N.J. Admin. Code § 10:60A-3.5

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:60A-3.5 - Fair hearing for Medicaid/NJ FamilyCare beneficiaries who are denied PMDC

(a) A Medicaid/NJ FamilyCare beneficiary may appeal a determination of clinical ineligibility made by the Division pursuant to N.J.A.C. 10:60A-3.4.

(b) To initiate an appeal, the Medicaid/NJ FamilyCare beneficiary must submit a request for a fair hearing pursuant to N.J.A.C. 10:49-10 and the Uniform Administrative Procedure Rules, N.J.A.C. 1:1.

(c) A request for an administrative hearing shall be considered timely filed if it is submitted within 20 days of the date of issuance to the beneficiary's parent of notice of the determination by professional staff designated by the Department of the child's clinical ineligibility for PMDC.

(d) At the administrative hearing, the burden is upon the Medicaid/NJ FamilyCare beneficiary to demonstrate clinical eligibility for PMDC.

N.J. Admin. Code § 10:60A-3.5

Amended and Recodified from 10:166-3.5 by 56 N.J.R. 262(a), effective 2/20/2024