N.J. Admin. Code § 10:79-6.5
Current through Register Vol. 57, No. 1, January 6, 2025
Section 10:79-6.5 - Grievances and appeals for NJ FamilyCare-Children's Program-Plan B, C, and D(a) It is the right of every applicant for, or beneficiary of, NJ FamilyCare-Children's Program-Plan B, C, or D, to be afforded the opportunity for a grievance review in the manner established in the policies and procedures set forth below. The notification of the right to a grievance review shall be incorporated in or attached to each adverse action notice and shall include explanation on how to request a grievance. Appropriate complaints and grievances regarding NJ FamilyCare-Children's Program should be referred to: NJ FamilyCare-Children's Program
PO Box 8367
Trenton, NJ 08650-9802
(b) In situations where a beneficiary is denied medical services to which he or she feels that he or she is entitled, and those services are considered fee-for-service under the NJ FamilyCare-Children's Program-Plan B, C and D, a request for a hearing and a brief explanation of the situation should likewise be sent to the above address.(c) In a situation where a beneficiary is denied services through the MCO provider, the beneficiary should be referred to the MCO's complaint and/or grievance system. (d) For those cases involving termination for program fraud and abuse, the applicant shall have the right to an administrative law hearing as indicated at N.J.A.C. 10:79-7.N.J. Admin. Code § 10:79-6.5
Amended by 49 N.J.R. 203(a), effective 1/17/2017