N.J. Admin. Code § 8:133-3.4

Current through Register Vol. 56, No. 21, November 4, 2024

Section 8:133-3.4 - Responsibilities of the Discharge and/or Financial Unit

(a) The Discharge or Financial Unit or equivalent shall:

1. Receive and process referrals for community placement and financial assistance;

2. Render eligibility decisions for Interim Assistance based on information received from the Social Security Administration;

3. Assemble the necessary information and documents for SSI applications, forward this material to the Social Security Administration, and monitor the SSI application process, including follow-up with Social Security on any applications pending for more than six months;

4. Obtain placements in suitable and approved residential settings, including, but not limited to, out-of-State facilities licensed by other states if located in an area served by New Jersey Medicaid providers and obtain signed Contracts for Interim Assistance (Appendix C) from congregate care providers or from a responsible family member, as appropriate for placements in a family residence;

5. Assist clients in negotiating community financial systems;

6. Provide follow-up contacts to ensure that the Personal Needs Allowance and maintenance payments are being regularly received and properly utilized;

7. Assist clients interested in appealing their denial by referring them to an agency for legal representation;

8. Notify the business manager to terminate Interim Assistance payments when eligibility or ineligibility for SSI benefits is established.

9. Notify the Social Security Administration of any change in the client's living arrangement, such as a return to the hospital or an elopement from the home; and

10. Notify the social services staff that the retroactive check is received and Interim Assistance has been terminated.

(b) The Discharge or Financial Unit or equivalent shall maintain a record of each referral received and processed. This record shall contain the dates when:

1. A referral is received;

2. Interim Assistance is approved or denied;

3. Authorization for Reimbursement of Assistance from SSI Award, Community Placements, form MH-30, with appropriate hospital GR Code is forwarded to the Social Security Administration District Office. GR codes are as follows:

i. Ancora--31910

ii. Greystone Park--31920

iii. Ann Klein Forensic Center--31980;

iv. Trenton--31940

v. Hagedorn--31950

4. A Contract for Interim Assistance is signed;

5. The hospital business manager is provided with written authorization to initiate Interim Assistance payments;

6. The housing provider is given 30 days notice of the State's intent to terminate the Contract for Interim Assistance. This requirement does not apply when the client is living with his or her family at home, when issues of life/safety or client welfare are involved, or when the resident leaves the home of his or her own accord;

7. An SSI application is forwarded to the Social Security Administration District Office;

8. An approval or denial of the SSI application is received; and

9. Interim Assistance is terminated.

(c) The Financial Entitlement Unit or equivalent shall, within five working days of receipt of a referral:

1. Submit an initial inquiry to the Social Security Administration to verify social security numbers and to determine if the client is already a recipient of SSI. (If clients are already on the active rolls of SSI and are not subject to the redetermination process they are generally not in need of the Interim Assistance Program);

2. Obtain from the treating psychiatrist or physician form SSA-787, Physician's/Medical Officer's Statement of Patient's Capability to Manage Funds (Appendix J);

3. Make an assessment of the client's potential SSI eligibility based on available documents and information. This evaluation shall result in one of the following decisions:

i. The client is eligible for Interim Assistance payments because he or she meets the eligibility criteria of the Interim Assistance Program and appears to be potentially eligible for SSI benefits; or

ii. The client is ineligible for Interim Assistance payments because he or she does not meet Interim Assistance eligibility criteria and/or does not appear to be potentially eligible for SSI benefits; and

4. Obtain from treating psychologist or psychiatrist a Social Security disability report form.

(d) The Financial Entitlement Unit or equivalent shall, for a client assessed as eligible for Interim Assistance:

1. Obtain from the client a signed SSI application (including an authorization to release medical records signed by the client) and a Payee Agreement (Appendix E);

2. Obtain the signature of the client's representative payee on the Representative Payee Agreement (Appendix E2);

3. As early as possible, notify the Medicaid Institutional Services Section about the client's impending placement date and location;

4. Forward, within two working days of the placement, the Payee Agreement and the signed form MH-30 to the hospital business manager;

5. Forward, within two working days of placement, one copy of the signed MH-30 to the Social Security Administration District Office, one copy to the client and retain one copy for the Financial Entitlement Unit's file;

6. For clients not on the active SSI rolls (within the past year), forward a completed SSI referral packet. This packet shall contain all required hospital forms and reports, necessary SSI application and supporting documents, and a copy of the court order of discharge, if applicable. The packet should be forwarded to the Social Security Administration District Office within 15 calendar days of submission of the signed form MH-30 to the Financial Entitlement Unit; and

7. Notify the client, the hospital business manager, the hospital social worker and the Office of Fiscal and Management Operations of the Division of Mental Health Services, in writing, of the client's eligibility for Interim Assistance.

(e) The Discharge Unit or equivalent shall:

1. If the client is not returning to his or her own home or family, locate an available, affordable and suitable approved residential facility or drug or alcohol treatment program for the client. Such facility shall be licensed and/or under contract to either the Division of Mental Health Services, the Division of Developmental Disabilities, the Department of Community Affairs, or the Department of Health, as appropriate;

2. If the client is not returning to his or her own home or family, the placement social worker shall visit the selected site with the client and, if the client finds it acceptable:

i. Review the Contract for Interim Assistance with the provider and assure that he or she understands the program procedures and payment system;

ii. Have the housing provider sign the Contract for Interim Assistance;

iii. Place the client in the selected facility; and

iv. Forward the signed Contract for Interim Assistance to the hospital business manager.

(f) The Financial Coordinator or equivalent shall:

1. Present to the hospital business manager, on the day of the client's placement, a written authorization for the client's initial Personal Needs Allowance payment;

2. Provide an authorization for PNA to the hospital business manager for each month that the client remains on Interim Assistance;

3. Keep the case active for as long as the client remains on Interim Assistance to ensure that Personal Needs Allowance and maintenance payments are being received and properly utilized.

4. Notify the hospital business manager of the client's SSI approval;

5. Notify the client and the hospital business manager in writing when Interim Assistance payments are being terminated as soon as possible but in no case later than the effective date of termination; and

6. Send the hospital business manager, if requested, an Interim Assistance maintenance report covering the client's final month on the program.

(g) For a client who has been found eligible for Interim Assistance and is subsequently denied SSI benefits, the Financial Entitlement Unit or equivalent shall:

1. Assist the client in filing an appeal to the Social Security Administration;

2. If the client files an appeal with the Social Security Administration, continue Interim Assistance payments upon authorization by the Financial Coordinator or equivalent during the period of the SSI reconsideration and the hearing at the Administrative Law level;

3. Assist the client in obtaining legal representation from the Community Health Law Project or local legal services corporation, as appropriate, for purposes of appealing an adverse SSI decision;

4. Notify Medicaid's Institutional Services Section of the SSI denial and the client's intent to appeal so that the Division of Medical Assistance and Health Services will be able to provide any assistance possible in the client's appeal and continue Medicaid coverage until the appeal is adjudicated;

5. Continue Interim Assistance until the SSI retroactive check is received in cases where the appeal to the Social Security Administration is successful;

6. Notify Medicaid's Institutional Services Section of the outcome of appeals to the Social Security Administration;

7. Immediately refer the client for General Assistance and continue Interim Assistance until a payment is received from the municipal welfare director, or up to 30 calendar days, whichever is less, in cases where the appeal to the Social Security Administration is unsuccessful;

8. Monitor the processing of the General Assistance application and notify the hospital business manager when the initial general assistance payment is received by the client; and

9. Immediately refer the client for General Assistance if the client fails or refuses to file an appeal to the Social Security Administration and continue Interim Assistance until a check is received from the municipal welfare director, or up to 30 calendar days, whichever is less.

(h) The Financial Entitlement Unit or equivalent shall, for a client assessed as ineligible for Interim Assistance:

1. Notify the client and the hospital social worker in writing of the client's ineligibility for Interim Assistance;

2. Advise the client of reason(s) for denial of Interim Assistance and of his/her right to appeal the decision, including procedures to be followed;

3. Assist the client in filing an appeal to the Financial Coordinator; and

4. Inform the client of the availability of General Assistance and of the procedures to be followed in applying for benefits, and assist the client in filing a General Assistance application.

N.J. Admin. Code § 8:133-3.4

Recodified from 10:38-3.4 54 N.J.R. 65(a), effective 1/3/2022