or Prevocational Training Section 17.15.5.7 (these standards are the same for

both services) shall be followed.

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17.5 Community Based Supports

Procedure

Codes

Units

Additional Descriptor

Budget Component

H2021HI

15 minutes

Base

Either (DSP Service applies)

H2021HI22

15 minutes

Acuity

Either (DSP Service applies)

H2021HI52

15 minutes

Self-Directed Employee

Either (DSP Service applies)

Please refer to Appendix H for current rates.

17.5.1 Description

Services that provide direct support and assistance for participants, with or without the caregiver present, in or out

of the participant's residence, to achieve and/or maintain the outcomes of increased independence, productivity,

enhanced family functioning, and inclusion in the community, as outlined in their Service Plan. Community-Based

Supports are delivered one-on-one with a participant and may include: assistance with community-based activities

and assistance to, as well as training and supervision of, individuals as they learn and perform the various tasks that

are included in basic self-care, social skills, and activities of daily living.

17.5.2 Service Limits

Self-directed employees providing Community Based Support Services may be members of a participant’s family

provided the family member has met the same standards as providers who are unrelated to the individual.

For information on determining the Reasonable and Customary Wage for an SDE please review section 8.3.2.0.1 –

Establishing a Self-Directed Employee (SDE) Hourly Wage Where the Direct Support Professional Service

Applies.

17.5.3 Provider Qualifications

All providers of Community Based Supports must comply with the standards set forth in this manual. In addition,

Community Based Supports providers shall complete State/Federal Criminal Background checks and Central

Registry checks for all staff, drug tests as applicable under Stephen Komninos’ Law, and ensure that all staff

successfully completes the Division mandated training, are a minimum of 18 years of age, and possess a valid

driver’s license and abstract (not to exceed 5 points) if driving is required.

If the Community Based Supports provider is a Home Health Agency or Health Care Service Firm, they

must meet the following additional license or accreditation requirements:

 Licensed per N.J.A.C. 8:42 and Certified by the Centers for Medicare and Medicaid Services -OR-

 Accredited by one of the following:

o New Jersey Commission on Accreditation for Home Care Inc. (CAHC)

o Community Health Accreditation Program (CHAP)

o Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

o National Association for Home Care and Hospice (NAHC)

o National Institute for Home Care Accreditation (NIHCA)

17.5.4 Examples of Community Based Supports Activities

*Please note that examples are not all inclusive of everything that can be funded through this service

 Support from staff to enable an individual to attend an event, take a class, etc.

 Support from staff to assist an individual participating in activities such as: assistance in completing

activities of daily living, ordering off a menu, purchasing items, learning basic cooking, laundry skills,

etiquette, travel training, accessing activities in the community, etc.

 One-on-one tutoring

 Support on a job site to assist in basic self-care, social skills, and activities of daily living.

o *Please note that Community Based Supports can be used in addition to but cannot replace

Supported Employment services (such as job coaching). Supported Employment services must be

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provided in accordance with the standards described in Section 17.20 by professionals who have

completed the Employment Specialist/Job Coach series of trainings. For example, Community-

Based Supports can be provided to assist an individual on a job site with safety awareness,

remaining focused on work tasks, self-care needs, eating lunch, etc., but cannot assist the individual

or their supervisor in learning work tasks, setting up accommodations to complete work tasks, or

the training associated with learning new aspects of their job duties. Those activities must be

conducted by an appropriately qualified and approved Supported Employment provider.

17.5.5 Community Based Supports Policies/Standards

In addition to the standards set forth in this manual, the service provider and staff must support and implement

individual behavior plans, as applicable, and comply with relevant licensing and/or certification standards.

17.5.5.1 Need for Service and Process for Choice of Provider

The need for Community Based Supports will typically be identified through the NJ Comprehensive Assessment

Tool (NJ CAT) and the person-centered planning process documented in the Person-Centered Planning Tool

(PCPT). Once this need is identified, an outcome related to the result(s) expected through the participation in

Community Based Supports will be included in the Individual Service Plan (ISP) and the Community Based

Supports provider will develop strategies to assist the individual in reaching the desired outcome(s). Individuals

and families are encouraged to include the Community Based Services provider in the planning process to assist in

identifying and developing applicable outcomes.

It is recommended that the individual research potential service providers through phone calls, meetings, visits, etc.

to select the service provider that will best meet their needs.

The Community Based Supports provider can require/request referral information that will assist the provider in

offering quality services. Once the Support Coordinator has informed the provider that the individual has selected

them to provide Community Based Supports, the provider has five (5) working days to contact the individual and/or

Support Coordinator to express interest in delivering services.

The agency identified to provide this service along with details regarding the extent of the service hours, duration,

frequency, etc. will be noted in the ISP providing prior authorization for the identified service provider to perform

this service. A copy of the approved ISP and Service Detail Report will be provided to the identified service

provider.

17.5.5.2 Minimum Staff Qualifications

The service provider shall meet the minimum staff qualifications and training set forth in this manual. Qualifications

and training shall be documented either in the employment application, resume, reference check, or other personnel

document(s).

 Minimum 18 years of age – AND –

 Complete State/Federal Criminal Background checks and Central Registry checks

 Valid driver’s license and abstract (not to exceed 5 points) if driving is required

17.5.5.3 Mandated Staff Training & Professional Development

The service provider shall comply with any relevant licensing and/or certification standards. Agency Trainers must

have a minimum of 1 year experience in the field or 1 year experience in training. All staff providing Community

Based Supports shall successfully complete the training outlined in Appendix E: Quick Reference Guide to

Mandated Staff Training.

17.5.5.4 Documentation and Reporting

Demonstration of completion of all mandated staff training must be documented through certificates of

attendance/completion; sign-in sheets from the training entity, provider, or trainer; information maintained through

the College of Direct Support, etc. and made available upon request of the Division. Supervisors shall conduct and

document use of competency and performance appraisals in the content areas addressed through mandated training.

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Documentation of the delivery of service must be maintained to substantiate claims. This documentation should

include the date, start and end times, and number of units of the delivered service for each individual and must align

with the prior authorization received for the provision of services.

17.5.5.4.1 Community Based / Individual Supports Log

The provider of Community Based Supports, in collaboration with the individual, must indicate the strategies the

Community Based Supports provider will be using to assist the individual in reaching their outcome(s) indicated in

the ISP. These strategies along with information about individualized activities experienced during service delivery

and progress toward the individual’s related outcome(s) must be indicated on the Community Based / Individual

Supports Log available in Appendix D.

17.5.5.5 Medication Standards

If the provider is distributing medications while delivering this service, the “Medication” standards described under

Day Habilitation Section 17.7.5.8 or Prevocational Training Section 17.15.5.7 (these standards are the same for

both services) shall be followed.

17.5.5.6 Quality Assurance/Monitoring

The Division will conduct quality assurance and monitoring of Community Based Supports providers in accordance

with the requirements of the Supports Program Quality Plan.

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17.6 Community Inclusion Services

Procedure

Codes

Units

Additional Descriptor

Budget Component

H2015HIU1

15 minutes

Tier A

Either (DSP Service applies)

H2015HIU2

15 minutes

Tier B

Either (DSP Service applies)

H2015HIU3

15 minutes

Tier C

Either (DSP Service applies)

H2015HIU4

15 minutes

Tier D

Either (DSP Service applies)

H2015HIU5

15 minutes

Tier E

Either (DSP Service applies)

Please refer to Appendix H for current rates.

17.6.1 Description

Services provided outside of a participant’s home that support and assist participants in educational, enrichment or

recreational activities as outlined in their Service Plan that are intended to enhance inclusion in the community.

Community Inclusion Services are delivered in a group setting not to exceed six (6) individuals.

17.6.2 Service Limits

Community Inclusion Services are limited to 30 hours per week. Transportation to or from a Community Inclusion

Service site is not included in the service.

17.6.3 Provider Qualifications

All providers of Community Inclusion Services must comply with the standards set forth in this manual. In addition,

all Community Inclusion Services providers shall complete State/Federal Criminal Background checks and Central

Registry checks for all staff, drug tests as applicable under Stephen Komninos’ Law, and ensure that all staff

successfully completes the Division mandated training, are a minimum of 18 years of age, and possess a valid

driver’s license and abstract (not to exceed 5 points) if driving is required.

If the Community Inclusion Services provider is a Home Health Agency or Health Care Service Firm, they

must meet the following additional license or accreditation requirements:

 Licensed per N.J.A.C. 8:42 and Certified by the Centers for Medicare and Medicaid Services; -OR-

 Accredited by one of the following:

o New Jersey Commission on Accreditation for Home Care Inc. (CAHC).

o Community Health Accreditation Program (CHAP).

o Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

o National Association for Home Care and Hospice (NAHC).

o National Institute for Home Care Accreditation (NIHCA).

17.6.4 Examples of Community Inclusion Services Activities

*Please note that examples are not all inclusive of everything that can be funded through this service

 Small group outings to community festivals, museums, book clubs, theater groups, cultural events, holiday

celebrations, sporting events, etc.

 Small group leisure activities in the community

 Small group educational activities in the community

17.6.5 Community Inclusion Services Policies/Standards

In addition to the standards set forth in this manual, the service provider and staff must support and implement

individual behavior plans, as applicable, and comply with relevant licensing and/or certification standards.

17.6.5.1 Need for Service and Process for Choice of Provider

The need for Community Inclusion Services will typically be identified through the NJ Comprehensive Assessment

Tool (NJ CAT) and the person-centered planning process documented in the Person-Centered Planning Tool

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(PCPT). Once this need is identified, an outcome related to the result(s) expected through the participation in

Community Inclusion Services will be included in the Individual Service Plan (ISP) and the Community Inclusion

Services provider will develop strategies to assist the individual in reaching the desired outcome(s). Individuals

and families are encouraged to include the Community Inclusion Services provider in the planning process to assist

in identifying and developing applicable outcomes.

It is recommended that the individual research potential service providers through phone calls, meetings, visits, etc.

to select the service provider that will best meet their needs.

The Community Inclusion Services provider can require/request referral information that will assist the provider in

offering quality services. Once the Support Coordinator has informed the provider that the individual has selected

them to provide Community Inclusion Services, the provider has five (5) working days to contact the individual

and/or Support Coordinator to express interest in delivering services.

The agency identified to provide this service along with details regarding the extent of the service hours, duration,

frequency, etc. will be noted in the ISP providing prior authorization for the identified service provider to perform

this service. A copy of the approved ISP and Service Detail Report will be provided to the identified service

provider.

17.6.5.2 Minimum Staff Qualifications

The service provider shall meet the minimum staff qualifications and training set forth in this manual. Qualifications

and training shall be documented either in the employment application, resume, reference check, or other personnel

document(s).

 Minimum 18 years of age; – AND –

 Complete State/Federal Criminal Background checks and Central Registry checks;

 Valid driver’s license and abstract (not to exceed 5 points) if driving is required.

17.6.5.3 Mandated Staff Training & Professional Development

The service provider shall comply with any relevant licensing and/or certification standards. Agency Trainers must

have a minimum of 1 year experience in the field or 1 year experience in training. All staff providing Community

Inclusion Services shall successfully complete the training outlined in Appendix E: Quick Reference Guide to

Mandated Staff Training.

17.6.5.4 Documentation and Reporting

Demonstration of completion of all mandated staff training must be documented through certificates of

attendance/completion; sign-in sheets from the training entity, provider, or trainer; information maintained through

the College of Direct Support, etc. and made available upon Division request. Supervisors shall conduct and

document use of competency and performance appraisals in the content areas addressed through mandated training.

Documentation of the delivery of service must be maintained to substantiate claims. This documentation should

include the date, start and end times, and number of units of the delivered service for each individual and must align

with the prior authorization received for the provision of services.

Standardized documents are available in Appendix D. Providers using an electronic health record (EHR) or billing

system that cannot duplicate these standardized documents will remain in compliance if all the information required

on these documents is captured somewhere and can be shown/reviewed during an audit.

17.6.5.4.1 Community Inclusion Services – Individualized Goals

The provider of Community Inclusion Services, in collaboration with the individual, must develop strategies for

each personally defined outcome related to the Community Inclusion Services that the service provider has been

chosen to provide as indicated in the ISP. These strategies must be completed within 15 business days of the date

the individual begins to receive Community Inclusion Services from the provider and must be documented on the

Community Inclusion Services – Individualized Goals document. Strategies must be revised any time there is a

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modification to the ISP that changes the service specific outcome(s) and when the annual ISP is approved. These

strategy revisions must be completed within 15 business days of the ISP modification or approval of the annual ISP.

17.6.5.4.2 Community Inclusion Services – Activities Log

The Community Inclusion Services provider will complete the Community Inclusion Services – Activities Log on

each date services are delivered to indicate which strategies were addressed that day and provide a notation of

activities done to address the strategy and what occurred that day as these activities were conducted.

17.6.5.4.3 Community Inclusion Services – Annual Update

On an annual basis, according to the individual’s ISP plan year, the Community Inclusion Services provider will

provide a summary of that year’s services by completing the Annual Update. This annual documentation will assist

in the development of the ISP for the upcoming year.

17.6.5.5 Medication Standards

If the provider is distributing medications while delivering this service, the “Medication” standards described under

Day Habilitation Section 17.7.5.8 or Prevocational Training Section 17.15.5.7 (these standards are the same for

both services) shall be followed.

17.6.5.6 Quality Assurance/Monitoring

The Division will conduct quality assurance and monitoring of Community Inclusion providers in accordance with

the requirements of the Supports Program Quality Plan.

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17.7 Day Habilitation

Procedure

Codes

Units

Additional Descriptor

Budget Component

T2021HIUS

15 minutes*

Tier A

Employment/Day

(DSP Service applies)

T2021HIU1

15 minutes*

Tier A/Acuity Differentiated

Employment/Day

(DSP Service applies)

T2021HIUR

15 minutes*

Tier B

Employment/Day

(DSP Service applies)

T2021HIU2

15 minutes*

Tier B/Acuity Differentiated

Employment/Day

(DSP Service applies)

T2021HIUQ

15 minutes*

Tier C

Employment/Day

(DSP Service applies)

T2021HIU3

15 minutes*

Tier C/Acuity Differentiated

Employment/Day

(DSP Service applies)

T2021HIUP

15 minutes*

Tier D

Employment/Day

(DSP Service applies)

T2021HIU4

15 minutes*

Tier D/Acuity Differentiated

Employment/Day

(DSP Service applies)

T2021HIUN

15 minutes*

Tier E

Employment/Day

(DSP Service applies)

T2021HIU5

15 minutes*

Tier E/Acuity Differentiated

Employment/Day

(DSP Service applies)

Please refer to Appendix H for current rates.

*A 5% absentee rate is factored into the Day Habilitation rates to account for time that individuals may not attend

program.

17.7.1. Description

Services that provide education and training to acquire the skills and experience needed to participate in the

community, consistent with the participant’s Service Plan. This may include activities to support participants with

building problem-solving skills, self-help, social skills, adaptive skills, daily living skills, and leisure skills.

Activities and environments are designed to foster the acquisition of skills, building positive social behavior and

interpersonal competence, greater independence and personal choice. Services are provided during daytime hours

and do not include employment-related training. Day Habilitation may be offered in a center-based or community-

based setting.

17.7.2 Service Limits

Day Habilitation does not include services, activities or training which the participant may be entitled to under

federal or state programs of public elementary or secondary education, State Plan services, or federally funded

vocational rehabilitation. Day Habilitation is limited to 30 hours per week.

17.7.3 Provider Qualifications

All providers of Day Habilitation services must comply with the standards set forth in this manual. In addition,

Day Habilitation providers shall complete State/Federal Criminal Background checks and Central Registry checks

for all staff, drug tests as applicable under Stephen Komninos’ Law, and ensure that all staff successfully completes

the Division mandated training, are a minimum of 18 years of age, and possess a valid driver’s license and abstract

(not to exceed 5 points) if driving is required.

17.7.3.1 Day Habilitation Certification

All Day Habilitation service providers shall only operate after receiving a valid Day Habilitation Certification and

becoming an approved Medicaid/DDD provider for Day Habilitation services.

Day Habilitation Certification is required for each specific site, is time limited, and is non-transferable.

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17.7.3.1.1 Provisional Certification

Prior to submitting the Combined Application to become a Medicaid/DDD provider for Day Habilitation services,

providers are required to obtain Provisional Day Habilitation Certification. This one-year certification verifies that

the agency’s Day Habilitation services have met the minimum requirements to provide Day Habilitation services at

each location in which these services will be offered.

Prior to the expiration of the one-year provisional certification, a full audit of the provider’s day habilitation services

will be conducted in order to determine ongoing certification.

17.7.3.1.2 Ongoing Certification

Upon expiration of the Day Habilitation Certification, an audit of the provider’s Day Habilitation services will be

conducted in order to determine ongoing certification. Audits will be conducted for all sites operated by each

provider. Providers will receive a day habilitation certification based on the lowest score obtained through the

auditing process. Certifications will be issued as follows:

 5 Year Certification – All sites obtain compliance scores of 86% and above in both critical and significant

standards

 3 Year Certification – One or more sites obtain compliance scores between 85% and 70% in critical

and/or significant standards

 Conditional Certification – One or more sites receive compliance scores of 69% or below in critical and/or

significant standards

17.7.4 Day Habilitation Activities Guidelines

The Division of Developmental Disabilities encourages best practices and engaging activities in day habilitation

services (day programs) and offers the following guidance as a starting point for day habilitation service providers

in planning and executing comprehensive activities in their programs.

17.7.4.1 General Guidelines

Day habilitation service providers should include activities that follow the following general guidelines:

 Be Age-Appropriate;

 Offer Variety & Choice;

 Emphasize Community Experiences; and

 Focus on Small Groups and Individual Interactions and Experiences.

17.7.4.1.1 Examples of Activities

*Please note that examples are not all inclusive of everything that can be funded through this service

Activities should be individualized based on likes, dislikes, areas of interests, desires, dreams, etc. as documented

in the Person-Centered Planning Tool (PCPT). The following list is not exhaustive, but is simply to generate ideas

on the types of activities that can occur and assist with the development of positive programming.

17.7.4.1.1.1 Community Experiences

Some of the following community experiences can assist in developing personal interests:

 Shopping – budgeting, money management

 Restaurants – ordering from menus, personal choices, paying the bill

 Sports/fitness events and activities

 Library, Book clubs

 Health fairs

 Museums

 Cultural events

 Travel and community safety, use of public transportation

 Theater, community concerts

 Community festivals

 Holiday celebrations

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 Parks, walking, picnics

 Community gardens

17.7.4.1.1.2 Activities

 Cooking, meal preparation, food safety

 Money management

 Health, fitness

 Laundry

 Personal hygiene

 Classes on skill development

o Advocacy

o Assertiveness

o Communication

o Choices, decision-making

o Problem-solving

o Boundaries

o Healthy sexuality

o Relationship building

 Developing personal interests

o Cards and competitive/collaborative games

o Painting, artwork, drawing, constructing models, needlecraft, jewelry design, sculpting,

woodworking, scrapbooking, photography

o Theater, filmmaking

o Dancing, music, playing instruments, singing

o Horticulture, gardening, terrariums

o Athletics, sports, fitness

o Reading, books, poetry

o Computer and other devices/technology, social media experience

 Current events

 Telling time

 Cleaning

17.7.5 Day Habilitation Policies/Standards

In addition to the standards set forth in this manual, the service provider and staff must support and implement

individual behavior plans, as applicable, and comply with relevant licensing and/or certification standards.

17.7.5.1Need for Service and Process for Choice of Provider

The need for Day Habilitations services will typically be identified through the NJ Comprehensive Assessment

Tool (NJ CAT) and the person-centered planning process documented in the Person-Centered Planning Tool

(PCPT). Once this need is identified, an outcome related to the result(s) expected through the participation in Day

Habilitation services – including outcomes that may be employment-related – will be included in the Individual

Service Plan (ISP) and the Day Habilitation service provider will develop strategies to assist the individual in

reaching the desired outcome(s). Individuals and families are encouraged to include the Day Habilitation provider

in the planning process to assist in identifying and developing applicable outcomes.

It is recommended that the individual research potential service providers through phone calls, meetings, visits, etc.

to select the service provider that will best meet their needs.

The Day Habilitation service provider can require/request referral information that will assist the provider in

offering quality services. Once the Support Coordinator has informed the provider that the individual has selected

them to provide Day Habilitation services, the provider has five (5) working days to contact the individual and/or

Support Coordinator to express interest in delivering services.

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The agency identified to provide this service along with details regarding the extent of the service hours, duration,

frequency, etc. will be noted in the ISP providing prior authorization for the identified service provider to perform

this service. A copy of the approved ISP and Service Detail Report will be provided to the identified service

provider.

17.7.5.2 Minimum Staff Qualifications

The service provider shall meet the minimum staff qualifications and training set forth in this manual. Qualifications

and training shall be documented either in the employment application, resume, reference check, or other personnel

document(s).

17.7.5.2.1 All Staff

 Minimum 18 years of age; – AND –

 Complete State/Federal Criminal Background checks, Child Abuse Registry Information (CARI) checks,

and Central Registry checks;

 Valid driver’s license and abstract (not to exceed 5 points) if driving is required.

17.7.5.2.2 Executive Director or Equivalent

 Bachelor’s Degree or high school diploma (or equivalent); – AND –

 5 years’ experience working with people with developmental disabilities, 2 of which shall have been

supervisory in nature.

17.7.5.2.3 Program Management Staff/Supervisors

 High school diploma or equivalent; – AND –

 1 year experience working with people with developmental disabilities.

17.7.5.2.4 Direct Service Staff

 High school diploma or equivalent.

17.7.5.2.5 Professional Services Staff (nurses, psychologists, therapists), if applicable

 Credentials for their profession required by Federal or State law.

17.7.5.3 Mandated Staff Training & Professional Development

The service provider shall comply with any relevant licensing and/or certification standards. Agency Trainers must

have a minimum of 1 year experience in the field or 1 year experience in training. All staff providing Day

Habilitation services shall successfully complete the training outlined in Appendix E: Quick Reference Guide to

Mandated Staff Training.

17.7.5.4 Documentation and Reporting