Applying for NJ MLTSS? Here are the acronyms you need to know

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

 

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