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NETI ELIGIBILITY CRITERIA
The Needle Exchange Treatment Initiative (NETI) funds medication-assisted and other treatment services for New Jersey residents who are indigent with an opiate addiction, with a particular emphasis on providing access to treatment for individuals referred by Syringe Access Programs (SAP). Exemptions to regulatory requirements regarding the prescribing and dispensing of medications to treat opiate dependence, such as the provision of treatment for persons under 18 years of age, shall be made only in accordance with Federal guidelines. At the time of admission and as an on-going process efforts are made by the NETI case manager to identify client eligibility to receive treatment funded through the NETI and other sources, including Medicaid. In addition to the above, the following protocol as outlined below should be adhered to:
Income Eligibility
On day one of the admission process, the case manager shall screen the client for financial eligibility (using the NJSAMS DASIE module) to determine if the client meets the income eligibility requirements for the NETI, Medicaid and/or other funding source. The case manager shall assist the client in the application and enrollment process for these programs to include:
1) Medicaid
2) Work First NJ SAI
3) NJ Family Care
4) DAS slot-funded services, if capacity allows
In order for the client to be eligible to obtain NETI services, the client’s total household income must be at or below 250% of the Federal Poverty Level (FPL). Income requirements will be based upon the most current NJ Family Care guidelines.
If the client is eligible for another payer source, the client shall be re-directed to those services within the course of treatment.
No self-pay clients can receive services from the mobile unit or office-based services. Clients whose income is above 250% poverty must attain a referral to treatment at an agency that accepts self-pay and private insurance.
If the client is eligible for Medicaid, reimbursement through these sources shall be considered as program income and must be reported as such by NETI providers.
If the client is eligible for SAI, the client shall become a SAI client. At anytime, if the client is no longer eligible for SAI, the client may return to the NETI.
Program Eligibility
The client must:
1) Be a resident of New Jersey
2) Have a history of intravenous drug use
3) Test positive for opiates or have a documented one year history of opioid dependence. (i.e. Individuals who have recently been incarcerated or in residential treatment may not test positive for opiates.)
4) Be able to provide proof of identification to prevent dual enrollment in medication-assisted treatment
5) Not currently be enrolled as a client in an OMT program or a client under the care of a physician prescribing Suboxone
6) Not have been enrolled as a client in an OMT program or a client under the care of a physician prescribing Suboxone within the past thirty (30) days
Clients, who are referred by Syringe Access Programs (SAP) and are either pregnant, homeless, or at risk of being homeless, shall be given priority consideration for admission.
Clinical Eligibility
Following a complete assessment, the treatment team will determine the most appropriate level of care for each client. If it is deemed necessary that a client receive a level of care or support services not provided via the mobile unit or office-based program, the client may be eligible to receive a voucher, which would enable the client to receive services from a program that has been accepted as a provider in the DAS NETI Network. Treatment services eligible for reimbursement through the NETI voucher are as follows:
1) Enhanced Detox (III.7D-E)
2) Long-term Residential
3) Short-term Residential
4) Intensive Outpatient
5) Outpatient
6) Methadone- under certain circumstances
§ Client placed in residential or supportive housing without access to local NETI provider
§ Other appropriate administrative or clinical reasons
Support services eligible for reimbursement through the NETI voucher are as follows:
1) Case Management
2) Continuing Care Assessment
3) Transportation
4) Thirty (30) days medication other than OMT (except when in III.7D-E)
Co-Occurring Service Eligibility
To be eligible to provide clients with on-site reimbursable comprehensive co-occurring services, NETI programs must be accepted as eligible providers in the DAS Co-occurring Provider Network. Approval to provide services as part of the Co-occurring Network requires an agency meet six core components that form the ideal delivery of services for clients with co-occurring disorders.
1) Providing access
2) Screening each client for co-occurring disorders
3) Completing a co-occurring disorder assessment
4) Providing or coordination a referral to an appropriate level of care
5) Providing co-occurring treatment via a multidisciplinary team
6) Ensuring continuity of care via on-going case management
NETI clients may be eligible to obtain co-occurring services as an enhancement at either the mobile unit, office-based program, or other NETI-approved voucher program as long as these provider agencies are accepted as eligible providers in the DAS Co-occurring Network.
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