New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 142 - PERSONAL PREFERENCE PROGRAM
Subchapter 8 - DISENROLLMENT AND REINSTATEMENT
Section 10:142-8.3 - Reinstatement standards and procedures
Current through Register Vol. 56, No. 18, September 16, 2024
(a) An individual who has been disenrolled pursuant to N.J.A.C. 10:142-8.1 or 8.2 may request a reinstatement to receive participant-directed services by contacting the State program office in writing, and completing the application process pursuant to N.J.A.C. 10:142-3.1 and 3.2 with the assistance of the State Program Office.
(b) A reinstatement of program services may be granted, with permission from an MCO, where appropriate, if a valid PCA nursing reassessment is current and establishes a need for assistance with personal care, and the Division affirms the individual's continued ability to manage services independently or with the assistance of a representative, in accordance with requirements under N.J.A.C. 10:142-6.3.
(c) Upon submission of a request for reinstatement to the program, participants will be required to contact the VF/EA to determine if new employer registration forms are required, at the discretion of the VF/EA, to enable reactivation of the program account.
(d) Individuals may obtain traditional agency PCA services, in the event of any delay in reactivation of a participant-directed services account by the VF/EA, in accordance with requirements under N.J.A.C. 10:142-8.2(c)1 and 2.
(e) Participants involuntarily disenrolled as a result of substantiated Medicaid fraud or abuse, and confirmed by the New Jersey Office of the State Comptroller, Medicaid Fraud Division (MFD), may be reinstated onto participant-directed services at the discretion of the Division Director, subject to the following standards and procedures:
(f) In reviewing a request for reinstatement for participant-directed services, in which there is a substantiation of Medicaid fraud or abuse by a participant, the Division shall give consideration to the following: