You probably know by now that NJ Medicaid’s Home and Community Based Services are now being administered NJ FamilyCare and that the State’s Comprehensive Medicaid Waiver has created a whole new landscape that is centered around managed care. http://www.state.nj.us/humanservices/dmahs/home/mltss.html When applying for these services you will encounter a lot of code words. For example, when your low-income or low-asset loved one is being discharged from the hospital, you might be told that “as soon as he’s eligible financially for MLTSS, you need to contact the ADRC, request a referral to OCCO for a PAS, then file an application at the CWA and then if they meet LOC, you’ll receive a PoC that includes HBSC and PCA, but you could choose the PPP instead, and you’ll have to sign off on the PoP and select an MCO.” Aagh! So I thought I’d help out by listing them here:
DHS – NJ Department of Human Services
DAS – Division of Aging Services
DMAHS – Division of Medical Assistance and Health Services (administers NJ Family Care)
ADRC – Aging & Disabiality Resource Connection – or AAA – Area Agency on Aging ( a county-based portal of entry for people seeking referrals for governmental programs)
DDS – Division of Disability Services (makes clinical determinations)
CWA – County Welfare Agency, sometimes called a Board or Division of Social Services (this is where the Medicaid application is filed and processed)
OCCO – Office of Community Choice Options (sends out the person to perform the clinical PAS, and decides whether to issue the PAS)
PAS – Pre-Admission Screening (required to establish clinical eligibility for Medicaid services)
LOC – Level of Care ( as in “she does not meet the level of care to receive services”)
HCBS – Home and Community Based Services (its an umbrella for many waiver services)
LTC – Long Term Care (nursing home care)
TBI – Traumatic Brain Injury Program ( a waiver program)
GO – Global Options (an older HCBS program waiver program under secn. 1915(c))
MFP – Money follows the Person, ( a federal mandate for funds to follow a person who is leaving a nursing home and going back to the community with services)
MCO – Managed Care Organization (all new Medicaid recipients must select an MCO to manage their care)
PoC – Plan of Care (must be developed by the Care Manager from the MCO before services are started)
There are a variety of types of services that can be incorporated into a PoC. These include HBSC – Home-Based Supportive Care (non-medical, such as help with chores); PCA – Personal Care Assistant; PERS – personal Emergency Response System (phone button or necklace); PDN – Private Duty Nursing (required for specific medical needs, up to 16 hours per day);
PPP – Personal Preference Program (Medicaid recipient becomes the employer and controls the terms and conditions of employment of their caregiving team)
IDT – Interdisciplinary Team review (done to assess costs and risks of the PoC)
ACT – Annual Cost Threshold (all services in the PoC are measured in comparison to this per-person capitation rate)
Next time … thoughts on the level-of-care assessment process.
Call us for legal advice on Medicaid eligibility … 732-382-6070