New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 79B - COMMUNITY SUPPORT SERVICES FOR ADULTS WITH MENTAL ILLNESS
Subchapter 2 - PROGRAM STANDARDS
Section 10:79B-2.1 - Beneficiary eligibility
Current through Register Vol. 56, No. 18, September 16, 2024
(a) Adult Medicaid/NJ FamilyCare Plan A and Alternative Benefit Plan beneficiaries (18 years or older) shall be eligible for adult CSS provided in/by community support service providers, if the client has a serious mental illness and such services have been determined by the Division of Mental Health and Addiction Services (DMHAS) or an authorized agent contracted with the Department of Human Services to be clinically necessary using the criteria established by DMHAS (see N.J.A.C. 10:37B). Other diagnoses not listed in N.J.A.C. 10:37B may be approved by DMHAS or their authorized agent if determined appropriate. The diagnoses shall be made by the referring agency or provider.
(b) NJ FamilyCare-Plans B, C, and D beneficiaries are not eligible for CSS.
(c) Beneficiaries eligible as "medically needy" in accordance with N.J.A.C. 10:70 shall not be eligible for CSS provided in/by community support service providers.
(d) DMHAS or a designated entity acting on behalf of DMHAS shall offer to eligible beneficiaries the opportunity to choose a CSS provider.