New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 46D - CONTRIBUTION TO CARE AND MAINTENANCE REQUIREMENTS
Subchapter 2 - FINANCIAL CRITERIA
Section 10:46D-2.2 - Determination of financial ability to pay

Universal Citation: NJ Admin Code 10:46D-2.2

Current through Register Vol. 56, No. 6, March 18, 2024

(a) The individual or his or her legally responsible relative shall be required to apply for the Medicaid DDD Community Care Waiver and all other benefits and to provide financial information, including, but not limited to, assets, resources, income, or insurance. The individual or his or her legally responsible relative shall comply with all requirements of the Medicaid DDD Community Care Waiver and 10:46D-1.1 to maintain eligibility for benefits.

(b) The individual is required to fulfill the obligations under 10:46D-2.2, prior to the provision of residential services by the Division.

(c) The Division or its agent shall complete the initial assessment. The Division shall conduct the annual reassessment unless an agency licensed under N.J.A.C. 10:44A has been designated to collect the contribution. If an agency has been designated, the agency shall conduct the reassessment.

1. The individual, his or her legal guardian or LRR(s), shall authorize the release of information necessary to complete the financial assessment and annual reviews, at the time of the application for eligibility.

2. All information required to complete the financial assessment shall be kept confidential pursuant to 30:4-24.3, except to the extent necessary to enforce the obligation to contribute.

(d) The individual shall be assessed according to the formula of financial ability to pay at 10:46D-3.1 to determine the individual's or legally responsible relative's ability to pay for all or part of his or her cost of care and maintenance as fixed by the Commissioner.

(e) A written notice shall be sent which informs the individual, legal guardian and/or LRR(s) of the figures used and how the amount due was calculated.

(f) The individual, legal guardian, LRR(s) and/or other responsible parties may, at any time, inquire as to how the particular amount due to be paid was determined.

(g) The individual, LRR(s), and/or other responsible parties shall make such payments as are required by 10:46D-3.1 or 3.2 for the cost of care. The individual or legally responsible relative shall receive written instructions informing them to whom payment shall be made.

(h) Payment calculations for the individual and/or LRR(s) shall be reviewed and revised annually, by the Division or its agent.

(i) If the individual or legally responsible relative's income changes prior to the annual reassessment, the individual, other responsible parties or LRR(s) shall immediately notify in writing, the administrative head of the developmental center or agency providing residential services. In the case of the agency providing residential services, the agency shall be responsible to contact the Division. In such instances, the contribution may be changed by the Division.

(j) The annual calendar year increases to Social Security benefits and other periodic increases to benefits shall not be grounds for a revision to the annual budget for expenses. No requests for a revision of the assessed contribution for the cost of care and maintenance may be made under this circumstance. This increase shall be considered at the time of the next assessment.

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