Current through Register Vol. 56, No. 18, September 16, 2024
(a) Each
CWA shall retain all material normally kept in the "case folder" for the time
periods indicated in (b) below. At the expiration of such time period the CWA
may, at its option, destroy records in accordance with (c) and (d) below,
continuing to retain those portions indicated. In permanent available archives,
the CWA shall retain information showing the date and manner of destruction of
each "case folder" destroyed.
1. "Case
folder" shall be construed to mean the entire set of financial eligibility
records related to eligibility determinations for one person or household. Each
such case folder may be reviewed as a single unit without reference to the fact
that the person(s) involved may have received Medicaid or may be receiving
Medicaid under another program.
(b) Retention periods are as follows:
1. In destroying records in this category,
the agency shall provide for the permanent retention of information by which to
assure itself in the future of the absence of a claim and the reason(s)
therefor.
| Case Folders | Retention Period |
| a. | Cases denied or rejected
without | Three years after the last |
| providing Medicaid coverage | official agency
action or court |
| action that influences the |
| granting or recovery of |
| b. | Cases in which all
incorrectly | Medicaid coverage or the receipt |
| provided Medicaid coverage has | of the final
recovery payment, |
| been repaid in full | whichever is later. |
| c. | Cases in which no repayment was |
| ever due |
| d. | Cases in which no further |
| repayment is due (repaid fraud |
| restitution, and other |
| incorrectly paid benefits in all |
| programs, repaid "suits and |
| claims") |
| e. | Cases in which a specific agency |
| decision has resulted in |
| abandonment of a claim(s) |
2.
The following concern records of cases in which reimbursement is owing:
i. In all instances of unresolved fraud or
other incorrectly paid benefit matters, unresolved "suits and claims" matters,
all records in each case shall be retained until the matter(s) in question is
resolved and the case falls into one of the groups listed below or in (b)1
above; then retain accordingly.
ii.
In destroying records of cases in which reimbursement is owing, the agency
shall retain enough information in permanent archives to provide clear
identification of debtors, to document the amounts, and to allow the taking of
any legal or administrative action which may become necessary in the future by
either the agency or by DMAHS.
iii.
Records in cases in which reimbursement is owing shall be retained as follows:
| Case Folders | Retention Period |
| AFDC-related Medicaid, New Jersey Care... Special
Medicaid Programs, Medically Needy, NJ FamilyCare -- Children's Program, MAA,
and Medicaid Only |
| a. | Beneficiary still
living | Indefinite |
| b. | Beneficiary deceased (see note below) |
| (1) | Probable recovery
pending | Indefinite |
| (2) | All known or probable
recoveries | Three years after death or last |
| completed or none possible | official action, is
later |
| whichever |
iv.
In accordance with actuarial practice, persons not known to be deceased may be
presumed dead at age 100 unless information to the contrary exists.
(c) Requests for
destruction of case records shall be submitted on State Form ED-6, Request and
Authorization for Records Disposal, which may be obtained from the Office of
Eligibility Policy, Division of Medical Assistance and Health Services. Form
ED-6 will be completed as follows:
1. Request
Number and Date: Each CWA shall assign its own number to each request and the
date upon which it was submitted;
2. Authorization Number and Date: For use of
the Bureau of Archives and History;
3. From: Provide complete address of CWA;
i. Item: Number the items in sequence
beginning with No. 1;
ii. Records
Title and Description: Indicate the number of case records by categorical
program and provide sufficient information to show where they are in the Record
Retention Schedule;
iii. Inclusive
Dates: Indicate the inclusive dates to which the material applies (for example,
the earliest application was taken and the most recent year a case was
closed);
iv. Volume: Volume is to
be measured in cubic feet (one file drawer equals two cubic feet). Measurements
should be rounded to the nearest cubic foot; do not use a measurement less than
one cubic foot;
v. Retention
Period: Complete in accordance with (b) above;
vi. Requested By: Signature of CWA director
or authorized agent; and
vii. The
appropriate State agency shall complete all other items;
4. All copies of the completed Form ED-6
shall be forwarded to Disposal Requests, Department of the Treasury, Division
of Revenue and Enterprise Services, PO Box 661, Trenton, NJ 08625-0661, for
approval. The CWA shall not destroy any records until such approval has been
received by the CWA in writing.
5.
Additional information regarding records management and disposal can be found
on the RMS website:
http://www.nj.gov/treasury/revenue/rms/index.shtml.
(d) When disposal is authorized,
records shall be destroyed in fact and shall not be allowed to fall into
unauthorized hands. Nonconfidential records may be sold for waste, providing
that they will eventually be processed to destroy their identity. Confidential
records shall be destroyed by burning, shredding or pulping, and a responsible
official shall supervise such disposal or accompany the records, if they have
to be transported, to see that they are in fact totally destroyed.
