Clarification: New Jersey's Personal Preference Program (PPP) and "fast track" enrollment process

August 17, 2020

Dear Colleague,

This is a clarification of one aspect of the email that was distributed recently, which provided information on New Jersey's Personal Preference Program (PPP) for Medicaid beneficiaries with disabilities. (Please see below for the original email from July 28, 2020)

It has come to my attention that there may be some confusion on the process for requesting "fast track" enrollment into PPP. If anyone is planning to request the "fast track" enrollment process, these are the key points to keep in mind:

The request for the fast track process to enroll in the Personal Preference Program (PPP) must be due to the diagnosis of COVID-19 or a situation directly related to COVID-19, such as the shut-down or cancellation of services, which would necessitate the member being enrolled in PPP more quickly than the usual process.
Anyone requesting the fast track PPP enrollment process should specify the connection to the aforementioned criteria.
If applicable, the enrollee or a family member should reach out to the MCO to request fast track enrollment for PPP.
The member's Medicaid MCO is the entity that determines whether the fast track PPP enrollment process will be used for the individual, or whether the usual enrollment timeframe will apply.

Thank you.

Bev

Beverly Roberts

Director, Mainstreaming Medical Care

The Arc of New Jersey

985 Livingston Avenue

North Brunswick, NJ 08902

Direct line and fax: 732.246.2567

www.mainstreamingmedicalcare.org

July 28, 2020

Dear Colleague,

New Jersey's Division of Medical Assistance and Health Services (DMAHS), also known as NJ Medicaid, has provided a long-standing benefit whereby Medicaid beneficiaries with disabilities who need assistance with activities of daily living (ADLs), (such as dressing, personal hygiene, bathing, feeding, and toileting) can be assessed and approved by their Medicaid managed care organization (MCO) to have a health care aide provide in-home personal care assistance (PCA) services. When the Medicaid MCO approves PCA services for an individual, an aide who is employed by a home care agency comes to the home for the pre-approved number of hours per day.

The Personal Preference Program (PPP) is an alternative to having a home health agency employee coming into the home. With the PPP, the individual or family chooses the person who will provide the ADL assistance, and that person could be the individual's mother or father, sibling, other relative or a friend. For the details about NJ's Personal Preference Program -- including the specific enrollment and operational procedures to be followed -- please see the helpful, 9-page, PPP Fact Sheet developed by the New Jersey Department of Human Services and the Division of Medical Assistance and Health Services (DMAHS).

PPP is viewed very favorably by many parents of individuals with I/DD for two main reasons:

1) The individual with I/DD knows and trusts the person who is providing the ADL assistance, and

2) The ADL assistance can be provided at flexible times, as needed, throughout the day. It is not likely that a home health agency could send an aide to a Medicaid beneficiary's home for only an hour or two at a time.

For families interested in applying for PPP for their son/daughter with I/DD, please see below for the PPP contact phone numbers for each Medicaid managed care organization (MCO): Please note that each MCO has a different process to initiate PPP. One MCO may have a phone number dedicated to PPP services, while others provide a more general phone number, in which the caller might need to hear an automated recording that mentions several other choices before being connected to someone who can answer questions about PPP.

Aetna Better Health 1-855-232-3596

Amerigroup 1-855-661-1996

Horizon NJ Health 1-855-465-4777

UnitedHealthcare Community Plan 1-800-645-9409

WellCare 1-855-642-6185

There is also a PPP State Program Office Helpline Number: 609-631-2481, which is available Monday thru Friday from 8:30 to 4:30. Callers should leave a voicemail message, and phone calls are usually returned within a few hours.

A new fast-track process for applications for PPP services:

A PPP fast-track application process was started to help families during the COVID-19 pandemic, and it will continue while the public health emergency continues. The decision on whether the fast-track process is applicable for a particular Medicaid beneficiary is made by the individual's Medicaid managed care organization (MCO). There must be a documented need for the expedited PPP enrollment process, for example, the closure of the individual's day program because of COVID-19. If the MCO approves of a request for a fast-track PPP enrollment, the time frame is usually 30 days or less from when the MCO determined the individual eligible. Please note that this does not include the time it takes the MCO to send out a PPP application, obtain the necessary medical documentation, and perform the personal care assistance assessment. A typical (non fast-track) application/enrollment process for PPP is approximately 90 days.

If additional PPP hours are needed due to an increased need for help with activities of daily living (ADLs):

Sometimes, an individual with I/DD who has been enrolled in the Personal Preference Program has an increase in medical or behavioral health problems necessitating more assistance with ADLs. If that occurs, the family should contact the Medicaid MCO to request a re-assessment and approval for additional PPP hours.

This is one of many emails that The Arc of New Jersey is distributing in an effort to help individuals with I/DD, their families, and staff to be safe and healthy throughout the COVID-19 pandemic. To see other emails that The Arc of New Jersey has distributed on this topic, please go to https://www.arcnj.org/information/covid-19-updates-information.html