New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 73 - CASE MANAGEMENT SERVICES
Subchapter 4 - YOUTH CASE MANAGEMENT YCM SERVICES
Section 10:73-4.5 - Youth Case Management (YCM) services; program description

Universal Citation: NJ Admin Code 10:73-4.5

Current through Register Vol. 56, No. 18, September 16, 2024

(a) Youth Case Management (YCM) services are case management services provided to Medicaid/NJ FamilyCare beneficiaries of CSOC services who are under the age of 18 or those young adults between the ages of 18 and 21 who are transitioning from the child service system to the adult service system. YCM services ensure that individualized mental, emotional, and/or behavioral health services are obtained for the child, youth, or young adult by advocating for necessary mental/behavioral services and other necessary financial, educational, social, or other services to serve the needs of the child, youth, or young adult by restoring, enhancing, and maintaining an optimal level of functioning, ultimately reducing or eliminating the need for case management services.

1. YCM services that are included as part of a transition/discharge plan from inpatient psychiatric hospitalization, CMO services or other more intensive level of services, including, but not limited to, discharge from a residential mental health rehabilitation program or inpatient psychiatric hospitalization, are intended to support the maintenance of the child, youth or young adult's attained treatment goals to facilitate a successful transition from inpatient hospitalization or CMO services and prevent a relapse which would result in rehospitalization or the need for additional intensive services or return to previous out-of-home placement.

(b) YCM services shall include, but shall not be limited to:

1. Coordinating transition into YCM services in collaboration with the CSA, the family and the community providers, and facilitating transition out of YCM services to an alternate level of care and case management as appropriate, ensuring linkages are in place prior to the transition out of YCM services;

2. Assessment, which is the ongoing process of identifying, reviewing and updating a child, youth or young adult's strengths and needs, based upon input from the child, youth or young adult, the caregiver(s), significant others including family members, and behavioral health/mental health professionals. The assessment process continues throughout the entire time the child, youth or young adult receives YCM services;

3. Service planning, which is the process of organizing the outcomes of the assessment in collaboration with the child, youth or young adult, the caregivers, significant others, potential service providers, and others as designated, coordinating the receipt of the concurrent review information from provider(s) and formulating a written service plan that addresses the child, youth or young adult's needs, planned services to address these needs, and plans to remain in the community. The service planning process continues throughout the child, youth or young adult's length of stay in YCM services;

4. Services linkage, which is the ongoing referral to, and enrollment and participation in, mental health and/or non-mental health program(s). Mental health program linkage means that the child, youth or young adult has completed the mental health program's intake process, that the child, youth or young adult has been accepted for service, and that the child, youth or young adult has effectively participated in the program. Services linkage includes ensuring that individualized services are obtained for the child, youth or young adult by facilitating linkages to community based resources and/or services included in the plan of care and preparing referral material for possible placement of the child, youth or young adult into an out-of-home treatment setting;

5. Ongoing monitoring, which consists of both beneficiary monitoring and service provider monitoring by the case manager, as follows:
i. Beneficiary monitoring, which is the ongoing review of the child, youth or young adult's status and needs, the frequency of which is contingent upon the child, youth or young adult's risk status and reported changes from the child/youth/young adult, significant others and/or service providers. An update of the service plan may result from the monitoring process to address changing needs. Beneficiary monitoring includes reviewing progress made toward the attainment of the defined treatment goals included in the individual YCM service plan, and ensuring that the child, youth or young adult and his or her family or caregiver is afforded the opportunity to participate in the beneficiary monitoring and review process; and

ii. Service provider monitoring, which is the process of routine follow-up with the child, youth or young adult's service providers to assess if services are provided as planned and if they meet the child, youth or young adult's needs. Provider monitoring may result in the adjustment of the service plan including provider changes. Service provider monitoring includes the following:
(1) Monitoring the plans, including the medication management plan for beneficiaries in need of such plans; and

(2) Coordination of services from multiple providers including calling and coordinating treatment team meetings of a child, youth or young adult's service providers until the child, youth or young adult leaves the YCM program;

6. Ongoing support services, which is the provision of face-to-face individualized support services for a child, youth or young adult and their natural support system, including their family. The frequency of support services is contingent upon the child, youth or young adult's individual needs; and

7. Advocacy, which is the process of assisting the child, youth or young adult in accessing, receiving and maintaining receipt of all benefits to which he or she is entitled. Beneficiary advocacy is an ongoing activity of the case manager, and includes advocating for services to meet the needs, desires and rights of the child, youth or young adult and his or her family or caregiver.

(c) YCM services include eligibility processing activities. All YCM providers shall:

1. Complete a presumptive eligibility (PE) application for each child, youth and young adult who is not otherwise covered under Medicaid/NJ FamilyCare at the time of the referral to the YCM, if the PE process has not already been initiated by another entity;

2. Submit all PE applications to DMAHS;

3. Assure that YCM case management and other appropriate staff complete DMAHS PE training;

4. Assist the child, youth or young adult and/or his or her family in collecting the documentation required to complete and submit a Medicaid/NJ FamilyCare application within 30 days of enrollment, if this process has not already been initiated by another entity;

5. As family circumstances indicate, review eligibility factors for each beneficiary and assist the beneficiary and/or his or her family in applying for any and all benefits for which they may be eligible, including, but not limited to, Medicaid/NJ FamilyCare; and

6. Assist the beneficiary and/or his or her family in maintaining eligibility for Medicaid/NJ FamilyCare and other benefits.

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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