Acuity Factor – an amount added to the tier for individuals with high clinical support needs based on medical and/or behavioral concerns, notated by “a” next to the tier assignment. The acuity factor can also impact the rate and/or unit of a service base rate for services where that may be applicable.
Bump-Up – a short-term increase in an individual’s budget if he/she experiences changes in life circumstances that result in a need for additional temporary services that exceed his/her budget. A bump-up is capped at $5,000 per individual, will be effective for up to one year, and can only be provided once every three years.
CCW – the Division of Developmental Disabilities initiative included in the Comprehensive Medicaid Waiver (CMW) that provides needed supports and services for individuals eligible for DDD who are not on the Community Care Waiver (CCW).
Centers for Medicare and Medicaid Services (CMS) – the federal agency within the U.S. Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children’s Health Insurance Program (SCHIP), and health insurance portability standards.
Children’s System of Care (CSOC) – the Division within the New Jersey Department of Children and Families that serves children (under 21) with emotional and behavioral health care challenges and their families and children (under 21) with developmental and intellectual disabilities and their families. Services include community-based services, in-home services, out-of-home residential services, and family support services.
College of Direct Support (CDS) – a collection of web-based courses designed for direct support staff, people with disabilities, their families and others who support people with disabilities. The course work connects learners with a nationally recognized curriculum that empowers people to lead more independent and self-directed lives.
Commission for the Blind and Visually Impaired (CBVI) – the Division within the New Jersey Department of Human Services that provides Specialized services to persons who are blind or visually impaired and provides education in the community to reduce the incidence of vision loss.
Community Care Waiver (CCW) – a New Jersey Home and Community-Based Services (HCBS) Medicaid waiver program that funds community-based services and supports for adults (age 21 and older) with intellectual and developmental disabilities who have been assessed to meet the specified level of care (LOC) for Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/ID) – i.e., an institutional level of care.
Comprehensive Medicaid Waiver (CMW) – the New Jersey Department of Human Services’ Medicaid waiver that is a collection of reform initiatives designed to sustain the program long-term as a safety-net for eligible populations, rebalance resources to reflect the changing healthcare landscape and prepare the state to implement provisions of the federal Affordable Care Act in 2014. The CCW is the Division of Developmental Disabilities’ initiative within this waiver.
Department of Children & Families (DCF) – the state agency that works to ensure the safety, well-being and success of children, youth, families and communities.
Department of Education (DOE) – the Department in state government that oversees the programs and services provided in all public and nonpublic primary and secondary schools in New Jersey; administers state and federal aid to schools and school districts; and establishes and regulates New Jersey’s educational policies.
Department of Human Services (DHS) – the Department of state government that serves seniors, individuals and families with low incomes; people with mental illnesses, addictions, developmental disabilities, or late-onset disabilities; people who are blind, visually impaired, deaf, hard of hearing, or deaf-blind; parents needing child care services, child support and/or healthcare for their children; and families facing catastrophic medical expenses for their children. DHS and its eight divisions provide programs and services designed to give eligible individuals and families the help they need to find permanent solutions to a myriad of life challenges.
Department of Labor and Workforce Development (LWD) – the Department of state government that provides workforce development, family leave insurance, analyzes labor market information, health and safety guidelines, social security disability programs, temporary disability, unemployment benefits, worker’s compensation and resources for employers. The Department of LWD also provides services and support to individuals with disabilities in the workforce through the Division of Vocational Rehabilitation Services. Division Circulars – documents issued by the Assistant Commissioner of the Division of Developmental Disabilities which set policy for the various agencies within the Division. Division Circulars can be found on the Division of Developmental Disabilities’ website at http://www.nj.gov/humanservices/ddd/news/publications/divisioncirculars.html
Division of Developmental Disabilities (DDD) – the Division within the New Jersey Department of Human Services that coordinates funding for services and supports that assist adults age 21 and older with intellectual and developmental disabilities to live as independently as possible. An overview of DDD is outlined in section 1.2 in this manual.
Division of Vocational Rehabilitation Services (DVRS) – the Division within the New Jersey Department of Labor and Workforce Development that provides services to assist individuals with disabilities to prepare for, obtain, and/or maintain competitive employment consistent with their strengths, priorities, needs and abilities.
Employment/Day Budget Component – the portion of the individual budget that can be used to purchase services that are categorized as supporting an individual with their employment and day support needs based. An indication of the budget component in which each service is categorized is available within the table provided for each service in Section 17 of this manual.
Fair Hearing – an administrative proceeding to resolve an appeal of a Medicaid waiver-funded service when the service has been denied, or will be reduced, suspended or terminated.
Fiscal Intermediary (FI) – the entity that manages the financial aspects of the CCW on behalf of an individual choosing to direct their services through a Self-Directed Employee. In addition, the FI acts as a conduit for an organization or enterprising entity that is not a Medicaid provider but engages in commercial, industrial, or professional activities that are offered to the general public and will be available to individuals enrolled in the CCW. More information about the Responsibilities of the FI can be found in section 10 of this manual.
Health Information and Portability and Accountability Act (HIPAA) – the federal law passed by Congress in 1996 that protects the privacy of protected health information (PHI) and personally identifiable information (PII) and establishes national standards for its written, oral, and electronic security.
Home and Community-Based Services (HCBS) – Medicaid-funded services and supports that are provided to individuals in their own home or community. HCBS programs serve a variety of targeted populations groups, including individuals experiencing chronical illness or individuals with mental illnesses, intellectual or developmental disabilities, and/or physical disabilities.
Individual/Family Supports Budget Component – the portion of the individual budget that can be used to purchase services that are categorized as providing support to the individual and/or family in addition to their employment/day services. An indication of the budget component in which each service is categorized is available within the table provided for each service in Section 17 of this manual.
Individual/Participant – an adult age 21 or older who has been determined to be eligible to receive services funded by the Division of Developmental Disabilities.
Individual Budget – an up-to amount of funding allocated to an eligible individual based on his/her tier assignment in order to provide services and supports. Each Individual Budget is made up of an Employment/Day budget component and an Individual/Family Supports budget component.
Individualized Service Plan (ISP) – the standardized Division of Developmental Disabilities’ service planning document, developed based on assessed needs identified through the NJ Comprehensive Assessment Tool (NJCAT); the Person-Centered Planning Tool (PCPT); and additional documents as needed, that identifies an individual’s outcomes and describes the services needed to assist the individual in attaining the outcomes identified in the plan. An approved ISP authorizes the provision of services and supports.
iRecord – DDD’s secure, web-based electronic health record application.
Level of Care – the assessed level of assistance an individual requires in order to meet his/her health and safety needs and accomplish activities of daily living. Eligibility for certain Medicaid-funded long-term services and supports is tied to an individual’s Level of Care designation.
Managed Care Organizations (MCO) – organizations, also known as HMOs or health plans, that contract with state agencies to provide a health care delivery system that manages cost, utilization and quality of Medicaid health benefits and additional Medicaid services.
Managed Long Term Services & Supports (MLTSS) – the program that ensures the delivery of long-term services and supports through New Jersey Medicaid’s NJ FamilyCare managed care program. MLTSS is designed to expand home and community-based services, promote community inclusion and ensure quality and efficiency. MLTSS provides comprehensive services and supports, whether at home, in an assisted living facility, in community residential services, or in a nursing home.
Medicaid – a federal and state jointly funded program that provides health insurance to parents/caretakers and dependent children, pregnant women, and people who are aged, blind or disabled. These programs pay for hospital services, doctor visits, prescriptions, nursing home care and other healthcare needs, depending on what program a person is eligible for.
National Core Indicators (NCI) – standard measures used across states to assess the outcomes of services provided to individuals and families. Indicators address key areas of concern including employment, rights, service planning, community inclusion, choice, and health and safety. NCI is a voluntary effort by public developmental disabilities agencies to measure and track their own performance.
NJ Comprehensive Assessment Tool (NJ CAT) – the mandatory needs-based assessment used by the Division of Developmental Disabilities as part of the process of determining an individual’s eligibility to receive Division funded services and assessing an individual’s support needs in three main areas: self-care, behavioral, and medical.
Person Centered Planning Tool (PCPT) – a mandatory discovery tool used to guide the person centered planning process and to assist in the development of an individual’s service plan.
Planning for Adult Life Project – a statewide project funded by the NJ Division of Developmental Disabilities (DDD) to assist students (ages 16-21) with developmental disabilities and their families in charting a life course for adulthood. This project facilitates student and parent groups and offers informational sessions, webinars, and resource materials that address core areas that include but are not limited to employment, postsecondary education, housing, legal/financial planning, self-direction, health/behavioral health, and planning/visioning a life course.
Planning Team – a team of people, with a valuable connection to the individual, that participate in planning meetings and contribute to the development of the PCPT and ISP. At a minimum, the planning team includes the individual and Support Coordinator. Parents, family members, friends, service providers, coworkers, etc. are also often included in the planning team as established by the individual.
Prior Authorization – the approval – obtained prior to service delivery – that details start/end dates, number of units, and procedure codes authorized in order for the identified provider(s) to receive payment for services once they have been rendered.
Provider Database – a searchable database of approved service providers.
Self-Directed Employee (SDE) – a person who is recruited and offered employment directly by the individual or the individual’s authorized representative to perform waiver services for which SDEs are qualified.
Service Provider – the entity or individual who will provide the waiver service(s) indicated in the ISP. Service providers must meet the qualifications and standards related to the service(s) being offered.
Support Coordination Agency (SCA) – an organization approved by the Medicaid and the Division of Developmental Disabilities to provide services that assist participants in gaining access to needed program and state plan services, as well as needed medical, social, educational, and other services.
Support Coordination Supervisor (SCS) – the professional within a Support Coordination Agency that provides oversight and management of the Support Coordinators and approves ISPs.
Support Coordinator (SC) – the professional responsible for developing and maintaining the Individualized Service Plan with the participant, their family, and other team members; linking the individual to needed services; and monitoring the provision of services included in the Individualized Service Plan.
Supported Employment Budget Component – an additional component of the individual budget that can be accessed in situations when the individual budget does not sustain the level of Supported Employment – Individual Employment Support needed in order for the individual to find or keep a competitive job in the general workforce.
Tier – an assigned descriptor, based on support needs determined through the NJ CAT, that determines the individual budget and reimbursement rate a provider will receive for that individual for particular services.