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New Jersey Department of Children and Families Policy Manual

 

Manual:

CP&P

Child Protection and Permanency

Effective Date: 8-22-1979

Volume:

V

Health Services

Chapter:

A

Health Services

Revised

Date: 10-1-2018

Subchapter:

4

Code 650 Medical Services

Issuance:

100

Code 650 Medical Services

 

Purpose:

 

This issuance establishes policy and procedures related to the Code 650 Medical Services Program.

 

Policy:

 

A)    CP&P Code 650 Medical Services

CP&P may pay for medical services under Medicaid Code 650 for children under the age of 18 and certain pregnant women who are not eligible for any federally-funded Medicaid or NJ FamilyCare programs.

 

B)   Eligibility Criteria

The Worker shall obtain authorization to provide Medicaid Code 650 through DCF Office of Clinical Services (OSC). Persons who may be eligible for Medicaid Code 650 are:

·         Children residing in CP&P-supported living arrangements who would otherwise qualify for, but are not eligible for, the Code 600 Medicaid Program;

 

·         Children who are residing in their own homes and need medical services as a part of a treatment plan for abuse or neglect, and are not eligible for any Medicaid or NJ FamilyCare program;

 

·         Children residing in CP&P subsidized adoption homes approved for a medical subsidy who do not qualify for the Code 600 Medicaid Program; and

 

·         Pregnant women under the age of 21 who require services on behalf of their unborn children and are not eligible for medical assistance through NJ FamilyCare.

 

C)   Children Residing in Their Own Homes

For children residing in their own homes, CP&P may provide Medicaid Code 650 only as a necessary part of a treatment plan for abuse or neglect, e.g., children whose immediate or imminent risk of harm is directly related to their lack of insurance, or for instances where an abuse or neglect investigation is directly impacted by a child’s lack of insurance. The Local Office shall submit an interoffice memo requesting use of Medicaid Code 650 and signed by the Local Office Manager via email to the Office of Clinical Services. The Worker shall document and record the CPS criteria for the provision of these services in the case record.

 

In addition to the CPS criteria, the following conditions shall exist. The Worker shall document them in the memo that is submitted to OCS.

 

·         Medical services are not available through private hospital or health insurance plans, union or other employee's health plan, SSI, or Health Maintenance Organizations.

 

·         Medical services are not available on a free or ability-to-pay basis through a local clinic or other community agency.

 

·         The family is not eligible for any county or municipal welfare program, including Medicaid or NJ FamilyCare.

 

If the above conditions are not sufficiently verified and documented, OCS shall not authorize Code 650 Medicaid coverage of a child. In this instance CP&P may provide essential medical services only with the written approval of the Local Office Manager using Local Office funds.

 

D)   Children Residing in CP&P-Supported Living Arrangements

Children residing in CP&P-supported living arrangements shall be eligible for the Code 650 Medical Services Program if they have been found ineligible for the Code 600 Medicaid Program. See CP&P-V-A-2-200, the section entitled Medicaid Eligibility Determination for CP&P Children, regarding policy and procedures related to initial determination of eligibility for Medicaid Code 600. OCS shall give this approval regardless of the family's capacity to support. CP&P shall not seek reimbursement.

 

The Medicaid Liaison shall note third party insurance coverage for the children when the children are enrolled in any DCF Medicaid Program. Third party insurance coverage shall not make children ineligible for the Medicaid Code 650 Program if the children are in CP&P-supported living arrangements.

 

E)   Time Limited Approval

A child’s enrollment in Medicaid Code 650 shall be time-limited as part of the family’s case plan. It is not meant to be the sole reason for CP&P involvement. The Office of Clinical Services shall give initial approval for the use of Medicaid Code 650 for the period of time as specifically designated in the requesting memo only.

 

When it is necessary for Medicaid Code 650 to continue beyond the initially-approved time period, the Local Office Manager shall submit a request for an extension of services to the Office of Clinical Services.

 

Procedures:

1)    Procedures Related to Determining Eligibility for Children Residing in Their Own Homes

 

RESPONSIBILITY

ACTION REQUIRED

Worker

 

1.    Determine service need and consult with Supervisor and LOM.

2.    Complete an Interoffice Memo. Include:

·         justification of need for Medicaid Code 650 services;

·         why no other coverage services are available; and

·         how long Medicaid Code 650 services are requested to alleviate current need.

Supervisor

3.    Review and approve request for Medicaid Code 650 services.

4.    Forward to Local Office Manager for approval.

Local Office Manager

5.    Review and approve or disapprove request for Medicaid Code 650 services.

6.    Notify Supervisor and Worker of decision.

Supervisor/Worker

7.    Advise Medicaid Liaison when the LO Manager approves the request.

Worker/Medicaid Liaison

8.    Email approved Memo to OCS Assistant Director and Medicaid Support staff.

OCS Assistant Director/Director

9.    Provide Authorization to Create Code 650 Medicaid line in NJ SPIRIT or consultation to Local Office on additional services that may be available.

10. Maintain a file of cases approved for Medicaid Code 650.

Medicaid Liaison

11. Open Code 650 Medicaid when authorized by OCS.

12. Provide Emergency Services Medicaid Letter and ensure that NJ SPIRIT Person Screen for authorized recipient(s) is up to date.

Local Office

13. Redetermine need for services after initial authorized period.

14. Complete Interoffice Memo for additional months, when necessary; or terminate service. See 3) Changes in Program Status, and 4) Procedures Related to Changes in Program Status, below.

 

2)    Procedures Related to Determining Eligibility for Children Residing in CP&P-Supported Living Arrangements

RESPONSIBILITY

ACTION REQUIRED

Worker/Medicaid Liaison

1.    Determine the child is ineligible for Code 600 Medicaid Program. See CP&P-V-A-2-200, the section entitled Children Eligible for the Medicaid Code 60 Program Through CP&P, regarding policy and procedures related to initial determination of eligibility for Medicaid Code 600.

Medicaid Liaison

2.    Open Code 650 Medicaid line in NJSPIRIT.

3.    Provide Emergency Services Medicaid Letter and ensure that NJ SPIRIT Person Screen for authorized recipient(s) is up to date.

 

3)    Changes in Program Status

CP&P is responsible for maintaining and updating the Medicaid status of children under CP&P supervision.

 

When a child who was eligible for Medicaid Code 650 medical services while he or she was in his or her own home is subsequently placed in a CP&P-supported living arrangement, CP&P makes a formal determination of eligibility for Code 600 Medicaid. If the child is eligible for Code 600 program, the Local Office Medicaid Liaison changes the child's Medicaid program status from Code 650 to Code 600 upon notice of placement. See CP&P-supported living arrangement, CP&P makes a formal determination of eligibility for Code 600 Medicaid. If the child is eligible for Code 600 program, the Local Office Medicaid Liaison changes the child's Medicaid program status from Code 650 to Code 600 upon notice of placement. See CP&P-V-A-2-200, the section entitled Medicaid Eligibility Determination for CP&P Children, regarding policy and procedures related to initial determination of eligibility for Medicaid Code 600. If the child is not eligible for Code 600, CP&P continues the child in the Medicaid Code 650 program until placement ends.

 

When a child residing in his or her own home is determined no longer eligible for or no longer in need of Medicaid Code 650 medical services, the Worker notifies the parent or guardian of the termination.

 

The Local Office Medicaid Liaison updates the Medicaid Status File and NJS.

 

4)    Procedures Related to Changes in Program Status

RESPONSIBILITY

ACTION REQUIRED

Worker/Medicaid Liaison

1.    Redetermine eligibility for Code 600 or Medicaid Code 650.

2.    Make change in program status per instructions, when appropriate, or terminate services, when appropriate.

3.    Retrieve and void the child's Medicaid Card when terminated.

 

Key Terms (Definitions):

 

·         Code 650 Medical Services Program means DCF’s non-federally funded coverage option for children who do not qualify for federally-matched DCF Medicaid (Code 600) due to financial ineligibility caused by parental income; individual income, i.e., Social Security benefits; not being a citizen or lawfully- admitted immigrant; or residing in his or her own home.

·         CP&P-supported living arrangement means that CP&P placed a child in a resource family home, group home, shelter, residential facility, or independent living arrangement and is paying for the service.

 

Forms and Attachments:

 

None

 

Policy History:

 

·         11-21-2011

·         11-7-2011

·         10-26-1998

·         8-5-1994

·         9-26-1986

·         7-28-1986

·         9-14-1984

·         7-7-1981

·         8-22-1979