N.J. Admin. Code § 10:60C-9.4

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

Section 10:60C-9.4 - Outcome of fair hearings

(a) If the outcome of a fair hearing proceeding results in upholding the adverse action initiated by the MCO or State program agency, the following will take place:

1. The MCO shall issue a new service authorization to the Division to execute changes to the budget allocation. Upon receipt of such authorization, the Division shall inform the participant and VF/EA of the changes.

2. Modifications to the budget allocation and cash management plan shall be made effective in accordance with procedures at N.J.A.C. 10:60C-4.7.

(b) If the outcome of a fair hearing proceeding results in upholding the appeal filed by the participant on an adverse action initiated by either the MCO or State program agency, the provision of services shall be continued without change, however, future changes may be impacted by any subsequent nursing reassessment.

(c) If a settlement is obtained during a hearing proceeding, whereby the applicant or participant resolve a matter in dispute, the agreement terms and conditions shall be communicated with the Division or MCO, as appropriate, as a part of final outcome.

N.J. Admin. Code § 10:60C-9.4

Amended and recodified from 10:142-9.4 by 56 N.J.R. 2294(a), effective 12/2/2024