New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 142 - PERSONAL PREFERENCE PROGRAM
Subchapter 9 - ADMINISTRATIVE REVIEWS, ADVERSE AGENCY ACTIONS, AND FAIR HEARINGS
Section 10:142-9.4 - Outcome of fair hearings

Universal Citation: NJ Admin Code 10:142-9.4

Current through Register Vol. 56, No. 18, September 16, 2024

(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 under N.J.A.C. 10:142-4.7.

(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.

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