Current through Register Vol. 56, No. 18, September 16, 2024
(a) A
child, youth, or young adult may be eligible for YCM 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 systems administrator (CSA), to require YCM services due to
any one or any combination of the following:
i. He or she has emotional or behavioral
health challenges which adversely affect his or her capacity to function in the
community;
ii. The child, youth or
young adult and his or her family or caregiver requires face-to-face assistance
in obtaining and coordinating treatment, rehabilitation, financial and/or
social services, without which the child, youth or young adult could reasonably
be expected to require more intensive services, including, but not limited to,
intensive case management services provided by a care management organization
(CMO), to maintain an optimal functional capacity; and
iii. The child, youth, or young adult's CSOC
assessment indicates a need for the level of case management services provided
by a YCM.
(b)
Referrals to YCMs for YCM services shall be made in accordance with this
subchapter and only by the Department of Children and Families, or other agent
designated by the Department of Children and Families, including, but not
limited to, the CSA.
(c) A child,
youth, or young adult shall not be referred for YCM services if:
1. The child, youth or young adult's sole
diagnosis is:
i. Substance abuse;
or
ii. Developmental
disability;
2. The
child, youth, or young adult's CSOC assessment, or an evaluation performed by
an authorized agent of the Department of Children and Families, does not
indicate a need for YCM services;
3. The child, youth or young adult no longer
requires YCM services to effectively function within the home and community;
or
4. The child, youth or young
adult or his or her parent or caregiver refuse YCM services.
(d) A child, youth, or young adult
shall be discharged from YCM services if:
1.
The child, youth, or young adult's CSOC assessment, ISP, and other relevant
information indicate that the child, youth, or young adult no longer needs YCM
services; or
2. The child, youth or
young adult or his or her parent or caregiver refuse YCM services.
(e) The youth case manager shall
provide information to the child, youth or young adult, or to his or her parent
or caregiver, regarding accessing the appropriate level of services to meet the
needs of the child, youth or young adult and shall provide assistance in the
transition to the level of case management services recommended in the ISP, if
such services are needed, for any child, youth or young adult who is discharged
from YCM services.
