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Beginning July 1, 2014, participants in the following Medicaid 1115 (c) Waiver programs will be enrolled automatically in the Managed Long Term Services and Supports (MLTSS) program through their current Medicaid managed care organization (MCO), also known as a health plan. These programs now will be offered under MLTSS:

 

  • AIDS Community Care Alternatives Program (ACCAP);
  • Community Resources for People with Disabilities (CRPD);
  • Traumatic Brain Injury (TBI) Waiver and
  • Global Options for Long-Term Care (GO).

 

MLTSS is a new and improved way to help individuals to live in the community with long-term services and supports for as long as possible.  New Jersey received federal approval in 2012 for MLTSS under an 1115(a) demonstration waiver known as the Comprehensive Medicaid Waiver.

 

Previously in the ACCAP, CRPD, TBI and GO programs, for instance, an individual’s Medicaid home and community based services were coordinated by a care management agency that was independent from their MCO.  Now in MLTSS, the State’s existing MCO contracts are amended to require management of all long-term care services including home and community based services and nursing facility services for individuals with physical disabilities and seniors.

 

Individuals on the ACCAP, CRPD, TBI and GO programs have already been enrolled in an MCO for the provision of their acute care services, including hospitalization, laboratory tests and X-rays; early and periodic screening, diagnostic and treatment, doctor visits and pharmacy costs.  If individuals are receiving Personal Care Assistance (PCA) services and Adult Day Health Care, they have been receiving them through their MCO since 2011. For PCA, they still will need to complete the PCA Cost Report forms detailed below.

 

Personal Care Assistance (PCA) Provider-Related Issues

The annual Cost Report forms and instructions for Personal Care Services can be found at www.nj.gov/humanservices.dds  The forms are Excel spreadsheets. While you must complete the entire Cost Report, you will only be required to submit Schedule A1, A2 and Schedule C1 (columns a, b, c, d, e, f, g) to the Division. You will also only be expected to provide information on the costs and expenditures for “personal care assistant services as described in N.J.A.C. 10:60-3.3.” – which are Medicaid PCA Services.

The Cost Reports for the prior year are due not later than May 1st of the following year. For instance, the Cost Reports for 2014 will be due May 1, 2015. The three schedules listed above, together with the completed Cost Report Cover Page should be e-mailed to: AnnaMarie.Treglia@dhs.state.nj.us 

Should you have questions, please contact (609) 631-2486 to speak with Anna Marie Treglia at the Division of Disability Services.

 
 
 
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