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

Universal Citation: NJ Admin Code 10:142-8.3

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:

1. The participant shall be required to make financial restitution to the State of New Jersey prior to granting any reinstatement.

2. The participant shall agree in writing to a corrective action plan, set forth by the Division, and complete all required remedial action(s) as set forth in the plan, to return to good standing with program guidelines and retain eligibility. Failure of a participant to adhere to a mandatory correction plan shall result in a lifetime ban from the program, whereby all future reinstatement requests shall be automatically denied.

3. Any substantiated Medicaid fraud or abuse that has been referred to the New Jersey Office of Attorney General for possible criminal action may result in an automatic denial of any request for reinstatement and a lifetime ban from re-entry into the program, as determined by the Division Director.

(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:

1. The availability and overall benefit of returning to traditional agency services;

2. The impact of the determination on the participant's health and/or welfare; and

3. The participant's willingness and cooperation in making any required restitution and/or remedial action(s) pursuant to (e)1 and 2 above.

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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