determine need for scope of and anticipated outcome of

ADDENDUM to Attachment 31 A

Page 13d10STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

STATE OF NEW JERSEYLimitations on Amount Duration and Scope of Services provided to the Categorically Needy itRehabilitation Services Mental Health Community Support Services

Service Description

Community Support Services consist of mental health rehabilitation services andsupports necessary to assist the client in achieving mental health rehabilitative andrecovery goals as identified in the individualized rehabilitation plan includingachieving and maintaining valued life roles in the social employment educationaland or housing domains and to restore a consumerslevel of functioning to that whichallows the consumer to achieve community integration and to remain in an

independent living setting of hisher choosingThe following are components of Mental Health Community Support Services CSS

1 Comprehensive Rehabilitation Needs Assessment

The behavioral health and rehabilitation needs assessment process is a consumerdriven process that consists of a facetoface comprehensive assessment with theclient and may also include identified family members and other collateral serviceproviders The purpose of this assessment is to gather all information required todetermine need for scope of and anticipated outcome of rehabilitation services Thisincludes individual strengths preferences needs abilities psychiatric symptomsmedical history and functional limitations

2 Contribution to the development implementation monitoring and updating ofrehabilitation plan agreements in partnership with the client and in consultation withidentified providers and significant others

The individualized rehabilitation plan includes the rehabilitation and recovery goalsobjectives strategyintervention to be employed anticipated outcomes the expectedfrequency and duration of each Community Support Service activity the type ofpractitioner to provide the service location where the service is to be delivered andthe schedule of updates to the plan Such plan is to be reviewed quarterly andmodified or updated as needed Each rehabilitation plan and subsequent revisionsmust be authorized by a physician or licensed practitioner authorized by state law torecommend a course of treatment

3 Therapeutic rehabilitative skill development with the aim of promoting communityintegration and restoring the individual to the maximum possible functional level byimproving functional social interpersonal problemsolving coping and

communication skills Reimbursable activities are those that involve teaching theconsumer various physical cognitiveintellectual and behavioral skills related to

TN 11 01 Effective Date 1012011

Supersedes NEW Approval Date JUN 0 8 2011

ADDENDUM to Attachment31A


STATE OF NEW JERSEYa of Services provided to the Categorically NeedyP P g YLimitations on Amount Duration and Scope

Rehabilitation Services Mental Health Community Support Services

identified goals in a focused manner that leads to increased competence andproficiency in identified skills At a minimum skill teaching involves the followingdiscussions with the consumer about the skill to be learned including past experiencein using the skill what the skill entails when to use the skill and the benefits oflearning the skill breaking the skill down into its component parts showing examplesof how the skill is correctly used or performed arranging opportunities to practice skilluse in community settings where the skill is to be used and providing evaluation andfeedback on skill performance

Skills development may target one or more of the following areasa Skill development to promote the restoration of daily living skills eg health

and mental health education money management maintenance of livingenvironment personal responsibility nutrition menu planning and groceryshopping personal hygiene groomingb

Social skills development to promote the restoration of appropriate socialfunctioning in various community settings communication and interpersonalrelationships the use of community services and the development ofappropriate personal and natural support networks

c Skills related to accessing and using appropriate mainstream medicaldental and mental health services for example making and keepingappointments preparing questions to ask the doctor asking an employer fortime off to attend a doctors appointment arranging transportation etcd Skills related to accessing renewing and using appropriate publicentitlements such as Social Security Section 8 food stamps Medicaid andMedicare for example completing applications preparing for interviewsnavigating the social services agency determining which benefits areneeded etc

e

Skills related to how to use recreation and leisure time and resources forexample engaging in hobbies inviting friends learning about communityresources applying for club memberships adhering to club memberrequirements researching available resources etc

f

Skill training in selfadvocacy and assertiveness in dealing with citizenshiplegal and or other social needs for example how to vote appropriateparticipation in community meetings and civic activities participating inmental health advocacy activities testifying at public hearings expressingneeds in appropriate manner etcg Skills of negotiating landlordneighbor relationships

TN 11 01Effective Date 1012011

Supersedes NEWApproval Date JUN 08 2011

1 ADDENDUM to Attachment 31A


STATE OF NEW JERSEY

Limitations on Amount Duration and Scope of Services provided to the Categorically NeedyRehabilitation Services Mental Health Community Support Services

h Cognitive and behavior skills including but not limited to the handling ofemergencies and problem solving

Skills development related to leading a wellness and healthy lifestyle forexample engaging in health promoting habits practicing stress

management activities developing wellness plans establishing and

maintaining regular exercise participating in spiritual or religiouscommunity etc

j Work readiness activities excepting skills related to a specific vocationtrade or practice including work related communication skills work relatedpersonal hygiene and dress work related time management other relatedskills preparing the recipient to be employable

4 Illness Management and Recovery training and support includes cooccurringsubstance use disorders This includes

a Symptom monitoring and self management of illness and symptoms whichshall have as its objective the identification and minimization of the negativeeffects of psychiatric symptoms which interfere with the individualsdaily living

b Medication managementc Education and training on mental illness relapse identification prevention and

the promotion of recovery

d Relapse preventione Evidence based practices including motivational enhancement cognitive

behavioral and behavioral shaping interventions

Evidence Based Practices EBP EBPs demonstrate effectiveness as atreatment or intervention for specific problems through repeated empiricalresearch EBPs to be delivered are

1 Motivational Enhancement Motivational enhancement is a directiveclient centered counseling style for eliciting behavior change by helpingclients explore and resolve their ambivalence and achieve lastingchange for a range of problematic behaviors

2 Behavior Modification Behavior modification techniques is a treatmentapproach based on the principles of operant conditioning that replacesundesirable or unproductive behaviors with more desirable and effectiveones through positive or negative reinforcement

TN 1101 Effective Date 1012011


ADDENDUM to Attachment 31A


STATE OF NEW JERSEY


3 Cognitive Behavioral Techniques CBT CBT integrates features ofbehavior modification into traditional cognitive restructuring approach tochange unhealthy and unproductive behaviors

5 Crisis Intervention face to face short term interventions with a client who isexperiencing increased distress andor an active state of crisis Interventions andstrategies include

a Contributing to the development and implementation of the recipients crisiscontingency plan and Psychiatric Advance Directiveb Brief situational assessment

c Verbal interventions to deescalate the crisisd Assistance in immediate crisis resolutione Mobilization of support systemsf Referral to alternative services at the appropriate level

6 Coordinating and managing services by1 Providing oversight for the integrated implementation of goals objectives and

strategies identified in the recipientsservice agreement2 Assuring stated measurable goals objectives and strategies are met within

established timeframes

3 Assuring all service activities including collaborative consultation and guidanceto other staff serving the recipient and family as appropriate

4 Coordination to gain access to necessary rehabilitative and medical services5 Monitoring and follow up to determine if the services accessed have adequatelymet the individualsneeds





STATE OF NEWJERSEY


Consumer Participation Criteria

Eligible participants will meet standards for medical necessity by having severe mentalhealth needs evidenced by having a current diagnosis of mental illness and item 1 andone or more of items 2 3 or 4

1 Requires active rehabilitation and support services to achieve the restoration offunctioning to promote the achievement of community integration and valued life rolesin the social employment educational andor housing domains and2 At risk for hospitalization or other intensive treatment settings such as 24 hoursupervised congregate group or nursing home as assessed using a predefinedinstrument or

3 Deterioration in functioning in the absence community based services and supportsthat would lead to 2 or

4 The individuals own resources and support systems are not adequate to providethe level of support needed to live safely in the community

Provider Participation Criteria

Provider entities shall be community mental health service providers licensed by the NJDivision of Mental Health Services to provide Community Support Services Within a

licensed entity the following chart details what service components can be provided bystaff with what credentials and supervision



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STATE OF NEW JERSEY


Location of Service

Community Support Services may be furnished in any relevant setting as it pertains tothe specific services to be rendered eg supermarket banks healthcare provideroffice etc

All facetoface discussions delivered by providers as enumerated above consistingof qualifying activities as described above advancing the rehabilitative goalsenumerated in the plan of care provided directly to or on behalf of the servicerecipients regardless of the physical location where or when the service is providedincluding in a vehicle shall be allowable

Freedom of Choice

Each client enrolled in the program shall select one agency that will be hisherCommunity Support Services provider Within this agency the client will have accessto one Community Support Worker who will be identified as the primary point ofcontact and while this person may provide a majority of services and interventionsthe client will have access to a team of Community Support Workers and has freechoice to choose other providers As such enrollees have the option of selectingdifferent staffwithin an agency or a different agency if desired

TN 1101 Effective Date 1012011

UN 0 8 2011Supersedes NEW Approval Date

Attachment419B

Page 251STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

STATE OF NEW JERSEYReimbursement for Rehabilitation Services Mental Health Community Support Services

Basis of Reimbursement

Reimbursement will be a fixed rate fee for service The unit of service will be fifteencontiguous minutes of facetoface contact with or on behalf of the client

Rate Setting Methodology

1 The Division of Mental Health Services DMHS conducted an analysis of all ofthe cost reimbursement contracts for Community Support Services CSS ofproviders under contract which consisted of 66 programs for contract yearsending63009 and 123108

2 Contracts for specialty programs which are more resource intensive wereidentified and excluded from ensuing analysis

3 Projected costs of each non specialty CSS contract were arrayed for allproviders by budget category

4 Every line item in every contract was analyzed and directly identifiableunallowable costs were reclassified to the budget category specific assistanceto clients for exclusion from rate calculation Unallowable costs included suchitems as rental assistance room and board personal items and medication

5 Personnel salary costs were segregated according to allowable direct servicesvs allowable administration and support Direct service personnel salary costsand related hours were further segregated according to educational credentialDirect service salaries and hours for positions with like credentials weregrouped at each provider and an average costhour at each provider for eachcredential computed Average costhour for each credential from eachprovider were aggregated across all providers to develop an overall averagecost per hour for each educational credential

6 Fringe benefits were aggregated across all providers and were expressed as apercentage of aggregated salaries to yield an average fringe benefit rate acrossall providers


JUN 0 8 2011Supersedes NEW Approval Date

Attachment419B

Page 252STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

STATE OF NEW JERSEY

Reimbursement for Rehabilitation Services Mental Health Community Support Services

7 Remaining otherwise allowable Other than Personnel Services OTPS costsincluding Consultants and Professional Fees Materials and Supplies FacilityCosts General and Administrative and Other costs were allocated for eachprovider between directly identifiable allowable salary and fringe costs anddirectly identifiable unallowable costs using the proportion of each to the sum ofdirectly identifiable allowable salary and fringe and directly identifiable

unallowable costs

Directly identifiable allowable salary and fringe costs and the allocable portionof allowable OTPS at each provider were added to yield total allowable costsTotal allowable costs were aggregated across all providers

Allowable salary and fringe from each provider were then aggregated across allproviders and expressed as a percentage of total aggregated allowable costs toyield the average of total cost represented by allowable salary and fringeLikewise allowable allocable OTPS costs from each provider were aggregatedacross all providers and expressed as a percentage of aggregated totalallowable cost to yield the average of total cost represented by allowableallocable OTPS

The average salary cost per hour including fringe benefits for each of theeducational credentials was divided by the average proportion of total costsrepresented by salary and fringe to yield an average fully loaded cost per hourfor allocable salary fringe and allocable OTPS

8 Credentials were grouped into 5 bands 1 Physician 2 Advanced PracticeNurse 3 RN and Masters level staff 4 BA and LPN 5 Associates DegreeHigh School and peers not otherwise having an educational credential Fullyloaded costs for direct care salary fringe and OTPS for each credential withineach band were averaged to develop one average costavailable servicehourband

9 The average fully loaded costhourband was adjusted to account for theaverage number of available service daysyear The number of available workdaysyear was estimated applying the criteria for new NJ State employeesworking 5 daysweek ie 12 vacation days 12 sick days 3 personal days and12 holidays to arrive at 222 days during which service can be expected to bedelivered It was also assumed 5 daysyear would be dedicated to continuingstaff education and this is unavailable for service provision yielding 217available service days The available service days year represent 8346217260 of the year



Documents

determine need for scope of and anticipated outcome of