• Individuals must be in need of institutional care and meet, at a minimum, the nursing facility (NF) level of care criteria.
• The waiver can serve disabled individuals of any age eligible under SSI, New Jersey Care, Family Care Part A, Division of Youth and Family Services foster care, or if it is an individual not eligible for one of the above full service Medicaid programs, through the institutional Medicaid program administered through the County Board of Social Services
• For children, parental income or resources are not considered in the determination of eligibility when applying for CRPD under the institutional Medicaid program at the County Board of Social Services.  For adults applying for CRPD under the same program at the County Board of Social Services the spouse’s income is not considered but the spouse’s resources are considered in the determination of eligibility.  However, up to one-half of the total resources are protected for the use by the spouse.
• Any individual applying for the CRPD waiver must be determined disabled by the Social Security Administration (SSA) or by the Disability Review Section of the DMAHS using SSA disability criteria.
• Individuals must need a minimum of two CRPD waiver services:  case management plus another service.
• Any individual applying for the CRPD waiver in order to obtain private-duty nursing (PDN) services must have a live-in primary caregiver (adult relative or significant other adult) who accepts 24-hour responsibility for that applicant’s health and welfare.

Case management is provided by a social worker or nurse employed by a County Board of Social Services, home care agency, or Special Child Health Services Unit.  Case management is a process of planning, locating, coordinating, and monitoring a group of services designed to meet the individual needs of the person being served.

Private-duty nursing (PDN), provided by licensed nurses, is defined as individual and continuous care, in contrast to part-time or intermittent care.  Nurses can be employed by a licensed, certified home health agency or a licensed, accredited health care service firm.  Private-duty nursing is limited for each beneficiary to a maximum of 16 hours per day from all payment sources.  As mentioned earlier, it will be provided only when there is a live-in primary caregiver (adult relative or significant other adult) who accepts 24-hour responsibility for the health and welfare of the beneficiary.

Environmental/vehicular accessibility adaptation: Those physical adaptations to the home and/or the vehicle, required by the individual's plan of care, which are necessary to ensure the health, welfare and safety of the individual, or which enable the individual to function with greater independence in the home or community, and without which, the individual would require institutionalization.  Such adaptations may include the installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems required to accommodate the medical equipment and supplies which are necessary for the welfare of the individual.  Excluded are those adaptations or improvements to the home and/or the vehicle which are of general utility, and are not of direct medical or remedial benefit to the individual, such as carpeting, roof repair, central air conditioning, etc.  Adaptations which add to the total square footage of the home are excluded from this benefit.  All services shall be provided in accordance with applicable State or local building codes and/or State motor vehicle codes.  The service includes needed vehicle modification (such as electronic monitoring systems to enhance beneficiary safety) to a beneficiary or family vehicle as defined in an approved plan of care.  To receive an environmental/vehicular modification, a beneficiary must first require ongoing home and community-based State Plan or waiver services.  This is not a stand-alone service.  The beneficiary must need other home and community-based service supporting the return to the community (de-institutionalization) or to remain in the community (at risk for placement).

Personal Emergency Response System (PERS):  PERS is an electronic device which enables certain individuals at high risk of institutionalization to secure help in an emergency.  The individual may also wear a portable "help" button to allow for mobility.  The system is connected to the person's phone and programmed to signal a response center once a "help" button is activated.  The response center is staffed by trained professionals, as specified in Appendix B-2.  PERS services are limited to those individuals who live alone, or who are alone for significant parts of the day, and have no regular caregiver for extended periods of time, and who would otherwise require extensive routine supervision.  To be approved for a PERS an individual must first require ongoing home and community-based State Plan or waiver services.  This is not a stand-alone service.  PERS will not be reimbursed for individuals who reside in congregate settings.

Community Transitional Services: These may aid in the transitioning of individuals from institutional settings to their own home in the community through coverage of one-time transitional expenses.  Examples of those expenses include the cost of furnishing an apartment (basic living items such as bed, table, chairs, window blinds, eating utensils, and food preparation items), moving expenses required to occupy and use a community domicile, the expense of security deposits, utility connection fees (e.g., telephone, electricity, gas, etc.) health and safety assurances, such as pest eradication, allergen control, or one-time cleaning prior to occupancy.  These may not constitute payment for housing or for rent.  The concept of essential furnishings does not include diversional or recreational items (TV, VCR, cable access, etc.).  Reasonable costs are necessary expenses in the judgment of the state for an individual to establish his or her basic living arrangement.

There is no retroactive reimbursement of waiver services prior to program enrollment.

Regional representatives from the DDS review and approve plans of care initially, and, at a minimum, annually thereafter.  Program oversight is provided by the DDS and the DMAHS Quality Assurance Unit.