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NJACP is your resource for State issues, legislation and regulation affecting providers and people with intellectual and developmental disabilities.

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Updated Housing Development Policy

Following ongoing stakeholder discussions, the Division has updated its Housing Development Policy, effective July 1, 2017. The July 1 policy rescinds and replaces the housing development policy distributed April 1, 2016. The updated policy, as well as other housing-related information, is available on the Community Living Options page of the Division’s website.

Lawmakers Plan Joint Hearing on Christie’s Reorganization of Mental Health Services

Democratic lawmakers said Tuesday that Gov. Chris Christie’s plan to transfer mental health and addiction services from the state Department of Human Services to the Department of Health needs a public hearing process.

“This reorganization plan has not been vetted by the Legislature and, more importantly, by the families and providers who will be directly impacted,” said Assemblywoman Valerie Vainieri Huttle, who chairs her chamber’s Human Services Committee. Huttle and Sen. Joseph Vitale, chair of the Senate health committee, are planning a joint hearing on the issue in the coming weeks.

Christie, in a memo dated June 29, proposed the transfer of the entire Division of Mental Health and Addiction Services. With an annual budget of just under $1 billion, the division employs around 200 people to oversee mental health and substance abuse treatment and prevention efforts, including residential, inpatient and outpatient services, as well as the state’s four psychiatric hospitals.

The reorganization will become effective within 60 days, unless the Legislature passes concurrent resolutions opposing the move.

Christie has made efforts to fight opioid addiction and reduce stigma around addiction as the cornerstone of his final year in office. He was also appointed the chair of a national commission on opioids by President Donald Trump. The group is expected to release a draft report later this month.

In the memo, Christie says the transfer is necessary to “improve health care, remove bureaucratic obstacles to the integration of physical and behavioral health care, and effectively address substance use disorder as the public health crisis that it is.”

Vitale said he hopes to hear from administration officials before the hearing.Health Commissioner Cathleen Bennett said in a statement her agency was “eager to continue its work in population health and providing holistic care to individuals.”

The integration of physical and mental health services has been a long-running challenge for the state agencies. A 2016 report from researchers at Seton Hall University, funded by the Nicholson Foundation, found New Jersey providers sometimes face outdated and inconsistent guidance from the two agencies when it comes to licensing and reimbursement for integrated care.

With more than 11,000 employees, the Department of Human Services is the largest state agency in terms of size and budget and is responsible for administering the state’s $15 billion Medicaid program. The Department of Health has fewer than 1,100 employees.

Vitale and Huttle said they both support the goal of integration, but are worried about the speed at which the governor wants to transition. “I’m just questioning the governor’s plan to do it now — the intent and the reasoning behind it.” I think that a major change could significantly impact these critical services,” Huttle said.

The move also comes at a time of increased uncertainty for certain community mental health providers as they shift from fixed-cost contracts with the state’s Medicaid program to fee-for-service reimbursements. Some providers have testified at recent budget hearings that they will no longer have the same cushion they had under the previous system, since the new rates rates won’t cover overheard, administration and staffing costs or the shortfall from caring for people without insurance.

“We think that undertaking another major systemic change while there is already such uncertainty and difficulty could be a significant disruption,” said Debra Wentz, president and CEO of the New Jersey Association of Mental Health and Addiction Agencies. “We’re excited about the long-term prospect but apprehensive and concerned about the timing.” Read Christie’s reorganization plan here. As reported by Politico.

Governor Announces Transition of Mental Health and Addiction Services to Department of Health

Please see the following announcement sent by Department of Health Commissioner, Cathleen Bennett:

The Governor has issued an Executive Reorganization Plan that will transfer the Division of Mental Health and Addiction Services in the Department of Human Services to the Department of Health (DOH).   Transferring mental health and addiction services to DOH is necessary to improve health care, remove bureaucratic obstacles to the integration of physical, mental and behavioral health care, and effectively address substance use disorder as the public health crisis that it is.

This reorganization recognizes that the DOH focus on population health, which involves helping healthy New Jerseyans stay well, preventing those individuals at risk from getting sick, and keeping those individuals with chronic health conditions from becoming sicker, is the right focus and especially the right focus for integration of physical health, behavioral health and mental health.

Research demonstrates that integrating mental, behavioral and physical health care is the most effective way to treat the “whole person;” yet for historical reasons, health care is too often fragmented into separate components: physical; mental; and substance use disorder. In the absence of integrated health care, persons with serious mental illness often suffer from physical health conditions that go unaddressed.

This reorganization recognizes that mental health and behavioral health problems in general, and opioid addiction in particular, need to be treated as illnesses no different than infectious diseases such as Zika virus or chronic conditions such as hypertension, heart disease, diabetes or obesity. All are best addressed by preventive measures. Only through such a public health approach can we overcome the stigma that for too long has characterized efforts to treat addiction as something that must be cordoned off from the rest of health care.

People with serious behavioral health conditions suffer for lack of access to primary care, while people with mild to moderate behavioral health conditions, often unconnected to behavioral health care, could benefit from access to care in primary care settings.

This plan will take effect 60 calendar days after the date of filing with the Secretary of State and Office of Administrative Law.

Studies Shed Light on High Cost of Housing in New Jersey

The Garden State was the sixth-most-expensive state for renters, based on a new report published by the National Low Income Housing Coalition cited by the Housing and Community Development Network of New Jersey.  “In order to afford a modest two-bedroom home in the Garden State, a family must earn an hourly wage of $27.31, far more than the state’s average hourly wage of $17.86 or the $8.44 minimum wage,” the HCDN said in a news release. “As the Fair Market Rent in the state for a two-bedroom rental is $1,420, a family must earn $56,810 annually in order to make it affordable. Using that formula, a minimum wage worker would have to work 129 hours per week year-round to be able to afford a two-bedroom home at FMR.”

The organization has urged state officials to “Build a Thriving New Jersey” and invest $600 million into housing residents can afford. HCDN said that, as part of its campaign, funding for 10 community developments, which was in the past diverted or abandoned, may be used.  The firm said it hopes to carry out its mission with the help of the Affordable Housing Trust Fund, the State Rental Assistance Program, the Neighborhood Revitalization Tax Credit Program, as well as Lead Poisoning Prevention and Weatherization and Homeless Service programs.

“Home rental costs are steadily increasing each year and, when you factor in other expenses like groceries and utilities, it’s a struggle for countless New Jersey residents,” Staci Berger, CEO and president of the HCDN, said. “Our housing market is like a car dealership that only sells Maserati cars and only a handful of Ford Fiestas. We need more variety, so that all our residents can afford to call New Jersey home. We can’t ‘Build a Thriving New Jersey’ if our elected officials don’t make investments that help create a balanced housing market.”

The report, “Out of Reach 2017,” was released at an event in Jersey City by the Garden State Episcopal Community Development Corp. Jersey City Deputy Mayor Marcos Vigil, Jersey City Council President Rolando Lavarro and Councilwoman Joyce Waterman attended the event.

“We have the resources to solve the affordable housing crisis by realigning federal tax expenditures and reinvesting the savings in rental housing programs that serve our nation’s most vulnerable,” Diane Yentel, CEO and president of the NLIHC, said. “We lack only the political will to do so.”

To view entire article, click here.

 

 DDD Holds Leadership Meeting

On May 22, DDD held its monthly membership meeting with the three provider associations focusing mainly on housing.  The following reflects the discussion.

Housing

Jonathan Seifreid shared a number of documents for Leadership review prior to their distribution to the provider community, including:

  • Guidance for the Conversion of Housing Payments from Division Contract to the Supportive Housing Connection.
  • Guidance for Individuals and Families on the Conversion of Housing Payments from Division Contract to the Supportive Housing Connection.
  • Sample Residency Agreement(for provider controlled settings).

It was noted that an agency may use a lease or residency agreement and both can be personalized for the agency; for example, the agency may decide to add additional information, however, essential elements as outlined by DDD must remain in the document.

Moving forward in FFS, DDD housing funding will change.  Sixty thousand dollars will be provided for homes for accessibility and agencies may ask for additional funding for sprinklers and fire alarms.  Major maintenance for properties will continue for state owned properties.  Once the house flips to FFS, funding will go away.

Funding:

Detailed information will be provided but Assistant Commissioner Liz Shea noted that there will continue to be “start-up” money between now and December 31.  These funds will cover start-up operations/development, for vehicles and funds for furniture.  There will be no new acquisition funds after July 1.  As of January 1, funds will still be made available for furniture but will no longer be available for startup operations/development, or vehicles.

Purchase of Homes:

DDD is reviewing it policies and procedures for review and approval of housing sites/housing.  More information will be forthcoming from DDD.  The thrust of the discussion was whether DDD would have any involvement if an agency is not seeking any state funding for the purchase of a home.

Oversight

Clarification was requested regarding the various oversight to which providers will be subjected.  Ms. Shea noted that Support Coordinators will have oversight of the individual, case managers will continue to provide intensive case management for high profile cases, the provider unit will focus on training to give providers assistance in technical areas and help providers move to a more employment based  focus as well as providing assistance for more creative housing solutions.  There will be staff that will oversee quality (they are adding more staff to this function). Staff will review service plans (on paper) and will conduct site visits as necessary.  The Quality staff will also examine the adequacy of provider networks including the availability of psychiatrists, psychologists, etc.  And finally, licensing will still be conducting its review as

will Medicaid. The associations raised concern regarding the number of entities with oversight (DDD, DHS, and Medicaid) and specifically what that oversight will entail.  Providers were led to believe that there would be a streamlining of the State’s oversight.  This will be discussed in greater depth at a future meeting.

Transitioning to FFS

There are three agencies in a Pilot that is intended to “test” the billing process.  Ten additional agencies will be in the July FFS flip.   The Pilot should flip approximately 2000-2500 people between July 1, 2017 and September 2017.  If individuals receive residential services from these agencies but are attending a day program run by a separate agency, the day program must be prepared to flip, as well (or they will relocate individuals to a different day program that is ready).

Individuals that are with the ten agencies must have selected a support coordination agency or they will be auto-assigned.  Ms. Shea noted that for the first quarter, the contract will be guaranteed so there is a cushion to support providers as they go through the transition, however, agencies must agree to not seek a reassessment in year one.  To facilitate a more timely transition to FFS, Support Coordinators will not complete a full ISP prior to the flip but, rather, they will have additional time to complete a comprehensive ISP.  She noted, however, that the minute a person wants to adjust their plan or request a reassessment, then the Support Coordinator will have to develop a comprehensive ISP at that time.  It was questioned if there will be something included in the limited ISP or existing IHP that is not acceptable to Medicaid.  This issue will be discussed further and clarification will be sought from Medicaid.

Agencies that would like to flip homes/programs beginning July 1, should reach out to Ms. Shea as each agency will have to be reviewed and approved.  DDD must stay within the budget so if all agencies with high level tiers want to flip at the same time, DDD could run out of funds prior to the end of the fiscal year.

NJ Legislature Considering Changes to Paid Family Leave Plans  

Concerned that New Jersey lags behind other states in the utilization of its current paid family leave program, Senate President Steve Sweeney (D-3) and Assembly Speaker Vince Prieto (D-32) developed two separate plans to enrich the benefit, making it easier for employees to consider using it. Currently, businesses with fewer than 50 employees do not have to guarantee an employee’s position will be available when the leave is ended. Prieto’s plan contains job protection for all employees taking paid family leave with the belief that if a person’s job is not protected they will not use the benefit in a time of need.

Both plans also increase the amount of each employees paycheck during utilization of paid leave. Currently, the law limits pay while taking leave to two-thirds of a paycheck. Prieto’s bill increases pay to 90% for the lowest earners and 80% for higher earners, with caps on both. Sweeney has a more complicated calculation which is less than Prieto’s and does not guarantee job protection. Neither proposal has been heard in committee or contains a fiscal estimate. Employees pay into the program in each paycheck and there are also suggestions that increases to that contribution could fund any of either bills changes.

For more information regarding both proposals, click here.

Community Health Law Project Announces It Will Be Accepting New Clients Under a Contract with the Division of Developmental Disabilities (DDD)

The Law Project is very pleased that once again its attorneys and advocates can provide legal and advocacy assistance to individuals and families in the community who are receiving services from the Division of Developmental Disabilities.

The Law Project has provided representation to residents of New Jersey for forty years through its five regional offices and four satellite offices. Attorneys and advocates will provide representation and brief service in many civil law issues and in entitlement cases.

Assistance will be available in areas including:

  • Housing advocacy such as landlord-tenant disputes
  • Public entitlements, including eligibility for SSI, SSDI, public assistance, and food stamps
  • Medicaid, Medicare, and other healthcare issues such as managed care disputes
  • Child support, visitation, domestic violence
  • Barrier-free accessibility, American with Disabilities Act and New Jersey Law Against Discrimination matters
  • Surrogate decision making issues including wills, living wills, advance directives, powers of attorney, and uncontested guardianships (also limited guardianship and conservatorship)

Please see the CHLP web site at http://www.chlp.org for further information about the Law Project.

The Community Health Law Project is a private not-for-profit organization dedicated to providing legal and advocacy services, training, education, and related activities to persons living with disabilities and the frail elderly, emphasizing those more vulnerable and needy.

Tier Request Form to be Replaced by Auto-Generated Tier Assignment Letters

Effective September 1, 2016, the Division will disseminate an auto-generated tier assignment letter upon completion of the NJ CAT (NJ Comprehensive Assessment Tool), and therefore will eliminate the Request for Tier Assignment process established in June 2015. Mailing of tier assignment letters to individuals who have already completed the NJ CAT is expected to begin August 2016.

The tier assignment is based on the NJ CAT self-care, behavior, and medical scores. An individual budget amount that corresponds to the individual’s tier assignment becomes effective only when:

  1. An individual enrolls in the Fee-for-Service Supports Program

-OR-

  1. An individual already enrolled on the Community Care Waiver (CCW) shifts into the Fee-for-Service system

Until an individual is enrolled or transitioned by the Division into the new Fee-for-Service system, the tier and the corresponding budget amount are not in effect.

Information about tiering and acuity is available in Section 3.4 of the Supports Program Policies and Procedures Manual. Information about individual budgets is available in the Fee-for-Service Individual Budgets: Quick Reference Guide.

Rutgers Pilot Could Signal a Move Toward Telemedicine

 A Rutgers Pilot program could signal a move toward telemedicine for New Jersey. The issue has been debated in committee in the Legislature and various interests have been unable to agree on parameters moving forward. However, many other states have already taken this step and a new Rutgers pilot program may provide a frame of reference for a program in New Jersey. Senator Joe Vitale (D-19), Chair of the Senate Health and Human Services committee reports he is considering holding additional hearings on the issue to determine which providers can participate and how they can be paid.

Rutgers Center for State Health Policy Releases Evaluation of NJ’s 1115 Waiver

The Rutgers Center for State Health Policy’s Draft Interim Evaluation of NJ’s 1115 Waiver is now posted on the DHS website: http://www.state.nj.us/humanservices/dmahs/home/Medicaid_Waiver_Interim_Evaluation.pdf

Listed on http://www.state.nj.us/humanservices/dmahs/home/waiver.html

Valerie Sellers Shares Response to Audit Report with Sue Livio of the STAR LEDGER

There is no question that every individual living within the community should receive the best and most appropriate care possible. There are thousands of individuals living within group homes and other supported settings that are, in fact, living safe and fulfilling lives.  Poor quality of care is not defensible and lessons will be learned from the auditor’s findings.  However, there are circumstances that are often simply beyond the control of providers.  For example, agencies are at the mercy of their managed care organizations (MCOs) for the repair or replacement of durable medical equipment, such as a wheelchair.  Also, delays in the placement of individuals are often not within control of an agency but rather the control rests with the Developmental Center as to when a client will be released to live within the community.   Having said this, pointing fingers serves no useful purpose.  The focus must continue to be on providing the best quality of care to all individuals with intellectual and developmental disabilities living within our communities as well as those that will eventually reside in communities throughout New Jersey; it should not be on keeping people within Developmental Centers.  The findings of this report will help focus on the continued need for the recruitment, training and retention of qualified and committed staff, however, it should not ignore or dismiss the work of thousands of direct support professionals who provide quality care that allows the individuals they serve to live within our communities and as our neighbors.

Read Susan Livio’s Article: Audit: Move to group homes caused problems for some disabled people in N.J.

DDD Announces a Change in the Process for Major Maintenance Funding

Please see the attached letter announcing a change to the process for major maintenance and capital funding payment.  Also attached is an updated DDD Capital Package checklist for your use.