N.J. Admin. Code § 10:141-1.7 - Approval and denial of supports/services from the Fund

(a) The following shall be the procedure and method for approval and denial for services:

1. The Committee shall review completed support plans and may take the following actions on each support plan for services:

i. Confirm eligibility and approve the support plan as presented;

ii. Confirm eligibility and modify the support plan;

iii. Confirm eligibility and hold the support plan, pending the receipt of further information; or

iv. Deny eligibility and/or the support plan as presented.

2. If the support plan is approved, the Division shall notify the applicant. Notice shall include start and end dates, frequency, and cost of the approved services/supports.

3. If an application is denied, the Committee shall notify the applicant, in writing, outlining the reason(s) for the decision. Individuals may appeal the denial as follows:

i. Within 30 calendar days of receipt of the notice of denial, the applicant may request reconsideration of the Committee's decision. The request shall be in writing and include additional information to clarify or refute the Committee's decision.

ii. Upon receipt of the applicant's request for reconsideration, the Committee, at its next regularly scheduled Review Cycle meeting, will conduct an informal review of the previous decision. The Committee may seek input from third-parties, if necessary. The Committee shall notify the applicant of its decision, in writing, within 60 days.

iii. If the denial is upheld, the applicant will be informed of the right to appeal to the Office of Administrative Law (OAL) in accordance with N.J.A.C. 10:6.

(b) If funds are limited, the Committee shall invoke the order of selection for the purpose of prioritizing applications for receipt of services/support from the Fund. Applicants with approved support plans not fully funded shall be considered for inclusion when funds are available, or at subsequent meetings of the Committee.

(c) The Committee shall determine policy regarding how support plans shall be reviewed and the methods by which cases are approved in conformance with this chapter.

Notes

N.J. Admin. Code § 10:141-1.7

Amended by 49 N.J.R. 1683(a), effective 6/19/2017