Counties in which your organization is applying to provide Day Habilitation Services Atlantic Gloucester Ocean Bergen Hudson Passaic Burlington Hunterdon Camden Mercer Somerset Cape May Middlesex Sussex Cumberland Monmouth Union Essex Morris Warren Supporting Documents Please submit this application along with the following documentation: A Service Delivery Plan explaining how your organization intends to provide services Activity Calendar which describes a selection of planned activities Admission Policies and Procedures, at minimum, shall include the following: Pre-admission process in person meeting, tour of services, documentation, physical exam… – Criteria for acceptance diagnosis/disability type, tier… – Appeal process Admission process determining date, submission of referral packet… – Waiting list Program rules and expectations, rights and responsibilities Suspension Policies and Procedures, which at minimum, include the following: Reasons for suspension must be explained and signed off by individual – Process for making determination determining that reasons are met, warning process, determining – length of suspension, notification to individual, caregiver, SC, DDD, etc. Return to services Appeal process Discharge Policies and Procedures Policies, which at minimum, include the following: Reasons for discharge must be explained and signed off by individual – Process for making determination determining that reasons are met, warning process, determining – length of suspension, notification to individual, caregiver, SC, DDD, etc. Appeal process Personnel Policies which including but not limited to: Table of Organization Education & Experience Requirements Job Descriptions Background Checks (Initial and Ongoing) Staff Training Requirements and Practices Emergency and Procedures Transportation Policies and Procedures, which include but are not limited to the following elements: Emergency/Accident Procedures Pick Up/Drop off Procedure Suspension Cancellations Application Submission Application and supporting documentation should be emailed to: Questions regarding this process should contact:
Counties in which your organization is applying to provide Day Habilitation Services Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Somerset Sussex Union Warren Supporting Documents Please submit this application along with the following documentation: A Service Delivery Plan explaining how your organization intends to provide services Activity Calendar which describes a selection of planned activities Admission Policies and Procedures, at minimum, shall include the following: Pre-admission process – in person meeting, tour of services, documentation, physical exam… Criteria for acceptance – diagnosis/disability type, tier… Appeal process Admission process – determining date, submission of referral packet… Waiting list Program rules and expectations, rights and responsibilities Suspension Policies and Procedures, which at minimum, include the following: Reasons for suspension – must be explained and signed off by individual Process for making determination – determining that reasons are met, warning process, determining length of suspension, notification to individual, caregiver, SC, DDD, etc. Return to services Appeal process Discharge Policies and Procedures Policies, which at minimum, include the following: Reasons for discharge – must be explained and signed off by individual Process for making determination – determining that reasons are met, warning process, determining length of suspension, notification to individual, caregiver, SC, DDD, etc. Appeal process Personnel Policies which including but not limited to: Table of Organization Education & Experience Requirements Job Descriptions Background Checks (Initial and Ongoing) Staff Training Requirements and Practices Emergency and Procedures Transportation Policies and Procedures, which include but are not limited to the following elements: Emergency/Accident Procedures Pick Up/Drop off Procedure Suspension Cancellations Application Submission Application and supporting documentation should be emailed to: Questions regarding this process should contact:
day_habilitation_provisional_certification_application.docx