NJCAT Reassessment and your Rights
You have the right to:
1) Request a reassessment of your NJCAT functional need and tier assignment; and
2) Appeal DDD’s refusal to conduct the reassessment through a Medicaid Fair Hearing.
What Is The NJCAT?
If you are receiving services from DDD through either the Community Care Program or the DDD Supports Program, the amount of your budget and tier assignment was determined based upon a functional assessment by DDD. That functional assessment is part of the New Jersey Comprehensive Assessment Tool (NJCAT) that is also used to determine your clinical eligibility for both programs.
The part of the tool that determines your budget is about your functional needs in three main areas: self-care, behavioral health, and medical. For example, the NJCAT asks how much assistance you need with certain tasks like getting dressed or taking a shower. It also asks questions about things like how you get your meals. You have the right to have someone assist you with answering these questions. Your tier assignment and budget is determined based upon your answers to these questions on the NJCAT.
What If I Believe My Annual Budget or Tier Is Not Supporting My Needs?
DDD is required to follow the federal person centered planning law, 42 C.F.R. 441.301(c)(1)-(3) with respect to the frequency of review of your Service Plan, including the functional needs assessment included in the NJCAT. In fact, this federal law is built into the NJ FamilyCare Comprehensive Demonstration Waiver, which describes the three conditions under which the NJCAT should be re-done:
The state must ensure the person-centered service plan will be reviewed and revised with reassessment of functional need at least annually, upon changes to the individual’s circumstances or needs, or at the request of the individual. The IDT team meets annually to review the ISP (Individualized Service plan) and PCPT (Person Centered Planning Tool). This is the best time to capture significant changes, however, you can ask DDD to conduct a new NJCAT assessment when you believe it is needed, and DDD must allow a reassessment. You do not need to wait a full year nor do you need to prove by sufficient evidence that there was a change in your self-care, behavioral health or medical needs, or that the initial assessment was conducted improperly.
For more information on NJCAT reassessments, please speak to your Support Coordinator or go to:
NJCAT Information
