N.J. Admin. Code § 10:46D-2.2 - Determination of financial ability to pay
(a) The
individual, or his or her legally responsible relative, shall be required to
apply for the Medicaid DDD Community Care Program and all other benefits and to
provide financial information, including, but not limited to, assets,
resources, income, or insurance. The individual, or his or her legally
responsible relative, shall comply with all requirements of the Medicaid DDD
Community Care Program and
N.J.A.C.
10:46D-1.1 to maintain eligibility for
benefits.
(b) The individual is
required to fulfill the obligations under
N.J.A.C.
10:46D-2.2, prior to the provision of
residential services by the Division.
(c) The Division or its agent shall complete
the initial assessment. The Division shall conduct the annual reassessment
unless an agency licensed under N.J.A.C. 10:44A has been designated to collect
the contribution. If an agency has been designated, the agency shall conduct
the reassessment.
1. The individual, his or
her legal guardian or LRR(s), shall authorize the release of information
necessary to complete the financial assessment and annual reviews, at the time
of the application for eligibility.
2. All information required to complete the
financial assessment shall be kept confidential pursuant to
N.J.S.A.
30:4-24.3, except to the extent necessary to
enforce the obligation to contribute.
(d) The individual shall be assessed
according to the formula of financial ability to pay at N.J.A.C.
10:46D-3.1 to determine the
individual's or legally responsible relative's ability to pay for all or part
of his or her cost of care and maintenance as fixed by the
Commissioner.
(e) A written notice
shall be sent which informs the individual, legal guardian and/or LRR(s) of the
figures used and how the amount due was calculated.
(f) The individual, legal guardian, LRR(s)
and/or other responsible parties may, at any time, inquire as to how the
particular amount due to be paid was determined.
(g) The individual, LRR(s), and/or other
responsible parties shall make such payments as are required by
N.J.A.C.
10:46D-3.1 or 3.2 for the cost of care. The
individual or legally responsible relative shall receive written instructions
informing them to whom payment shall be made.
(h) Payment calculations for the individual
and/or LRR(s) shall be reviewed and revised annually, by the Division or its
agent.
(i) If the individual or
legally responsible relative's income changes prior to the annual reassessment,
the individual, other responsible parties or LRR(s) shall immediately notify in
writing, the administrative head of the developmental center or agency
providing residential services. In the case of the agency providing residential
services, the agency shall be responsible to contact the Division. In such
instances, the contribution may be changed by the Division.
(j) The annual calendar year increases to
Social Security benefits and other periodic increases to benefits shall not be
grounds for a revision to the annual budget for expenses. No requests for a
revision of the assessed contribution for the cost of care and maintenance may
be made under this circumstance. This increase shall be considered at the time
of the next assessment.
Notes
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