New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 73 - CASE MANAGEMENT SERVICES
Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES
Section 10:73-3.5 - Eligibility and referral for CMO services
Universal Citation: NJ Admin Code 10:73-3.5
Current through Register Vol. 56, No. 18, September 16, 2024
(a) A child, youth, or young adult may be eligible for CMO services if:
1. He or she meets the requirements of this
subchapter and is:
i. Enrolled in Medicaid/NJ
FamilyCare as described at N.J.A.C. 10:49-2, and not enrolled in: :
(1) The Medically Needy Program, except that
pregnant women in that program may be eligible;
(2) The Home and Community Based Services
Waiver Program;
(3) The DDD Waiver
Program;
(4) The Traumatic Brain
Injury Waiver Program;
(5) The
Community Resources for People with Disabilities Waiver Program; or
(6) The Home Care Expansion Program;
or
ii. Receiving
services from the Children's System of Care and is not eligible for Medicaid/NJ
FamilyCare; and
2. He or
she has been determined by the Department of Children and Families, or its
designated contract system administrator (CSA), to require CMO services due to
any one or any combination of the following:
i. Serious emotional or behavioral health
challenges resulting in significant functional impairment which adversely
affects his or her capacity to function in the community;
ii. His or her CSOC assessment indicates a
need for the intensive level of case management services provided by a
CMO;
iii. He or she is involved
with one or more agencies or systems, including, but not limited to:
(1) DMHAS;
(2) CP & P;
(3) Crisis/emergency service
providers;
(4) Department of Human
Services or Department of Children and Families provider agencies;
(5) JJC; or
(6) The court system;
iv. A risk of disruption of a current
therapeutic placement exists;
v. A
risk of a psychiatric rehospitalization exists; or
vi. A risk of placement outside the home or
community exists, except for:
(1) Foster care
placement, unless one or more of the conditions in (a)2i through v above are
also present.
(b) Referrals to CMOs for CMO services shall be made only by the Department of Children and Families' Children's System of Care Implementation Team or other agent designated by the Department, including, but not limited to, the CSA.
(c) A child, youth, or young adult shall not be referred for CMO services if:
1. His or
her immediate crisis is not stabilized;
2. His or her sole diagnosis is:
i. Substance abuse; or
ii. Developmental disability;
3. His or her CSOC assessment, or
an evaluation performed by an authorized agent of the Department of Children
and Families, does not indicate a need for CMO services; or
4. The child, youth or young adult, or his or
her parent or caregiver, refuses CMO services.
(d) All records supporting determinations of eligibility or ineligibility made in accordance with this subchapter shall be maintained by the CMO provider.
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