New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 73 - CASE MANAGEMENT SERVICES
Subchapter 1 - GENERAL PROVISIONS
Section 10:73-1.2 - Definitions

The following words and terms, when used in this chapter, shall have the following meanings, unless the context indicates otherwise:

"Advocacy" means the ongoing process of assisting the beneficiary in receiving, and maintaining receipt of, all services and benefits to which he or she is entitled by working toward the removal of barriers to receiving needed services and benefits.

"Assessment" means the ongoing process of identifying and reviewing a beneficiary's strengths, deficits, and needs based upon input from the beneficiary and significant others including, but not limited to, family members and health professionals. The assessment process continues throughout the entire length of service. The assessments are updated periodically based upon availability of beneficiary information and the requirements of this chapter.

"Beneficiary monitoring" means the ongoing review by the provider of the beneficiary's status and needs.

"Case management services" means those services which will assist a beneficiary of Medicaid/NJ FamilyCare or a child, youth, or young adult receiving services from the Children's System of Care (CSOC) in gaining access to needed medical, social, educational, and other services.

"Centers for Medicare & Medicaid Services (CMS)" means the agency of the Federal Department of Health and Human Services which is responsible for the administration of the Medicaid program and the State Children's Health Insurance Program (SCHIP) in the United States.

"Child Protection and Permanency (CP & P)" means the agency that is the organizational component within the New Jersey Department of Children and Families that administers the Title IV-E program of the Social Security Act, Federal Payments for Foster Care and Adoption Assistance, 42 U.S.C. §§ 670-679b.

"Children's System of Care (CSOC)" means the organizational component within the Department of Children and Families that provides a comprehensive approach to the provision of mental health and behavioral health services to eligible children, youth, and young adults.

"Contract systems administrator (CSA)" means an administrative organization contracted by, and serving as an agent of, the State of New Jersey to provide utilization management, care coordination, quality management and information management for the Department of Children and Families' Children's System of Care (CSOC) in its management of the Statewide system of care that provides mental and behavioral health services and supports to eligible children, youth, and young adults.

"Contract systems administrator care coordination (CSACC)" means management and coordination of the assessment process by the CSA for children, youth and young adults with mental or behavioral healthcare needs.

"Department of Children and Families (DCF)" means the department of New Jersey government, created by P.L. 2006, c. 47, that has the goal of ensuring safety, permanency, and well-being for all children and has direct responsibility for child welfare and other child and family services, supported by strong inter-agency partnerships among other State departments also responsible for family services. The new department includes Child Protection and Permanency, the Children's System of Care (CSOC), the Division of Prevention and Community Partnerships, and the New Jersey Child Welfare Training Academy.

"DHS" means the New Jersey Department of Human Services.

"Division of Mental Health and Addiction Services (DMAHS)" means the organizational component of the New Jersey Department of Human Services that is responsible for the administration of the State's mental health programs, primarily for adults.

"Healthcare Common Procedure Coding System (HCPCS)" means a nationwide coding system, established and maintained by CMS in accordance with the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191. Level 1 codes are adapted from codes published by the American Medical Association in the Common Procedural Terminology (CPT) and are utilized primarily by physicians and independent clinical laboratories. Level 2 codes are assigned by CMS for physician and non-physician services which are not in the CPT.

"Juvenile Justice Commission (JJC)" means the agency in, but not of, the Department of Law and Public Safety which is mandated by statute to develop and operate both non-secure residential programs and secure facilities for adolescent juvenile offenders sentenced to the Commission by the New Jersey Superior Court, Family Part, and to provide parole supervision to juvenile inmates released by the New Jersey Parole Board. (See N.J.S.A. 52:17B-17O)

"Service planning" means the process of organizing the outcomes of the assessment in collaboration with the beneficiary, significant others, potential service providers, and others as designated, to formulate a written service plan that addresses the beneficiary's needs, planned services to address these needs, and plans to motivate the beneficiary to utilize services. The service planning process continues throughout the beneficiary's entire length of stay with the case management entity.

"Service provider monitoring" means the process of routine follow up with the beneficiary's service providers to assess provision and coordination of all aspects of the services specified in the beneficiary's service plan.

"Services linkage" means the referral to and enrollment with other appropriate service providers for the purposes of addressing the needs identified in the beneficiary's assessment, including facilitating linkages to community resources or services included in the beneficiary's treatment goals.

"Young adult" means, for purpose of eligibility for CSOC services, an individual at least 18 years of age and under 21 years of age who:

1. Prior to becoming 18 years of age, received services from the child-serving system in New Jersey, including, but not limited to:

i. CSOC;

ii. CP & P;

iii. The Juvenile Justice Commission; or

iv. Any other child-serving State agency; and

2. Demonstrates a clinical need for the continuation of services provided by the CSOC, as part of the transition into adult services.