N.J. Admin. Code § 10:60C-9.1

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:60C-9.1 - Request for administrative review

(a) Applicant/participant complaints, are defined as criticisms, protests, objections, concerns, or dissatisfaction related to any aspect of the Personal Preference Program.

(b) An applicant or participant may request an administrative review of any complaint(s), as described in (a) above, by contacting the Division in writing.

(c) Requests for an administrative review must state the question/issue to be resolved by a review made by letter and mailed to:

State Program Office

Personal Preference Program

Division of Medical Assistance and Health Services

PO Box 712

Trenton, New Jersey 08625-0712

(d) The State Program Administrator shall render a decision and respond in writing to all complaints within 30 days of receipt, and provide the applicant or participant the final decision on the matter in dispute.

(e) Applicants or participants who disagree with the decision of the administrative review, wherein the outcome results in an adverse agency action as described at N.J.A.C. 10:60C-9.2, may request a fair hearing before an administrative law judge pursuant to N.J.A.C. 10:60C-9.3. Instructions for such requests shall be incorporated into the written response noted at (d) above.

(f) An exception to (e) above shall apply in situations in which a participant is involuntarily disenrolled due to non-compliance with program requirements as described at N.J.A.C. 10:60C-8.2(a)1 through 14. The determination on the administrative review described at (d) and (e) above shall be deemed as the final agency decision, in which a participant will not be entitled to a fair hearing pursuant to N.J.A.C. 10:60C-9.3, or any additional appeals regarding the matter in dispute.

N.J. Admin. Code § 10:60C-9.1

Amended and recodified from 10:142-9.1 by 56 N.J.R. 2294(a), effective 12/2/2024