Get Personal Preference Program. Cash Management Plan - State Nj

This guide provides a detailed overview of how to effectively fill out the Personal Preference Program Cash Management Plan for the State of New Jersey. By following these instructions, users will be able to navigate the form with confidence, ensuring all necessary information is submitted accurately.

Follow the steps to complete your form online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by entering the consumer name, cash grant amount, representative name, and Medicaid number at the top of the form.
3. Select the type of plan you are submitting by checking the appropriate box — whether it is an initial submission, revision, or reassess.
4. Indicate the start date in the format provided, ensuring you calculate the number of hours per week multiplied by 4.33.
5. In Section I, provide details for Direct Employment, including service type/description, worker name, hourly wage, and total taxes per hour.
6. Calculate and enter the sum of hourly wages and taxes, followed by the number of hours per week and per month in the designated fields.
7. In Section II, fill out the details for Purchase of Agency Services — this includes agency name, service type/description, frequency, unit cost, and the total monthly cost.
8. In Section III, list any miscellaneous expenses along with the provider description and breakdown by frequency and unit cost, including home/workers comp insurance information.
9. Section IV focuses on Special Purchases/Modifications. Describe the work or purchase, provide the contractor/provider name, and enter estimated costs and payment details.
10. For Section V, outline Fiscal Intermediary Services & Fees by detailing services and fees per unit cost.
11. Complete the monthly reconciliation section by calculating and entering amounts that reflect total monthly cash benefits and subtracting costs detailed in Sections I through V.
12. Conclude by signing the form both as the consumer and representative, and make sure to include the date, followed by a consultant review and state program office approval, if required.
13. Once all information is accurate and finalized, you can save changes, download, print, or share the form as needed.

Start filling out your Personal Preference Program Cash Management Plan online today!